Event Liability Insurance
Statement of Facts
Event Details
Event Name
Type of Event
Date(s) of Event
Event Venue/Location
Event Address
Estimated Number of Attendees
Organizer Details
Organizer / Company Name
Contact Person
Contact Email
Contact Phone
Insurance Details
Sum Insured / Limit Required
Period of Cover
Risk Information
Describe all activities to be held at the event
Will food and/or beverages be served?
Yes
No
If yes, please provide details
Will alcohol be served or sold?
Yes
No
If yes, please provide details
Are there any hazardous activities? (e.g. rides, fireworks, animals, etc.)
Yes
No
If yes, please provide details
Previous Insurance / Claims History
Has any insurer ever declined or cancelled Your insurance or imposed special terms?
Yes
No
If yes, please provide details
Any claims, losses, or incidents in past 5 years?
Yes
No
If yes, please provide details
Declaration
I/We declare that the above information is true and correct to the best of my/our knowledge. I/We understand that non-disclosure or misrepresentation may result in denial of claims or avoidance of the policy.
Full Name
Date
Signature