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Phone: 1300 209 367

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OTTA Insurance

Phone: 1300 209 367

Your Dedicated Partner in Risk Management

Diligently Offering Insurance Solutions to Industries in Need

Slide Background

OTTA Insurance

Phone: 1300 209 367

Your Dedicated Partner in Risk Management

Diligently Offering Insurance Solutions to Industries in Need

Slide Background

OTTA Insurance

Phone: 1300 209 367

Your Dedicated Partner in Risk Management

Diligently Offering Insurance Solutions to Industries in Need

Jumping Pillows® Quote Request

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1. Insured Name *

2. ABN *

3. Phone *

4. Email Address *

5. Address *

6. Is your business a? *

Business Other

If Other – Please confirm business activities to be insured

Activities at location

6. Please confirm in full the activities completed at the location – For example, Pool, Swimming via Creek, Pedal Kart hire, Kayak Hire, Fishing, Convenience Store operations, Inflatable Pillow, Water Park etc. Please note, If any activities are missed this may impact your covers.

Please ensure you confirm in full the activities completed at the location. If any activities are missed it may impact your covers.

7. Public Liability Sum Insured Required *

Public Liability Sum Insured (Other - please advise)

8. If you provide Accommodations, please advise below. If no Accommodation is provided please note “0”

Unpowered sites – Holiday Let *

Powered sites – Holiday Let *

Unpowered sites – Permanently Let *

Powered sites – Permanently Let *

Cabins – Holiday Let *

Cabins – Permanently Let *

9. Turnover – Expected total revenue for the next 12 months *

10. Number of Staff *

11. Do you use Contractors / Sub Contractors? *YESNO

What activities are performed by the Contractors / Sub Contractors

Confirmation of payment to Contractors/Sub-Contractors *

12. Years of Operation *

13. Additional Covers you may require – Please advise if additional covers such as Loss of Income, Theft, Glass, Money, Management Liability, Cyber or other forms of cover are required – please note additional information may be required.

14. Have any of the persons to be insured in the past 10 years ever been placed into receivership, liquidation or been declared bankrupt? *YESNO

14. YES - please provide details

15. Have any of the persons to be insured in the past 10 years ever had any fines or penalties imposed for any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property? *YESNO

15. YES - please provide details

16. Have any of the persons to be insured ever had insurance declined, cancelled, or had special terms imposed by an insurance company? *YESNO

16. YES - please provide details

17. Have any of the persons to be insured had any previous claims/ losses, whether they were reported to the insurer or not? *YESNO

17. YES - please provide details

Your Information

By entering your details above, you agree for OTTA Insurance and it’s representatives to contact you (either by telephone or electronically) about its services including to help you find the right insurance for your business. You also agree for OTTA Insurance and it’s representatives to provide the information submitted/declared to insurers for quoting and policy placement purposes.

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OTTA Insurance Pty Ltd | ABN 15 680 819 014 | CAR 1314787
is a Corporate Authorised Representative of Regis Licensing Pty Ltd
ABN 71 130 820 727 | AFSL 338156

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