TOUR OPERATOR PL PROPOSAL FORM by wanghonghx

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									                        TOUR OPERATOR ACTIVITIES PUBLIC LIABILITY PROPOSAL FORM


1.    Applicant name: _________________________________________________________________

2.    Basis of constitution: Sole Proprietor / Closed Corporation / PTY LTD / Trust / Other

3.    Business Description:_____________________________________________________________

4.    Contact person:___________________________ Tel nr: ________________________________

5.    E-mail:__________________________________ Fax nr:_________________________________

6.    Postal Address___________________________________________________________________
      _______________________________________________________________________________
      Street Address:___________________________________________________________________
      _______________________________________________________________________________
7.    When Established: _______________________Vat Number: _____________________________

8.    Note branches and where they are: _________________________________________________

9.    Please provide a description of activities: ____________________________________________
      ________________________________________________________________________________

      _______________________________________________________________________________
      _______________________________________________________________________________
      ___________________________________________________________________________________________________
10.   THETA / DEAT recognized guiding qualifications: (Please provide Tour Guide reg. nr. As well as region)
      _______________________________________________________________________________
      _______________________________________________________________________________
      _______________________________________________________________________________
      _______________________________________________________________________________
11.   Main geographical area of operations:
      _______________________________________________________________________________
      _______________________________________________________________________________
12. Of which Association are you a member?
      _______________________________________________________________________________
      _______________________________________________________________________________
      _______________________________________________________________________________
      Was any association membership ever been cancelled?                            YES          NO

      If the answer was Yes, why was it cancelled? ___________________________________________
      ________________________________________________________________________________
      ________________________________________________________________________________
13. HISTORY OF PREVIOUS INSURANCE
      Were you previously insured for similar Insurance as applied for?              YES          NO
      If your answer is Yes could you please provide the following detail:- Insurer, Policy No & Period of Insurance:
     _________________________________________________________________________________
     _________________________________________________________________________________
     Has any similar policy to which you are applying ever been cancelled? YES     NO
     Why was it cancelled? _______________________________________________________________
     ________________________________________________________________ _________________
     Was any policy ever granted to you based on increased terms?                    YES          NO
     If the answer is yes, what was the reason: ______________________________________________ _
     __________________________________________________________________________________
     __________________________________________________________________________________
14. Please provide us with details of any claims made against you for which you would have been covered
    by this kind of insurance.
NR    YEAR          DETAIL                                                                  AMOUNT




      Are you, aware of any claim pending against you or any claim or circumstance likely to give rise to a claim
      in terms of the insurance being proposed for? Non disclosure of information could lead to any claims
      lodged with a date prior to this inception date to be repudiated.
       YES     NO


      If the answer is YES please provide us with full details: _____________________________________
      _________________________________________________________________________________
      _________________________________________________________________________________
15. Does your operation have the following agreements?
15.1 Formal written Contract with Client?                                          YES           NO
      If you do not have a written contract, please describe briefly the way in which you and your client agree to
      a service and a price for the service rendered
      ______________________________________________________________________________
      ______________________________________________________________________________
      ______________________________________________________________________________
15.2 Do you use an indemnity form for or any other means of waiver?                            YES             NO
      Please note that we need a copy of this document
16. Number of Employees:
      16.1. FULL TIME:          GUIDES:________________                      ADMIN__________________
      16.2 TEMPORARY:           GUIDES:________________                      ADMIN__________________
        If more than one guide who is not a principal, please provide names and qualifications on a separate
        sheet otherwise please complete section 16.
17. Names and Qualifications of Principals: (This section is compulsory)
      NAME                                                   QUALIFICATION




18. Anticipated turnover/revenue for the next 12 months: (This section is compulsory)
      _____________________________________________________________________
19. Please indicate to which amounts of cover you require a quotation for: (This section is compulsory)
R5M                   R7.5M                 R 10M                  R 15M                  R 20M
THIS SECTION IS COMPULSORY FOR ALL APPLICANTS AND NEED TO BE SIGNED AND FAXED
DECLARATION
I/We herewith confirm that all information as disclosed in this application is a true reflection of the affairs of my guiding
business. I further declare that I have not withheld any information and I understand that in not declaring all relevant
information, it could jeopardize claims instituted against me. I further agree that information in this proposal as well as other
relevant information supplied by me will form the basis of the contract between the insurer and me. I undertake to inform the
insurer of any material changes to my business at any time as it may occur.




________________________________                         ___________________________________
Date signed                                              Signature of proposer

        PLEASE FAX COMPLETED FORM AND ALL OTHER RELEVANT DOCUMENTATION TO 021 951 6572

								
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