Private Collectibles and Valuables
Insurance Proposal Form

Keystone recommends that the proposed Insured keep a record of all information supplied for the purpose of entering into an insurance contract. Please answer all questions in full. If there is insufficient space, please provide further details on a separate sheet. All attached documents form part of this Proposal.

General Details

Name(s) of person(s) requesting insurance (please list all names):

Date(s) of Birth:

Name of Superannuation Fund (as it should appear on the policy – IF APPLICABLE):

Insurance and Claims History

Has the proposed Insured had an insurance policy renewal declined or had any insurance policy cancelled for any reason within the last five years?	No ☐	Yes ☐
Has the proposed Insured or any member of the household of the proposed Insured had any losses which were or could have been covered by the proposed insurance within the last five years?	No ☐	Yes ☐
Has the proposed Insured ever been declared bankrupt?	No ☐	Yes ☐
Has the proposed Insured ever been convicted of a criminal offence?	No ☐	Yes ☐

If yes, please provide full details in the space provided on Additional Information page of this Proposal.

Details of Assets

Proof of Ownership and Value of Items

Independent valuations or purchase receipts that are less than three years old are requested for any items worth more than $5,000. Provision of these means that items will be listed in the Policy at agreed value. If there are none (or if they are older than three years), then the following Endorsement will be included in the Policy. The insured will need to provide evidence as to the ownership and value of the items at the time of loss. Keystone strongly recommends that independent valuations or purchase receipts are obtained and provided to Keystone from the outset whenever possible.

END-SP-2021-001

Proof of Ownership and Value Endorsement

The following is deleted in the Policy:

Basis of Settlement Clause 2.1.

The following is included in the Policy:

2.1. The basis of settlement for an Item that is individually listed:

2.1.1 with a value in the Schedule, is that agreed value, less the applicable Excess. Keystone will not be liable for more than the agreed value;

2.1.2 without a value, or not shown at all, in the Schedule is the market value immediately prior to the loss, less the applicable Excess.

If it is ‘market value’ then, in the event of loss or damage to an Item claimed to have been covered under this Policy, the onus is on the Insured to supply Keystone with:

a. all the information and documentation that Keystone require to prove the Insured’s ownership or legal responsibility for the Item; and

b. satisfactory evidence of the market value of the lost or damaged Item including, where applicable, any loss of value insured hereby.

Keystone will decide what is acceptable proof of ownership and value of the Item for which the Insured are claiming, considering its value at the time of loss or damage. Notwithstanding the foregoing, valuations or purchase receipts no more than three (3) years old will be deemed satisfactory proof of ownership and value. Examples of other information and documentation that may be required include, but are not limited to:

a. photographs of the Item that are not more than three (3) years old; and/or

b. a statutory declaration verifying the details of the Item and the claim, and any other matters connected with it; and/or

c. quote for replacement of the Item.

It is further noted and agreed that settlement of any loss shall be entirely at Keystone’s discretion in the event the Insured is unable to provide satisfactory details as specified above.

In all other respects the Policy remains unaltered.

Please detail any Jewellery and Valuables to be insured:

Please make descriptions as detailed as possible.

Description	Sum Insured
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

If there are more items to be listed, please provide details on the Additional Information page of this Proposal or attach a separate sheet.

Are valuations or purchase receipts less than three years old available for items worth more than $5,000?	Yes ☐	No ☐
If yes, please provide copies.

Please detail any Artwork and Collectibles to be insured:

Please make descriptions as detailed as possible.

Description (title, artist, year of production, medium, dimensions)	Sum Insured
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$

If there are more items to be listed, please provide details on the Additional Information page of this Proposal or attach a separate sheet.

Are valuations or purchase receipts less than three years old available for items worth more than $5,000?	Yes ☐	No ☐
If yes, please provide copies.

