Group Personal Accident Insurance Application

The Duke of Edinburgh's International Award - Australia arranges a Group Personal Accident insurance policy (“the Policy”) is for Award Centres that require top-up cover, for any gap in coverage limits between the coverage limit provided under the Award Centre’s policy and the coverage limits stipulated in the sub-licence agreement.

Upon acceptance of the Award Centre into the Policy (and payment towards policy cost), the Policy can, upon request, cover the Participants and Voluntary Workers of Award Centres where they are undertaking activities relating to The Duke of Edinburgh's International Award program.

1. Contact details

a. Please select your Award Operating Authority.

b. Name of Award Centre

As listed in the Online Record Book

c. Contact Name

d. Email address (for follow-up communication regarding this form)

2. Award Centre details

a. Number of Award Participants involved at this Award Centre

Numerals only

b. Number of Voluntary Workers involved in carrying out the Award at this Award Centre

Numerals only

Note: for the purpose of this Policy, “Voluntary Workers” shall mean any (paid or unpaid) persons associated with the Award Centre that undertake voluntary work relating to The Duke of Edinburgh's Awards program.

3. Claims and coverage

The following question (3a) relates to any injuries to a Participant or Volunteer involved with The Duke of Edinburgh's International Award - Australia.

a. Has the Award Centre had any claims under a Personal Accident policy in the last 5 years?

YesNo

i. You responded "Yes". Please provide details below.

b. Does the Award Centre currently have a Personal Accident policy in place?

YesNo

ii. You responded "Yes". Please provide the following information with respect to the policy:

	Amount
Aggregate Limit
Death & Capital Benefits Limit Per Person

c. Please advise if the intention is to cover the Award Centre on a:

Primary basisDifference in Limits basis

Primary basis = the Policy shall provide coverage from the 'ground up'.
Difference in Limits basis = the Policy shall provide coverage in excess of the existing insurance policy of the Award Centre

Please select Submit below and the Award will provide a quote for the Policy in due course.

Contact Information