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[]
[]
[{"$nulls":17},"Associated General & Dealer Underwriting Agency Pty Ltd"]
[{"$nulls":17},"ABN 80 108 259 481  AFS Licence No: 279854"]
[{"$nulls":17},"26 Hunter Street, Parramatta, NSW, 2150"]
[{"$nulls":17},"PO Box 569 Parramatta, NSW, 2124"]
[{"$nulls":17},"Phone (02) 9687 4828  Fax (02) 9687 4967"]
[]
[]
[]
[]
["AGD Dealer Pack Proposal Form "]
[]
["Your Duty of Disclosure"]
["Before you enter into this insurance contract with us for the first time, the Insurance Contracts Act 1984 requires you to provide us with the information we need to enable us to decide"]
["whether, and on what terms, your Proposal for Insurance is acceptable and to calculate how much premium is required for your insurance. "]
[]
["You will be asked various questions when you apply for this Policy. When you answer these questions, you must:"]
[null,"∙  give us honest and complete answers;"]
[null,"∙  tell is everything you know; and"]
[null,"∙  tell us everything that a reasonable person in circumstances could be expected to tell us"]
[]
["You do not need to tell us about any matter: "]
[null,"∙  that diminishes our risk;"]
[null,"∙  that is of common knowledge"]
[null,"∙  that we know or should know as an insurer; or"]
[null,"∙  that we tell you we do not need to know."]
[]
["Points to note on your Duty of Disclosure"]
[null,"∙  Everyone who is insured under the Policy must comply with the relevant duty"]
[null,"∙  If you or they do not comply with the relevant duty, we may cancel the Policy or reduce the amount we pay if you make a claim. If fraud is involved, we may treat the Policy "]
[null,"   as if it never existed and pay nothing"]
[null,"∙  A different duty applies for any variation or renewal or reinstatement of the Policy. Please refer to your Policy Document for this duty."]
[]
["The Privacy Act 1988 requires us to tell you that as an insurer, we collect your personal and other information in order to:"]
[null,"∙  decide whether to issue a Policy;"]
[null,"∙  determine the terms and conditions of your Policy;"]
[null,"∙  compile data; and"]
[null,"∙  handle claims. "]
[]
["We disclose personal information to third parties who we believe are necessary to assist us and them in providing the relevant services and products. For example, in handling claims we"]
["may have to disclose you personal and other information to third parties such as, other insurers, reinsurers, loss adjusters, external claims data collectors, investigators and agents or other"]
["parties as required by law. We limit the use and disclosure of any personal information provided by us to them for the specific purpose for which we supplied it. You have the right to seek"]
["access to your personal information and to correct it at any time. Please contact us on (02) 9687 4828, EST 9am-5pm, Monday-Friday and advise us of any changes. If you do not agree"]
["to the collection of your personal information, then unfortunately, we will be unable to process your Proposal. "]
[]
["Completion of this Proposal: For questions with multiple choice answers, you should select the correct answer. All other questions, please insert the information requested in the spaces"]
["provided. It is important you have read the AGD Dealer Pack combined PDS and wording before completing this proposal. Where additional space is required to answer any questions, "]
["please insert separately at the rear/end of the Proposal or attach an addendum, outlining the additional information or disclosures to help in our complete understanding of your Proposal to us. "]
[]
["Definitions: "]
["\"we\", \"our\", \"us\" or \"AGD\" means Associated General & Dealer Underwriting Agency Pty Ltd, AFSL: 279854, ABN: 80 108 259 481 (except in the Declaration)"]
["\"you\", \"your\" or \"yourself\" means any person, company or legal entity proposing for this insurance and seeking to be named on the Schedule."]
