This insurance is available to persons who regard themselves as Buskers, Street Performers, incl. Musicians & Singers (excluding Bands), Comedians, Jugglers, Magicians, Clowns, Face Painters, Mime Actors, Spruikers, Dancers, Puppeteers, Costume Characters, Balloon Artists, Temporary Spray on and Henna Tattoos, Palm Readers and Tarot Card Readers.Personal InformationContact* First Last Insured Name/ Performers Name* Is the Performer over 18?* Yes No Address* Street Address City State Postal Code Email* Phone* Website Facebook, Social Media Other, Social Media Other Mobile Phone Preferred method of contact*emailphonemobilefaxDo you wish to claim NSW Stamp Duty Exemption? (applies to NSW if your aggregate turnover is less than $2,000,000)* Yes No Please download and complete this NSW STAMP DUTY SMALL BUSINESS INSURANCE EXEMPTION DECLARATION FORM Download Insurance DetailsPeriod of Insurance - From* DD slash MM slash YYYY Period of Insurance - To* DD slash MM slash YYYY Do you currently have Insurance for performing* Yes No If Yes, Please provide full details*In the last 5 years Have you had any claims made against you (whether insured or not)?* Yes No If Yes, Please provide full details*Have you had any incident or accident occur which would have been covered by the proposed insurance policy?* Yes No If Yes, Please provide full details*In the last 5 years Have you had any insurance declined or cancelled, proposal rejected, renewal refused, claim rejected, special conditions or special excess imposed by an insurer?* Yes No If Yes, Please provide full details*In the last 10 years Have you ever been convicted of a criminal offence?* Yes No If Yes, Please provide full details*Estimated total number of performers:* Individual Duo Trio Other If Other, how many?* Please provide details of your activities & Name of Performers*Additional Information:Duty of DisclosureIn order to make an informed assessment of the risk and calculate the appropriate premium, your insurer needs information about the risk you are asking it to insure. For this reason, before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 to disclose to your insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk and, if so, on what terms. The duty also applies when you renew, extend, vary or reinstate a contract of insurance. You do not have to disclose anything that: Reduces the risk to be undertaken by the insurer; Is common knowledge; Your insurer knows, or in the ordinary course of its business, ought to know; or If the insurer has waived your obligation to disclose. If you do not comply with your duty of disclosure, your insurer may be entitled to reduce its liability in respect of a claim or may cancel your contract of insurance. If the non-disclosure was fraudulent, the insurer may be able to avoid (or cancel) the contract of insurance from its beginning. This would have the effect that you were never insured. One important matter to be disclosed is the history of losses suffered by the person seeking insurance or any closely associated person or entity. As you are responsible for checking that you have made complete disclosure, we suggest that you keep an up to date record of all such losses and claims.I have read the Duty of Disclosure above.* Yes CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.