Location (Situation) Details

Please confirm details of the location type for the Situation:

Note: If there is more than one Situation of the same type where insured items will be kept, please provide details on a proposal form Addendum for each additional Situation.	Transit required? If yes, also fill in Transit details on page 12.
Private home (occupied by the Proposed Insured)	Yes ☐ fill in Section A below	Yes ☐
Bank or safety deposit vault	Yes ☐ fill in Section B below	Yes ☐
Commercial storage facility	Yes ☐ fill in Section C below	Yes ☐
Professional wine storage facility	Yes ☐ fill in Section D below	Yes ☐
Exhibition venue	Yes ☐ fill in Section E below	Yes ☐
Other	Yes ☐ fill in Section E below	Yes ☐
Transit only (skip to Transit section on page 12)	Yes ☐

Section A – Private Home of the Insured (only fill in if the assets are to be kept at home)

Home Address:

State:	Postcode:

Value of Assets

Jewellery and Valuables:

(eg. jewellery, watches, coins, banknotes, currency, bullion and precious metals, diamonds and precious stones)

Total Sum Insured: $

Maximum amount worn at any one time: $

(this is the maximum combined value the proposed insured would like to wear at any point in time.)

Artwork and Collectibles:

(eg. paintings, objets d’art, silverware, tableware, glassware, porcelain, ceramics, pottery, china, sculpture, furniture, books, stamps, wine and spirits, antiques and collectibles of whatsoever nature)

Non-Fragile: $

(this is for artworks and collectibles of any nature that would still have value even if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Fragile: $

(this is for artworks and collectibles of any nature that would lose all value if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Building Construction

Walls	Brick ☐	Concrete ☐	Stone ☐	Timber ☐	Steel ☐	Other ☐
Roof	Tile ☐	Slate ☐	Concrete ☐	Metal ☐	Other ☐

Fire Protection

Smoke detector	Yes ☐	No ☐
Extinguishers	Yes ☐	No ☐

Security

Type of Home

Is the Situation an apartment?	Yes ☐	No ☐
If applicable, is the apartment self-contained?	Yes ☐	No ☐
If applicable, is the apartment located on level 4 or above?	Yes ☐	No ☐

Locks

Deadlocks on ALL external doors	No ☐	Yes ☐
If No, how are the doors secured?

Track lock or bolt on ALL sliding doors	No ☐	Yes ☐	N/A ☐
If No, how are the sliding doors secured?

Locks or catches on external windows	No ☐	Yes ☐
If No, how are the windows secured?

Alarm

Local alarm system (bells only)	Yes ☐	No ☐
If applicable, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐

Local alarm system (alert to mobile phone)	Yes ☐	No ☐
If applicable, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐

Monitored alarm system (alert to security service/police)	Yes ☐	No ☐
If applicable, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐

Safe

Secured safe in premises	Yes ☐	No ☐
If yes, please provide: Make Model Dimensions Year made Cash rating Torch and drill resistant? Yes ☐ No ☐
If yes, does the safe weigh more than 250 kg?	No ☐	Yes ☐
If no, is the safe secured to a solid wall or solid floor?	Yes ☐	No ☐

Occupancy

Will the situation ever be left unattended for more than 60 days at a time?	Yes ☐	No ☐
Will the situation be regularly left unattended at night?	Yes ☐	No ☐

Section B – Bank or Vault (only fill in if the assets are to be kept in a bank or secure vault facility)

Name of Bank/Vault Facility:

Address:

State:	Postcode:

Value of Assets

Jewellery and Valuables:

(eg. jewellery, watches, coins, banknotes, currency, bullion and precious metals, diamonds and precious stones)

Total Sum Insured: $

Artwork and Collectibles:

(eg. paintings, objets d’art, silverware, tableware, glassware, porcelain, ceramics, pottery, china, sculpture, furniture, books, stamps, wine and spirits, antiques and collectibles of whatsoever nature)

Non-Fragile: $

(this is for artworks and collectibles of any nature that would still have value even if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Fragile: $

(this is for artworks and collectibles of any nature that would lose all value if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Security

Does the bank or safety deposit vault have dual control procedures?	Yes ☐	No ☐

Outside Bank/Vault Cover

Is cover required outside the bank/safety deposit vault in the short term?	Yes ☐	No ☐
If yes: List items to be removed: $ for days $ for days $ for days Reason/s for removing the items from the bank/vault:
Valuation	Yes ☐	No ☐
Repair/cleaning	Yes ☐	No ☐
Wearing for special occasion	Yes ☐	No ☐
Exhibition (please provide details)	Yes ☐	No ☐
Other reason (please provide details)	Yes ☐	No ☐
Is transit cover required while outside the bank/vault?	Yes ☐	No ☐
Personal conveyance	Yes ☐	No ☐
Australia Post	Yes ☐	No ☐
Commercial Courier	Yes ☐	No ☐
How many times per year will transit be required? Address where item/s will be located when away from the bank/vault: State: Postcode: Security of this location (alarm, locks on doors/windows, CCTV, safe):