["\"Excess\" means either the amount of money specified in the Schedule or otherwise stated in the Policy for each applicable Section that you must contribute as the first payment for all claims"]
["arising out of the one event, or the period specified in the Schedule or otherwise stated in the Policy for which no payment will be made by us. A special Excess applies to loss or damage"]
["caused by an earthquake. This being the lesser of $20,000 or an amount equal to 1% of the total Declared Value values at the Situation under Section 1. The Excess applies"]
["to all loss or damage occurring within the 72-hour period immediately after the earthquake. "]
[]
["This Proposal uses words that have a special meaning. The definitions of these words can be found in the AGD Dealer Pack combined PDS and Wording. "]
[]
["Underinsurance: Section 1 - Industrial Special Risks: Material Damage, Section 2 - Industrial Special Risks: Business Interruption of this Contract contain underinsurance clauses. It is "]
["important in these Sections that you insure for the full value of the Property, Average Income/Gross Profit. If you do not do so, You will be underinsured and we may not pay your claim in full. "]
[]
["General Information"]
[null,"The Insured (and ABN)",{"$nulls":21},"ABN"]
[]
[]
[]
[null,"Names of the director(s) or trustee(s) of the insured entity"]
[]
[]
[]
[null,"Intermediary"]
[]
[]
[null,"Your Existing Insurer"]
[]
[]
[null,"Your Existing or Offered Premium"]
[]
[]
[null,"Interested Party(s)"]
[]
[]
[]
[null,"Period of Insurance"]
[null,null,"Effective Date",null,null,"2020-12-01"]
[null,null,"Expiry Date",null,null,{"$f":"IF(ISBLANK(F87),\"\",(DATE(YEAR(F87)+1,MONTH(F87),DAY(F87))))","v":"2021-12-01"},null,"at 4:00pm"]
[]
[null,"Other Commercial Operations allowed in addition to the Dealership Business"]
[]
[]
[]
[null,"General Questions:-"]
[null,"Have you or any of your directors or executive managers:",{"$nulls":21},"Yes / No"]
[null,1,"Had their license suspended? Been convicted of, or had any fines or penalties imposed for, a criminal offence in the last 10 years?"]
[null,2,"Been placed in bankruptcy, receivership or liquidation within the last ten years?"]
[null,3,"Had any insurance refused, cancelled or had special conditions or restrictions imposed on your policies?"]
[null,4,"Has another insurer made risk recommendations in respect of your business that have not been attended to?"]
[null,5,"Are there any exceptional circumstances or anything special or unusual about your business which "]
[null,null,"would increase the likelihood of loss, destruction, damage or liability?"]
[null,6,"Made a claim or suffered a loss by any event for which Insurance is now being proposed within the last five years?"]
[null,null,"In response to question 6, please complete the claims declaration and provide history on previous or existing insurer letterhead"]
[]
[null,"Franchises Held"]
[]
[]
[]
[null,"Business Details"]
[null,1,"Principal Situation"]
[]
[null,2,"Description of Business"]
[]
[]
[null,3,"Are the Premises occupied exclusively as a Motor Dealership, including incidental service and repair of"]
[null,null,"vehicles, parts Suppliers and/or a Service Division?"]
