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Limits Of Indemnity:
Please provide the following financial information for your Event:
100% Gross Revenue:
100% Costs and
Expenses:
Please select the basis of Indemnity you require:
Gross Revenue
Cost and Expenses
Non Appearance:
Is coverage required for Non Appearance:
Yes
No
Please note the policy contains a 30 day health warranty and a pre-existing medical condition
exclusion
Type of Non Appearance coverage required:
Key Speaker
1. First
name
Last name
Date of Birth
2. First
name
Last name
Date of Birth
3. First
name
Last name
Date of Birth
If there are more than 3 persons to be insured please attach additinal names and dates of birth in
the space provided
Is any Key Speaker a member of a royal family or serving/former head of state?
Yes
No
Individuals or Group of Individuals
1. First
name
Last name
Date of Birth
2. First
name
Last name
Date of Birth
3. First
name
Last name
Date of Birth
If there are more than 3 persons to be insured please attach additinal names and dates of birth in
the space provided
Simultaneous Non-Appearance for 25% or more of Participants due to Common
Accident or Common Illness
Yes
No
Please confirm there are 20 or more performers in total
Yes
No