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18. Is/are the person(s) to be insured suffering from any physical, psychological or other medical conditions? Is/are
the person(s) to be insured undergoing any form of medical or other treatments? Is/are the person(s) to be
insured following any prescribed medical regime? (only for non-appearance coverage)
If answered Yes to any of these questions, please provide full details:
Yes No
19. Have all necessary arrangements for the successful fulfillment of the performance(s) or event(s) to be insured
been made?
If No, please provide details:
Yes No
20. Have all necessary licenses, visas, and/or permits been obtained and have all contractual arrangements been
confirmed in writing?
If No, please provide details:
Yes No
21. Please complete both of the following categories (see definitions listed below) and please indicate which amount is to be insured:
A. Gross Revenue from event $ _________________________
B. Expenses from event $ _________________________
Sum Insured =
(either A or B above) $ _________________________
Please attach justification of the Sum Insured, explaining how the dollar amount provided was calculated. If possible, please
attach the budget for the event.
DEFINITIONS OF CATEGORIES
A. GROSS REVENUE: All monies paid or payable to the Applicant from every source arising out of the event.
B. EXPENSES: The total of all costs and charges incurred by the Applicant for, and in connection with, the planning, preparation,
and staging of the event.
22. Do these sums represent the full extent of your financial responsibilities?
If No, please provide details:
Yes No
23. If the performance(s) or event(s) has/have been held before under the present management or any other, has
there ever been a loss?
If Yes, please provide full details:
Yes No
24. Has the Applicant sustained any loss or damage during the last five years which would have been covered by this
type of insurance had it been in force?
If Yes, please provide full details:
Yes No