[null,null,"If NO, please provide details"]
[]
[]
[]
[null,4,"Does the owner of this Dealership own other business's or operate any other business from the premises"]
[null,null,"declared, if so, please attach full details of these operations"]
[null,null,"(Your Dealership Policy does not cover any other commercial operations unless specifically agreed and noted on the Schedule)"]
[]
[null,"Situation Risk",{"$nulls":21},"Post Code"]
[null,1," "]
[null,2," "]
[null,3]
[]
[null,"Dealership Security"]
[null,null,"Window Locks / Bars / Grills",{"$nulls":12},"CCTV",null,"Patrol",null,"Monitored Alarm",{"$nulls":3},"Type of Alarm"]
[null,null,"(Please Specify)",{"$nulls":12},"(Yes/No)",null,"(Yes / No)",null,"(If yes, who monitors?)",{"$nulls":3},"(i.e. GSM, Landline)"]
[null,1]
[null,2]
[null,3]
[]
[null,null,"Type of Locking Device on Roller Door(s)",{"$nulls":11},"Type of Locking Device on ",{"$nulls":5},"Bollards",null,"Deadlocks",null,"Perimeter"]
[null,null,"(Please Specify)",{"$nulls":11},"Entrances & Doors",{"$nulls":5},"All Exits",{"$nulls":3},"Fence"]
[null,1]
[null,2]
[null,3]
[]
[null,null,"Key Security",{"$nulls":20},"Yes / No"]
[null,null,"Does the Dealership have key cabinets affixed to a structural wall"]
[null,null,"What other security does the Dealership employ to ensure the safety of keys? Please provide details below"]
[]
[]
[]
[null,"Risk Information"]
[null,null,"Occupancy",{"$nulls":3},"Age of the ",{"$nulls":7},"Type of material used",{"$nulls":3},"Type of material used",{"$nulls":3},"Type of material used"]
[null,null,"(Storage / Land / Yard)",{"$nulls":3},"Buildings (approx.)",{"$nulls":7},"for the Floors",{"$nulls":3},"for the Roof",{"$nulls":3},"for the Walls"]
[null,1]
[null,2]
[null,3]
[]
[null,null,"Number of Floors",{"$nulls":3},"Number of Buildings",{"$nulls":9},"Approx. Size of",{"$nulls":4},"Any EPS in Building / Premises"]
[null,null,"In the building",{"$nulls":3},"On each location",{"$nulls":9},"Building (Square Meters)",{"$nulls":4},"if so, please provide details below**"]
[null,1]
[null,2]
[null,3]
[]
[null,null,"Sprinklers",null,"Monitored Smoke Detectors",{"$nulls":8},"Hydrants",null,null,"Hose Reels",null,null,"Extinguishers",null,null,"Extinguishers & Hose Reels "]
[null,null,"Yes / No",null,"Yes / No",{"$nulls":8},"Yes / No",null,null,"Yes / No",null,null,"Yes / No",null,null,"Certified 6 Monthly?"]
[null,1]
[null,2]
[null,3]
[]
[null,null,"**If there is EPS in the buildings, please provide details on why there is EPS, what fire suppressants you have and what maintenance occurs?"]
[]
[]
[]
[null,null,"How long has the business been established?"]
[null,null,"Number of Employees "]
[null,null,"Number of Employees authorised to conduct test drives"]
[null,null,"Percentage of vehicle stock kept inside and outside",{"$nulls":19},"Outside:"]
[{"$nulls":22},"Inside:"]
[null,null,"Do you Import Vehicles or Accessories"]
[null,null,"Please provide full details if you answered \"Yes\""]
[]
[]
[]
["Section 1 - Industrial Special Risks: Material Damage"]
[null,"Is this section required?"]
[]
[null,"Limit of Indemnity"]
[]
[null,"Declared Values"]
[{"$nulls":3},"Buildings",{"$nulls":4},"Contents",{"$nulls":4},"Stock",{"$nulls":4},"Customers Goods",{"$nulls":4},"Total"]
[{"$nulls":3},"(incl. Signage)",{"$nulls":4},"(incl. Machinery & Plant)",{"$nulls":4},"(incl. Vehicles)",{"$nulls":4},"(incl. Vehicles)"]
[null,null,1,0,{"$nulls":4},0,{"$nulls":4},0,{"$nulls":4},0,{"$nulls":4},{"$f":"SUM(D190:W190)","v":0}]
[null,null,2,0,{"$nulls":4},0,{"$nulls":4},0,{"$nulls":4},0,{"$nulls":4},{"$f":"SUM(D191:W191)","v":0}]
[null,null,3,0,{"$nulls":4},0,{"$nulls":4},0,{"$nulls":4},0,{"$nulls":4},0]
[]
[{"$nulls":3},"Total",{"$nulls":19},{"$f":"SUM(X190:Z192)","v":0},0,0]
[]
["Section 2 - Industrial Special Risks: Business Interruption",{"$nulls":20},"(Section 1 must be taken)"]
[null,"Is this section required?"]
