General Cancellation Application

Client Information

Organization Information
Contact Information

Event Details

Please attach a copy of the contract with the venue and email it to

Event Dates
Event Date 1: from to
Event Date 2: from to
Event Date 3: from to
Event Date 4: from to
Event Date 5: from to

If the event is longer than five days, please attach additional dates and times on a separate sheet and email to

What allowance in the itinerary has been made for:
Only for non- appearance coverage
Other Details

Please complete both of the following categories (see definitions listed below) and please indicate which amount is to be insured:

Definition of Categories
GROSS REVENUE: All monies paid or payable to the Applicant from every source arising out of the Event
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.

Fraud Statements

Signing this application does not bind the Applicant or the Company to complete the insurance, but it is understood and agreed that the information contained herein shall be the basis of the contract should a policy be issued. If any of the above questions have been answered fraudulently or in such a way as to conceal or misrepresent any material fact or circumstance concerning this insurance or the subject thereof, the entire policy shall be void.
To the best of my knowledge and belief the information provided in this application, whether in my own hand or not, is true and I have not withheld any material facts.
I understand that non-disclosures or misrepresentation of a material fact will entitle the company to void the Insurance.
I understand that signing this Application does not bind me to complete the insurance but agree that should an insurance policy be issued, this Application and the statements made therein shall form the basis of the insurance policy.