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Family Day care Educators

You are here: Home / Family Day care Educators

Name of Family Day Care Educator*
Business Address*
Street Address City State Postcode Country
Email Address*
Phone
Name of Family Day Care Scheme
Date of Birth*
Day
Month
Year
Start Date of the policy*
DD slash MM slash YYYY
Years in Business*
Estimated Annual Income?*
Insurance Policy Start Date*
DD slash MM slash YYYY
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
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
Educator’s Name*
Date*
DD slash MM slash YYYY
Signature*
Comments
This field is for validation purposes and should be left unchanged.

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Address

Victoria
Unit 112, Level 1
22-30 Wallace Avenue
Point Cook VIC 3030

Queensland
WOTSO Chermside
Level 2, Westfield Chermside
Chermside QLD 4032

Postal Address

PO BOX 6353
Point Cook VIC 3030

Phone

VIC +61 3 8379 7300

QLD +61 7 3180 2604

Fax

+61 3 8677 9344

Email

info@megalines.com.au

Limit Required

In the last 10 years, has your business or you or any partner or director

Address

Postal Address

Phone

Fax

Email