[]
[null,"Limit of Indemnity",{"$nulls":21},0]
[null,"Maximum Indemnity Period  ",{"$nulls":21},"12 Months"]
[]
[null,"Declared Values (Total all Situations)"]
[null,null,"Gross Profit",{"$nulls":20},0,0,0]
[null,null,"Payroll (if not included in Gross Profit)",{"$nulls":20},0,0,0]
[null,null,"Loss of rent receivable (Gross Rental)",{"$nulls":20},0,0,0]
[null,null,"Other",{"$nulls":20},0,0,0]
[null,null,"Total ",{"$nulls":20},{"$f":"SUM(X203:Z206)","v":0}]
[]
[null,"Uninsured working Expenses "]
[null,null,1]
[null,null,2]
[null,null,3]
[]
[null,"Further Notes for Insurer Consideration"]
[]
[]
[]
[]
["Section 3 - Industrial Special Risk: Crime & Contingencies"]
[]
[null,"3.1 Theft"]
[null,"Do you require cover for Theft?"]
[]
[null,"Limits of Indemnity"]
[null,null,"Theft: Vehicles",{"$nulls":16},"Per Vehicle - Buildings"]
[{"$nulls":19},"Per Vehicle - Open Air",{"$nulls":3},0]
[{"$nulls":19},"Maximum Per Event",{"$nulls":3},0]
[]
[null,null,"Theft: ","Accessories* (attached to a vehicle)",{"$nulls":19},0]
[{"$nulls":3},"Contents Plant & Machinery (other than vehicles and accessories)",{"$nulls":19},0]
[{"$nulls":3},"Other",{"$nulls":19},0]
[{"$nulls":3},"* Note that if Theft Accessories is not taken then fitted accessories will not be covered under this section"]
[]
[null,"3.2 Money"]
[null,"Do you require cover for Money?"]
[]
[null,"Limits of Indemnity"]
[null,null,"Combined",{"$nulls":20},0]
[null,null,"Outside Business Hours - not in safe (maximum $2,000)",{"$nulls":20},0]
[]
[null,"3.3 Glass"]
[null,"Do you require cover for Glass?"]
[]
[null,"Do you have a Showroom?"]
[]
["Section 4 - Public & Products Liability "]
[null,"Is this section required?"]
[]
[null,null,"Limit of Indemnity",{"$nulls":20},{"v":20000000,"d":"$20,000,000"}]
[]
[null,"Risk Information"]
[null,null,"No of Directors/Principles"]
[null,null,"No of Employees"]
[null,null,"Turnover from all sources in Australia"]
[null,null,"Retailing/Wholesaling - Vehicles",{"$nulls":20},0,0,0]
[null,null,"Retailing/Wholesaling - Watercraft",{"$nulls":20},0,0,0]
[null,null,"Retailing /Spare Parts",{"$nulls":20},0,0,0]
[null,null,"Vehicles Service",{"$nulls":20},0,0,0]
[null,null,"Commissions from Finance and Insurance Agency",{"$nulls":20},0,0,0]
[null,null,"Other Income ",{"$nulls":12},"Please Detail ",{"$nulls":7},0,0,0]
[null,null,"Total",{"$nulls":20},{"$f":"SUM(X254:Z260)","v":0}]
[]
[null,"Contractual Agreements "]
[null,null,"Have you, or do you intend to, assume obligations under any contract or agreement, e.g. waivers of liability, hold harmless, or indemnification agreements?"]
[null,null,"Please provide full details if you answered \"Yes\""]
[]
[]
[]
["Section 5 - Commercial Motor"]
[null,"Is this section required?"]
