Hospitality Industry Insurance

New Policy

Please note that the form needs to be completed once started as we cannot save your information in draft.
It is extremely important that this form is completed with as much detail as possible.

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Insurance proposal details

As Hospitality Industry Insurance is a specialised insurer and has a specialised licence please call 02 8251 9069 to discuss your new policy.

If applicable
Contact Person
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*If multiple policies exist for one year please add all
Related Corporations
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Grouping of Related Employers
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Accept file types .pdf, .doc, .docx, .jpg, .jpeg, .png, .bmp, .tif, .tiff, .msg

After New Policy details page, you will be redirected to the Direct debit form

Declaration:
By replying to this email, you are declaring that you are the Employer or an authorised representative and:
  • The information provided, and any attachments is true, correct, and complete
  • No information has been suppressed or omitted
  • That all information supplied is made in accordance with the records required to be kept under the Workers Compensation Act 1987
  • You acknowledge that the terms and conditions of the policy are as prescribed by Schedule 3 of the Workers Compensation Regulation 2010
  • You consent to the information provided in this form, and any further information provided, being used for the purpose of evaluating and administering the employer's workers compensation policy and any related purpose
  • You are authorised by the employer to reply to this email on behalf of the employer
Privacy Statement

For further information on our privacy practices please select the Privacy Statement
By providing this information I agree to the Hospitality Industry Insurance Privacy Statement.
For Privacy statement please click here

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