Section C – Commercial Storage (only fill in if the assets are to be kept in a commercial storage facility)

Name of storage facility:

Address:

State:	Postcode:

Value of Assets

Artwork and Collectibles:

(eg. paintings, objets d’art, silverware, tableware, glassware, porcelain, ceramics, pottery, china, sculpture, furniture, books, stamps, wine and spirits, antiques and collectibles of whatsoever nature)

Non-Fragile: $

(this is for artworks and collectibles of any nature that would still have value even if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Fragile: $

(this is for artworks and collectibles of any nature that would lose all value if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Building Construction

Walls	Brick ☐	Concrete ☐	Stone ☐	Timber ☐	Steel ☐	Other ☐
Roof	Tile ☐	Slate ☐	Concrete ☐	Metal ☐	Other ☐

Fire Protection

Smoke detector	Yes ☐	No ☐
Extinguishers	Yes ☐	No ☐

Security

Locks - How is the hired storage space secured?

Padlocked	Yes ☐	No ☐
Keypad access	Yes ☐	No ☐
Other – please describe	Yes ☐	No ☐

Alarm – Is the hired storage space alarmed?

Entire complex/building only	Yes ☐	No ☐
Individual hired storage space is alarmed	Yes ☐	No ☐

Staff – Are there staff on site?

Business hours only	Yes ☐	No ☐
Business hours plus after-hours access and weekends	Yes ☐	No ☐
24 hours	Yes ☐	No ☐

Access

Does the Proposed Insured have exclusive access to the hired storage space?	Yes ☐	No ☐

If no, who has access to the storage space?

Storage Conditions

Does this storage facility provide climate-controlled conditions for stored items?	Yes ☐	No ☐

Section D – Wine/Spirits Storage (only fill in if the assets are to be kept in a commercial wine storage facility)

Name of storage facility:

Address:

State:	Postcode:

Value of Assets

Total Sum Insured: $

Building Construction

Walls	Brick ☐	Concrete ☐	Stone ☐	Timber ☐	Steel ☐	Other ☐
Roof	Tile ☐	Slate ☐	Concrete ☐	Metal ☐	Other ☐

Fire Protection

Smoke detector	Yes ☐	No ☐
Extinguishers	Yes ☐	No ☐

Security

Locks - How is the hired storage space secured?

Padlocked	Yes ☐	No ☐
Keypad access	Yes ☐	No ☐
Other – please describe	Yes ☐	No ☐

Alarm – Is the hired storage space alarmed?

Entire complex/building only	Yes ☐	No ☐
Individual hired storage space is alarmed	Yes ☐	No ☐

Staff – Are there staff on site?

Business hours only	Yes ☐	No ☐
Business hours plus after-hours access and weekends	Yes ☐	No ☐
24 hours	Yes ☐	No ☐

Access

Does the Proposed Insured have exclusive access to the hired storage space?	Yes ☐	No ☐

If no, who has access to the storage space?

Storage Conditions

Where is the wine stored within this location?

Purpose built cellar (climate controlled)	Yes ☐	No ☐
Wine fridge	Yes ☐	No ☐
Storage racks (climate controlled)	Yes ☐	No ☐
Other (please provide details)	Yes ☐	No ☐

Section E – Other Location (only fill in if the assets are to be kept at a location such as a gallery, a private home other than that owned by the Insured, or an exhibition space)

Home Address:

State:	Postcode:

Value of Assets

Jewellery and Valuables:

(eg. jewellery, watches, coins, banknotes, currency, bullion and precious metals, diamonds and precious stones)

Total Sum Insured: $

Maximum amount worn at any one time: $

(this is the maximum combined value the proposed insured would like to wear at any point in time.)

