Completing this online Proposal Form

Please answer all questions giving full and complete answers.
It is the duty of the proposer to provide all information that is requested in this Proposal Form as well as to disclose relevant facts. A relevant fact is a known fact or circumstances that may influence the evaluation of risk by the insurer. If you are uncertain about what a relevant fact is, please contact us.
If renewing an existing policy with Fenton Green, please ensure you check all information and make any necessary changes.

Business Details

Income Details

Total Annual Income

Employee Numbers

Number of staff (including you)

Do you perform any other activities other than

The provision of conflict management and alternative dispute resolution services, including but not limited to mediation, family dispute resolution, conciliation, consulting, facilitation, consensus building, conducting public dialogues, adjudication, arbitration, dispute system design, training, conflict coaching, restorative justice initiatives, education and capacity building to mitigate or prevent disputes and conflict and counselling services in relation to mediation only.

Yes No

Describe the Other activities you perform:

Are you involved in union disputes?

Yes No

State

Are you a small business eligible for exemption from paying NSW stamp duty on certain types of Insurance?

Yes No

Association

Are you a member of an association?

Yes

Please enter the association name

Please enter your membership no.

Are you domiciled in Australia or an Australian based and registered company?

Yes No

Period of Insurance

Policy Start Date