Multiple Event Insurance Proposal Form

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1. General Information

Are you an Insurance Broker or Direct Client*
 Insurance Broker Direct Client
Insurance Broker Company Name
Financial Services Authority Number
Insured Company Name (or Insured Person)*
Contact Name*
Telephone*
Email*
Type of event
Your interest at the event. Organiser, Exhibitor
Location
Please state the experience you or the organiser have for events of this type (for example: 2 years, 10 events) *
Have you or any of your events ever suffered a loss?*
 Yes No
If Yes please provide details


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