Artwork and Collectibles:

(eg. paintings, objets d’art, silverware, tableware, glassware, porcelain, ceramics, pottery, china, sculpture, furniture, books, stamps, wine and spirits, antiques and collectibles of whatsoever nature)

Non-Fragile: $

(this is for artworks and collectibles of any nature that would still have value even if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Fragile: $

(this is for artworks and collectibles of any nature that would lose all value if damaged or broken, and that are not jewellery, precious stones, currency, negotiable instruments, or precious metals)

Building Construction

Walls	Brick ☐	Concrete ☐	Stone ☐	Timber ☐	Steel ☐	Other ☐
Roof	Tile ☐	Slate ☐	Concrete ☐	Metal ☐	Other ☐

Fire Protection

Smoke detector	Yes ☐	No ☐
Extinguishers	Yes ☐	No ☐

Security

Type of Home

Is the Situation an apartment?	Yes ☐	No ☐
If applicable, is the apartment self-contained?	Yes ☐	No ☐
If applicable, is the apartment located on level 4 or above?	Yes ☐	No ☐

Locks

Deadlocks on ALL external doors	No ☐	Yes ☐
If No, how are the doors secured?

Track lock or bolt on ALL sliding doors	No ☐	Yes ☐	N/A ☐
If No, how are the sliding doors secured?

Locks or catches on external windows	No ☐	Yes ☐
If No, how are the windows secured?

Alarm

Local alarm system (bells only)	Yes ☐	No ☐
If applicable, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐

Local alarm system (alert to mobile phone)	Yes ☐	No ☐
If applicable, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐

Monitored alarm system (alert to security service/police)	Yes ☐	No ☐
If applicable, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐

Safe

Secured safe in premises	Yes ☐	No ☐
If yes, please provide: Make Model Dimensions Year made Cash rating Torch and drill resistant? Yes ☐ No ☐
If yes, does the safe weigh more than 250 kg?	No ☐	Yes ☐
If no, is the safe secured to a solid wall or solid floor?	Yes ☐	No ☐

Occupancy

Will the situation ever be left unattended for more than 60 days at a time?	Yes ☐	No ☐
Will the situation be regularly left unattended at night?	Yes ☐	No ☐

Who occupies this location and how are they associated with the Proposed Insured?

Exhibition

Will items to be insured be part of an exhibition?	Yes ☐	No ☐ Go to Transit

Name of Exhibition (if applicable)

Dates of Exhibition (if not a full year): From:	To:

Location of exhibition (if other than that detailed in Section E above)

Values on Exhibition

Highest value of single item	Maximum value of all items together
Paintings/Non-fragile artworks	$	$
Fragile artworks	$	$
Jewellery and Valuables	$	$

Are Jewellery and or Valuables to be exhibited?	Yes ☐	No ☐
If yes, will they all be displayed in locked showcases?	No ☐	Yes ☐
If no, how will these be protected?
How will they be protected after hours?
Will at least one employee or representative of the Insured, or the Insured themselves be always with the items during Exhibition hours?	No ☐	Yes ☐
If no, please provide details:

Please give details of Exhibition security including after Exhibition hours.

Is transit cover required to and from the Exhibition?	Yes ☐	No ☐ Go to Declaration
If yes, please fill in the Transit section below.

Transit

Is transit of the items to be insured required?	Yes ☐	No ☐ Go to Declaration
If yes, reason for transit:	☐ Moving house
☐ Moving items into storage
☐ Obtaining valuations of items
☐ Items to be sold at gallery/auctioneers
☐ Repair of items
☐ Moving items between locations listed on policy
☐ Exhibition of items

Type of transit required

Wall-to-wall cover (includes packing of items and installation at destination)	Yes ☐	No ☐
Domicile-to-domicile cover (transit only from collection of item/s to set down at delivery – no packing or unpacking)?	Yes ☐	No ☐

Who is packing the items for transit?

Name:

Qualifications/Experience:

Please describe how items will be packed and the packaging materials used:

If fragile items are to be packed please describe how these will be protected against breakage while in transit.

Who is doing the transit?

Note Artworks: Keystone requires that all artworks be transported by professional art courier. Artworks are not covered when transported privately.

Note Jewellery and Valuables: Keystone prefers that Jewellery or Valuable items be transported by a security courier. If this is not the case, please state the reason/s why here, and indicate below who will be doing the transit.