[]
[null,"Limits of Indemnity"]
[]
[null,"Part A - Loss or Damage to Vehicles"]
[]
[null,"(i)","Held as stock or for which you are legally responsible in the care of Authorised Drivers (Max per vehicle)"]
[null,null,"(This section is available for vehicles being driven by potential purchasers and others having the authorised"]
[null,null,"use of Stock Vehicles"]
[]
[null,"(ii)","Specified and owned privately"]
[null,null,"(this section is available for vehicles, other than Stock Vehicles, as would be insured under usual commercial motor vehicle"]
[null,null,"terms. You are responsible for providing you client with a PDS)."]
[]
[null,"Specified Vehicles ",{"$nulls":3},"(Not stock & not included in total stock limit)"]
[null,null,"Registration Number ",null,"Year / Make / Model ",{"$nulls":10},"Value ",null,"Drivers Date of Birth",null,null,"Registered Owner"]
[null,1,{"$nulls":12},0]
[null,2,{"$nulls":12},0]
[null,3,{"$nulls":12},0]
[null,4,{"$nulls":12},0]
[null,5,{"$nulls":12},0]
[]
[null,"(iii)","While Trade Plates are Affixed",{"$nulls":17},"Limit of Indemnity",null,null,{"$f":"X276","v":0}]
[]
[null,"Total stock value of the vehicles at each situation"]
[null,1,{"$nulls":21},0]
[null,2,{"$nulls":21},0]
[null,3,{"$nulls":21},0]
[]
[null,"Risk Management / Other information "]
[null,null,"Are all vehicles locked in buildings during non-business hours (own, customers and stock)"]
[null,null,"Does the business have a Key Safe to store customer's vehicles keys (not a cabinet) "]
[null,null,"If yes, provide security details below of make / style / supplier"]
[]
[]
[null,"Part B - Liability to Third Parties"]
[]
[null,"Property Damage",{"$nulls":3},{"v":20000000,"d":"$20,000,000"},{"$nulls":6},"Bodily Injury (CTP Gap Liability) ",{"$nulls":5},{"v":5000000,"d":"$5,000,000"}]
[]
[null,"Risk Information"]
[null,null,"No of Trade Plates and Plate Registration Numbers held by the Dealership"]
[]
[null,"Declared Drivers/Vehicles",{"$nulls":10},"Position",{"$nulls":3},"Driver",{"$nulls":3},"DOB",null,null,"Maximum Value of Vehicle driven"]
[null,"(For completion in respect of Part A(i).  Use of Stock Vehicles by the below)",{"$nulls":21},0]
[null,"Provide name and date of birth of Authorised Drivers",{"$nulls":21},0]
[{"$nulls":23},0]
[{"$nulls":23},0]
[{"$nulls":23},0]
[{"$nulls":23},0]
[{"$nulls":23},0]
[{"$nulls":23},0]
[{"$nulls":23},0]
[]
["Section 6 - Machinery Breakdown"]
[null,"Is this section required?"]
[]
[null,null,"Limit of Indemnity"]
[{"$nulls":18},"Yes / No"]
[null,null,1,"Blanket Machinery",{"$nulls":19},0]
[null,null,2,"Specified Machinery (as listed below) ",{"$nulls":19},0]
[]
[null,null,"Item ",{"$nulls":20},"Value "]
[null,null,1,{"$nulls":20},0]
[null,null,2,{"$nulls":20},0]
[null,null,3,{"$nulls":20},0]
[]
[]
["Section 7 - Computer / Electronic Equipment Breakdown"]
[null,"Is this section required?"]
[]
[null,"Limit of Indemnity"]
[]
[null,"On computer and or Electronic Equipment - up to the Cost of new Replacement",{"$nulls":21},0]
[]
[null,"Sub Limits"]
[null,null,1,"Restoration of data (except computer virus) - as defined which is $1,000",{"$nulls":19},0]
[null,null,2,"Increased cost of working (3 month limit)",{"$nulls":19},0]
[]
[null,"Risk Information"]
[null,"Is there a maintenance program in place?"]
