Childcare Work Experience Scheme

You are applying for individual Public Liability Insurance coverage for temporary Work Experience whilst completing your formal Childcare Services Qualification / Studies.

Policy Limits & Excess are as follows;

Limit: $10,000,000 Each and Every Claim
Excess: $500 Each and Every Claim,
Period of Cover: 31 days from effective date of policy

Please contact Insurance House Surety on 02 8913 9100 if you have any questions or need assistance in the completion of this application.


Details of Insured/Applicant (Please provide all details in full)
First Name:
Last Name:
Date of Birth: (dd/mm/yy)
Residential Address: Street
Suburb:		State:
Postcode:		Tel No:
Fax No:		Mob No:
Your Email Address:
Date the cover is required	(dd/mm/yy)

Name of Educational Institution:
Course Name:
Name of Childcare Centre you will be working at:

Premium Payable:

Your occupation/activity is described as: Temporary Work Experience Learners obtaining practical experience in the childcare industry whilst completing formal qualification / studies.

Your Duty of Disclosure

During the past five years have you made any claim against a Public Liability Policy for Loss
or Damage?

Yes
No

Had any insurance declined or cancelled, application rejected, renewal refused, special Conditions or Excess imposed by an insurer? If Yes, please provide further details below;

Yes
No

Have you suffered any loss or damage which would have been covered by this Public Liability Insurance Policy?

Yes
No

Have you ever been convicted of any criminal activity within the past 10 years (other than minor traffic offences)

Yes
No

Are you aware of any facts, circumstances or acts that may give rise to any future claims under this proposed Policy?

Yes
No

If "Yes " to any question above please provide full details in an attachment or describe fully in the text box below:

Please take note of the different total premium for each state, which is due to varying levels of tax between each state.

New South Wales	Total Payable $185.90
Victoria	Total Payable $187.00
Queensland	Total Payable $184.25
South Australia	Total Payable $188.10
Australian Capital Territory	Total Payable $187.00
Tasmania	Total Payable $184.80
Northern Territory	Total Payable $187.00
Western Australia	Total Payable $187.00