Professional art carrier (note: required for all artworks)	Yes ☐	No ☐
If yes, name of carrier/service

Personal Conveyance	Yes ☐	No ☐
If yes, name/s of person/s doing the transit

Commercial Courier	Yes ☐	No ☐
If yes, name of business doing the transit

Security Courier (preferred for Jewellery/Valuables transport)	Yes ☐	No ☐
If yes, name of business doing the transit

Collection Address:

State:	Postcode:

If this is for multiple transits, are the items always collected from this address?	Yes ☐	No ☐	N/A ☐

Delivery Address:

State:	Postcode:

If this is for multiple transits, are the items always delivered to this address?	Yes ☐	No ☐	N/A ☐

Is cover required at the delivery address?	Yes ☐	No ☐
If Yes, who occupies the location?
If Yes, please provide details of security at the location:
Locks
Standard locks on external doors	Yes ☐	No ☐
Deadlocks on external doors	Yes ☐	No ☐
Locks on external windows	Yes ☐	No ☐
Alarm
Local alarm system (bells only and/or alert to mobile phone)	Yes ☐	No ☐
If yes, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐

Monitored alarm system (alert to security service/police)	Yes ☐	No ☐
If yes, does the alarm cover all areas containing the insured items?	Yes ☐	No ☐
Safe
Is there a Safe at the premises?	Yes ☐	No ☐
If yes, does the safe weigh more than 250 kg?	No ☐	Yes ☐
If no, is the safe secured to a solid wall or solid floor?	Yes ☐	No ☐

What period of cover is required?

From:	To:

Is return transit required?	Yes ☐	No ☐

Values in Transit (only fill in if this proposal is for transit/s only, no static cover)

Highest value of single item	Maximum value of all items together
Paintings/Non-fragile artworks	$	$
Fragile artworks	$	$
Jewellery and Valuables	$	$

Declaration

After making appropriate enquiries, I declare that:

I am authorised on behalf of the proposed Insured(s) to complete this Proposal.

I have read and understood the Important Notices accompanying this Proposal.

Where I have provided information about another individual, I declare that the individual has been made aware of that fact and of the Keystone Privacy Statement.

I authorise Keystone to collect or disclose any personal information relating to this insurance to or from other insurers or insurance or credit reference services.

I confirm that the statements and information in this Proposal are true and complete.

I understand that, until a contract of insurance is entered into, I am under a continuing obligation to immediately inform Keystone of any change to the information contained in this Proposal.

I acknowledge that, if a contract of insurance is entered into, this Proposal and any accompanying documents will form the basis of the contract.

Name:	Signature:

Date: _____/_____/_____

Additional Information

Important Information

This Policy is issued by:

Keystone Underwriting Pty Ltd ABN 78 601 944 764 (Keystone)

Keystone Underwriting Pty Ltd is a Corporate Authorised Representative (No. 000468712) of:

Keystone Underwriting Australia Pty Ltd ABN 59 634 715 674 AFS License No: 518244

Who is the Insurer?

Certain Underwriters at Lloyd’s (“Underwriters”) will be providing the financial service. Keystone is authorised to quote, bind and issue Certificates of Insurance under a Binding Authority Agreement (Binder) granted to Keystone by those Underwriters. Keystone will provide details of the syndicate numbers and the proportions underwritten by them on request.

General Insurance Code of Practice

Lloyd’s supports the General Insurance Code of Practice and its purpose of raising the standards of practice and service in the general insurance industry.

What makes up the Insurance Contract?

This contract of insurance is made up of the Schedule, this Policy and any Endorsements that Keystone issues when an application is accepted or an existing Policy is renewed or amended.

Significant Features, Benefits and Exclusions

This Policy provides many significant features and benefits, subject to Conditions and Exclusions. Exclusions apply to this Policy and all of them are important. It is important that this Policy is read carefully to be aware of and understand the extent of cover that it offers. It will give full details of the Exclusions.

Significant Risks

The Insured should make sure that the sum insured and the limits to be purchased will be sufficient. All the terms and conditions contained in this Policy need to be understood.

Alteration to Risk and Deregistration

This Policy requires an Insured to notify Keystone within thirty (30) days of any material change to the business, or in the event of insolvency or bankruptcy. This Policy requires an Insured to give immediate notice of the cancellation, suspension, termination or imposition of conditions in respect of an Insured’s statutory registration. Claims arising from conduct which occurs subsequent to the cancellation, suspension or termination of the Insured’s statutory registration, licence, certification or authorisation under any relevant legislation or industry code of practice governing the Insured’s profession are excluded from indemnity under this Policy. However, this condition does not apply if the suspension relates purely to the late payment of registration fees.

Doctrine of Utmost Good Faith

Every insurance contract is subject to this doctrine which requires the parties to the contract to act toward each other with the utmost good faith. Failure to do so may prejudice any claims and/or the continuation of the insurance contract.

