Page 2
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User Details:
Name
*
Street
*
Suburb / Town
*
State
*
-- Please Select
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Postcode
*
Phone
*
Email
*
Website
*
Indicates mandatory field
Page 3
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Activity Indication:
Is your operation a Registered Training Organization?
*
Yes
No
Year Established as a training facility?
*
Estimate number of students per year?
*
Do you offer course in:
Beauty Therapy?
*
Hairdressing?
*
Make-Up & Prosthetics?
*
Body Piercing / Tattooing
(including cosmetic make-up)
*
Intense Pulse (IPL) and/or
other industry Equipment Certifications?
*
Business Operations and management courses?
*
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Other
Please specify in general
*
Indicates mandatory field
Page 4
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Current Insurance:
Current Insurer
What type of Business Insurance do you currently hold?
Professional Indemnity
*
Public and Product Liability
*
Property Insurance
*
Yes
No
Yes
No
Yes
No
Expiry Month
None
January
February
March
April
May
June
July
August
September
October
November
December
Estimate of Current Premium paid
Do you use a Broker?
*
Yes
No
Answer is required
If yes, what is the name of the Broking Firm?
Broker Firm is required
*
Indicates mandatory field