Over 3,000 Australian Businesses entrust us to look after their Insurances. That is all we do. In 13 + years, that trust continues to grow.

Family Day Care Service/Scheme

Name of Family Day Care Service*
Business Address
Street Address City State Postcode Country
Contact Address
(if different from above)

Street Address City State Postcode Country
Email*
Contact Number*
Name of Director*
Date of Birth
DD slash MM slash YYYY
Start Date of the policy
DD slash MM slash YYYY
Have you been granted your Family Day Care Service Approval?*
- Yes
- No
Do you require this insurance policy for your Family Day Care Service Approval?*
- Yes
- No
Number of Educators?*
- 0-30
- 31-50
- 51-100
- 100+
Limit Required
Public Liability*
- 10 Million
- 20 Million
Do you require any interested parties to be noted on your policy?*
- Yes
- No
Name of Interested Party
Nature of Interest
Are you a member of Health Care Providers Association (HCPA)?*
- Yes
- No
In the last 10 years, has your business or you or any partner or director:
Been Refused, Declined or cancelled any of insurance Policies?*
- Yes
- No
Been convicted of any criminal offences?*
- Yes
- No
Been declared bankrupt?*
- Yes
- No
Suffered any loss or damage which would have been covered by the proposed insurance policy?*
- Yes
- No
Director’s Name*
Signature*
Date*
DD slash MM slash YYYY
Phone
This field is for validation purposes and should be left unchanged.

Limit Required