Community Insurance Program Community Groups Expression of Interest (EOI) Form


Definitions of Insurance:

Public and Products Liability Insurance

A public and products liability policy will protect you from the financial risk associated with these types of claims. For a claim that is covered by the policy, the policy will pay the costs to investigate, defend or settle such claims and will also cover the cost of compensating the injured party.

Volunteer Workers Insurance: Death and Capital Benefits

Voluntary Workers Personal Accident Insurance provides financial compensation and cover for defined out-of-pocket expenses if an accident results in the injury or death of a volunteer.

The personal information collected on this form will be used by the Town of Bassendean to manage and administer its services and meet legal and governance obligations. Your information may be disclosed to relevant third parties where necessary to provide these services or where required or permitted by law

Applicant Details

Community Group Details

Is the group currently in operation?*This field is required.
Does the group currently have insurance?*This field is required.
Any past claims?*This field is required.
Does the group currently have access to insurance through an affiliate organisation, or state or national body ?*This field is required.
Is the group currently registered as a sole trader or business*This field is required.
Is the group currently located/operating in the Town of Bassendean (Ashfield, Eden Hill or Bassendean)?*This field is required.