Duty of Disclosure

The Insured has a duty to tell Keystone anything they know, or could reasonably be expected to know, may affect Keystone’s decision to provide cover and on what terms, before entering into an insurance contract. This duty continues until Keystone agree to provide insurance. The same duty applies before renewal, extension, variance or reinstatement of an insurance contract.

Limits of Disclosure

The Insured does not have to disclose to Keystone any matter:

(a)	that diminishes the risk to be undertaken by Keystone; or

(b)	that is of common knowledge; or

(c)	that Keystone knows or, in the ordinary course of Keystone’s business, ought to know; or

(d)	for which Keystone has given a waiver.

Non-Disclosure

Keystone may cancel the Policy or reduce the amount paid to the Insured if a claim is made, or both if the Insured does not tell Keystone anything they are required to. Keystone may refuse to pay a claim and treat the contract as if it never existed if the Insured’s failure to tell Keystone is fraudulent.

Change of Circumstances

The terms and conditions of this Policy will be based on information the Insured provided to Keystone. It is essential Keystone are advised of any material change that occurs to this information prior to the inception of this Policy. Failure to do so by the Insured may prejudice any subsequent claims under the Policy and/or jeopardise the continuation of the insurance contract.

Buying Insurance

Set out below are important matters that apply to the initial enquiry, buying of insurance, and renewal of cover. Defined terms are the same as in the Policy.

Information that Keystone ask

Keystone will only ask for and consider relevant information when assessing the Insured’s application for cover.

Assessing Applications

The Insured will have access to information that Keystone has relied on in assessing their application and an opportunity to correct any mistakes or inaccuracies. Keystone may decline to release information in special circumstances, but will not do so unreasonably. Keystone will give reasons in these circumstances, and the Insured will have the right to request Keystone to review the decision through Keystone’s complaints handling procedures. Keystone will provide reasons in writing upon request.

Mistakes

Keystone will immediately initiate action to correct an error or mistake in assessing the Insured’s application for cover where it is identified.

Misrepresentation

Keystone’s sales process will be conducted in a fair, honest and transparent manner.

Declining Cover

If Keystone cannot provide insurance cover, Keystone will:

(a)	give reasons; and

(b)	refer the entity/person seeking insurance to another insurer, AFCA or NIBA, for information about alternative insurance options (unless they already have someone acting on their behalf).

Keystone will make available information about Keystone’s complaints handling procedures if the entity/person is unhappy with Keystone’s decision.

Policy Information

Information about Keystone’s policy wordings will be available when the Insured buy insurance from Keystone as well as on request. They will also be available on Keystone’s website at www.keystoneunderwriting.com.au.

Subrogation

The Insured may prejudice their rights regarding a claim if, without prior approval from Keystone, the Insured makes an agreement with a third party that would prevent Keystone from recovering any applicable loss (in whole or in part) from that, or another party.

This Policy contains provisions that have the effect of excluding or limiting Keystone’s liability for a claim under this Policy if you have entered into any agreement that excludes, limits or delays the Insured’s right to recover damages from another party in respect of such claim.

Cost of Policy

The cost of this Policy is made up of premium plus any applicable policy fees, government taxes and charges. Keystone may cancel this Policy if the Insured fails to pay the total premium due.

Deductibles

The Insured may be required to pay a deductible or excess if a claim is made under this Policy. Details of applicable deductibles or excess are provided in the Schedule. This Policy sets out the terms relating to the payment of deductibles or excesses.

Taxation

All taxes and charges are shown as separate items (e.g. fire and emergency services levy, stamp duty depending upon location and GST).

Cooling-off Period

The Insured has the right to cancel this Policy with Keystone within 14 days of the date that the Policy incepted, unless a claim is made. Keystone will refund the full amount of the premium less any duties or taxes payable if this cancellation occurs during the cooling-off period. This Policy will be terminated from the date Keystone receive the request to cancel.

Making a Claim

Benefits are payable if the Insured suffers a loss that is covered under this Policy during the Period of Insurance, except if an Exclusion or Condition applies. The Insured must immediately notify Keystone or their insurance adviser if there is a loss under this Policy.