[]
["Section 8 - Transit"]
[null,"Is this section required? "]
[]
[null,"Limit of Indemnity",{"$nulls":17},"any one conveyance",{"$nulls":3},0]
[]
[null,"Sub-Limit"]
[null,null,"Debris Removal",{"$nulls":12},"Limited to 10% of the consignment value or $50,000 whichever is the lesser"]
[]
[null,"Risk Information"]
[null,null,"Total Sending's",{"$nulls":19},"annual",0]
[null,null,"Do you own and operate a vehicle carrying conveyance?"]
[]
["Section 9 - Hail"]
[null,"Is this section required? "]
[]
[null,"Limit of Indemnity  (maximum $200,000)",{"$nulls":21},0]
[]
[null,null,"Declared Values"]
[null,null,"Total value of Vehicle stock exposed",{"$nulls":20},0]
[null,null,"Total value of Vehicle stock protected by specifically built hail structures",{"$nulls":20},0]
[null,null,"Total value of Vehicle stock held within permanent building structure",{"$nulls":20},0]
[null,null,"Total value of Vehicle Stock (must equal declared stock under section 1)",{"$nulls":20},{"$f":"SUM(X369:Z371)","v":0}]
[]
[null,null,"Cover is provided for hail damage to Insured vehicles at the situation up to the Limit of Indemnity"]
[]
["Claims Declaration "]
[null,"Notes"]
[null,null,"∙  Please include claims experience for at least 5 years"]
[null,null,"∙  Insurance is conditional upon receiving full claims experience from holding Insurer (New Business only) for at least the last 3 years"]
[]
[{"$nulls":3},"Date of Loss",null,"Claims Paid + Outstanding)",{"$nulls":3},"Excess",null,"Type of Loss",null,null," Description of Loss"]
[{"$nulls":5},0,{"$nulls":3},0]
[{"$nulls":5},0,{"$nulls":3},0]
[{"$nulls":5},0,{"$nulls":3},0]
[{"$nulls":5},0,{"$nulls":3},0]
[{"$nulls":5},0,{"$nulls":3},0]
[]
[null,"Other Information"]
[null,null,"Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you"]
[]
[]
[]
["Declaration"]
[null,"This declaration applies to all the insurance You are applying for in this Proposal."]
[]
[null," I/We declare and agree:"]
[null,null,"·  that I/We have received or have been offered a copy of the AGD Dealer Pack Combined PDS and Policy Wording;∙"]
[null,null,"·  that I/We have read the information concerning the Duty of Disclosure and other Important Notices;"]
[null,null,"·  that I/We have been truthful and accurate in completing this form and declaration and have not withheld any information likely to affect the acceptance of this insurance;"]
[null,null,"·  that I/We have either completed this form personally or, if it has been completed by someone else, have checked that the questions have been fully and accurately answered;"]
[null,null,"·  to make the Premise available for inspection by AGD if so requested;"]
[null,null,"·  upon acceptance, this insurance shall be subject to the AGD Dealer Pack Combined PDS and Policy Wording;·"]
[null,null,"·  where personal information has been provided on someone else’s behalf, that that person consented to this provision;"]
[null,null,"·  that I/We have read and understood the Privacy Act 1988 information and consent to the collection, storage, use and disclosure or personal and sensitive information of "]
[null,null,"   all persons covered by this Proposal:"]
[null,null,"·  that if anything happens during the Period of Insurance, which alters any of the information provided, I/We will promptly inform the insurer;"]
[null,null,"·  that I/We realize that if I/We have not complied with the Duty of Disclosure and Duty of Good Faith, any claims may not be met.·"]
[]
[null,"Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you –"]
[null,"Please attach additional information if insufficient space."]
{"$rows_empty":7}
[null,null,"SIGNATURE OF POLICY HOLDER (NOT BROKER)"]
[]
[]
[null,null,"NAME (BLOCK LETTERS)"]
[]
[]
[null,null,"DATE"]