Anytime Fitness Quote Request

Details of Party to be Insured

Note: If you would like a quote for multiple fitness centre locations, please complete a new quote request for each location.

Entity Name *Company Name eg. Sampletown Fitness Pty Ltd

Business Name *Trading Name - eg. Anytime Sampletown

Contact Email *

Business Phone Number *

Address of Club to be Insured *

Postal Address *

Number of Staff *

Annual Gross Revenue *

Preferred Policy Inception Date (When would you like your policy/policies to start?) *

Business Package Insurance

Property Details

Landlords entity name detailed within lease to be listed as an interested party (if applicable) *

Have you made any property claims in the last 3 years? *

Yes (can be multiple)No

Approx. Year Built *

Are the walls insulated with expanded polystyrene (foam type material) to your knowledge? *

YesNo

Flooring *

Concrete SlabBricksWooden Floor Foundation

Location *

Street facingWithin a shopping centreWithin an industrial complex

Combined General Liability, Professional Indemnity & Management Liability

Would you like to receive a quote for cover under the Combined General Liability, Professional Indemnity & Management Liability Policy? *

YesNo

General Questions

Sustained more than 3 losses or had losses totalling in all more than $5,000 in the last 3 years for those sections to be insured by this contract (excluding motor vehicles and management liability)? *

YesNo

Ever had an insurance policy cancelled, declined or terms imposed? *

YesNo

During the past five years been declared bankrupt or insolvent? *

YesNo

During the past five years been convicted of a criminal offence? *

YesNo

Other Cover

Are you interested in receiving quotations for any additional covers? *

Yes, Cyber Insurance (NEW exclusive rates for Anytime Franchise Owners)Yes, Motor Vehicle InsuranceYes, Workers Compensation (WA, NT & TAS Franchisees Only)Yes, OtherNo thank you, we are not interested in receiving quotes for any additional covers.

Additional Comments

Completed by (First Name) *

Completed by (Last Name) *

Position (Job Title) *

By submitting this form you agree you are authorised to complete this information of behalf of the insured and that all information provided is accurate as at the submission date.

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