Cancelling the Policy Before the Due Date

The Insured may cancel this Policy at any time by notifying us in writing, detailing the date that the cancellation will take effect. Keystone will refund any unearned premium to the Insured or their insurance adviser within 15 working days after the date of cancellation. Unearned premium will be computed pro rata for the unexpired term of this Policy, unless agreed in advance through the insurance adviser and set out in this Policy.

Privacy

Keystone are committed to safeguarding and protecting the Insured’s privacy. Keystone is bound by the provisions of the Privacy Act 1988 which sets out the standards to meet in the collection, use and disclosure of personal information.

The Act defines “personal information” as “information or an opinion about an individual whose identity is apparent or can reasonably be ascertained from the information or opinion”.

Purpose of Collection

Keystone will only use personal information the Insured provides to quote on and insure risks and matters incidental thereto, including investigating and managing claims.

It may be necessary for Keystone to provide the Insured’s personal information to others, such as other insurers or reinsurers, claims investigators, lawyers and other professionals, and government bodies. Keystone will not under any circumstances trade, rent or sell the information.

Keystone cannot properly quote insurance and cannot insure the Insured if they do not provide Keystone with complete, accurate and up-to-date information. If the Insured provide Keystone with personal information about anyone else, Keystone will rely on the Insured to have told them that their information will be provided to Keystone, to whom Keystone may provide it, the purposes for which Keystone will use it and that they can access it. Keystone relies on the Insured to have obtained their consent on these matters if the information is sensitive.

Access to Information

The Insured can check the personal information Keystone holds about them at any time. Requests for access can be made in writing to:

The Privacy Officer

Keystone Underwriting Australia Pty Ltd

17/296 Bay Road

Cheltenham VIC 3192

Keystone will keep the Insured informed of any delays in responding to the Insured’s request throughout the process.

Complaints

Keystone take all complaints seriously and have established internal dispute resolution procedures to ensure complaints are handled fairly, honestly and in a timely manner in accordance with the General Insurance Code of Practice.

The Code sets out a two-stage process:

Stage One Keystone will respond to the Insured’s Complaint within 15 business days of the date of receipt of the Complaint, provided Keystone has all the necessary information and have completed any investigation required. If Keystone cannot respond within 15 business days because Keystone does not have all necessary information or has not completed the investigation: (a) Keystone will let the Insured know as soon as reasonably practicable within the 15-business-day timeframe, and agree a reasonable alternative timetable with the Insured. Keystone will advise the Insured of the right to take the Complaint to Stage Two of the Complaints process if Keystone cannot reach an agreement with the Insured on an alternative timetable; and (b) Keystone will keep the Insured informed about the progress of the Complaint at least every ten business days, unless agreed otherwise. Keystone will respond to the Complaint in writing and advise the Insured of: (a) Keystone’s decision in relation to the Insured’s Complaint; (b) the reasons for Keystone’s decision; (c) the Insured’s right to take the Complaint to Stage Two if Keystone’s decision at Stage One does not resolve the Complaint to the Insured’s satisfaction. If the Insured wishes to make a Complaint, please contact: The Complaints Officer Keystone Underwriting Australia Pty Ltd 17/296 Bay Road Cheltenham VIC 3192 Phone: 1300 956 530 Email: complaints@ksua.com.au	Stage Two – Review by Lloyd’s Australia The Insured may take the Complaint to Stage Two if Keystone’s Stage One decision does not resolve it to the Insured’s satisfaction or if the Insured is unhappy with the way Keystone are handling it. The Insured can do this at any time during Stage One. Taking the Complaint to Stage Two, the Insured should contact: Lloyd’s Australia Limited Level 9 1 O’Connell Street Sydney NSW 2000 Phone: (02) 8298 0753 Email: idraustralia@lloyds.com Where the complaint is eligible for referral to the Australian Financial Complaints Authority (AFCA) the complaint will generally be reviewed by Lloyd’s Australia. Otherwise, the matter will be referred to the Complaints Team at Lloyd’s based in the UK.

The Insured may be referred to the Australian Financial Complaints Authority (AFCA) under the terms of the General Insurance Code of Practice if the Complaint remains unresolved. AFCA can be contacted by post at GPO Box 3, Melbourne, Victoria 3001, phone 1800 931 678 or email info@afca.org.au. More information can be found on their website www.afca.org.au. The Insured will be referred to other proceedings for resolution of other disputes. Details are available from Lloyd’s Australia Limited at the address above.