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Applicant Organization Profile

This is the name that will be shown on the Policy as the Insured Organization. This should be the name under which your organization is incorporated or registered.
Mailing Address
What's Your Name?*
This is where all documents and correspondence will be sent for your insurance and billing.
This should be the primary phone number for the organization. This may be your personal contact number if there is no formal office number.
CA$
This amount should include all grants and funding. If you are a new organization please estimate your expected annual operating budget. (Example: 20000)
Are you an existing Shaw Sabey, Metrix, or Axis client?

Discounts & Description

Which of the below best describes the operations of your organization?*
Membership must be in good status for your discount and insurance to be valid

Check Eligibility

Which of the following best describes the legal status of your organization?*
Does your organization identify your principal operations as any of the following?*

Underwriting Details

Do you have annual payroll greater than $2,500,000?*
Have you ever been cancelled or non-renewed by an insurance company for similar coverage (including Directors and Officers, Employment Practices Liability, General Liability, Property, and other coverage related to this application)?*
Have you incurred any Property, Casualty (liability), or Directors and Officers claims/losses in the past 5 years?*
Do you have any employees, volunteers, or operations located outside of Canada?*
Any plans to dismiss employees or volunteers in the next 12 months?*
Have you currently, or at any time in the past 3 years, been in breach of its financial debt covenants or loan agreements?*
Are you currently in arrears on any statutory liability obligations?*
Are you currently, or at any time in the past 3 years, been in arrears in its payments to any Canadian federal or provincial tax authority?*
If your organization holds a charitable status, has this status ever been revoked or been subject to a review by Canadian federal or provincial tax authority?*
Has any proposed Insured given written notice under any prior or current insurance policy of specific facts or circumstances which might give rise to a Claim under this proposed insurance?*
Is any proposed Insured aware of any inquiry, investigation, communication fact, circumstance, situation, or Wrongful Act that might give rise to a Claim under the proposed insurance?*

Coverage Selection

I require limit or coverage options that are not provided here
Nonprofit Directors and Officers Liability Limit
This insurance applies to charities as well. Directors and officers coverage provides legal defense and award costs for the organization and its directors and officers who may be individually named in a lawsuit for their involvement subject to the policy wording and limits
General Liability
General Liability covers third party bodily injury (slips, trips and falls) and 3rd party property coverage for claims arising from alleged or actual negligence of your organization or its staff subject to the policy wording and limits.
Crime Liability
Crime covers theft by employees and theft of cash subject to the policy wording and limits
$
If you had to replace all of your organizations belongings, how much would it cost? You should value your belongings on a replacement cost basis. This means the price you would have to pay to purchase all of your usable stuff new, regardless of its current age. Also include the value of labor and materials for any improvements you have paid for in your leased space (shelving, flooring, kitchen etc.)
For which date would you like coverage to be effective?
Coverage will be effective at 12:01am on the date indicated

Standard Application Declaration & Warranty Statement

DECLARATIONS: The undersigned authorized officer of the Applicant, on behalf of the Applicant declares:

  • All statements and answers made in this application form, including any attachments to this application, and the information provided or made available by the Applicant to the Insurer in connection with the underwriting of the proposed insurance are true, accurate, and complete
  • The Applicant will report to the Insurer immediately, in writing, any material change in the Applicant’s operations, condition, or answers provided in this application form that occur or are discovered between the date of this application form and the effective date of any policy, if issued. The Insurer reserves the right to modify or withdraw any proposal for insurance the Insurer has offered if such a material change occurs.Other than indicated in Question 22 above, no proposed Insured is aware of any fact, circumstance, situation, or Wrongful Act that could give rise to a Claim under the proposed insurance.
  • The Applicant understands that, without prejudice to any other rights or remedies of the Insurer, if any proposed Insured has such knowledge, whether or not disclosed, then any Claim arising from such fact, circumstance, situation, or Wrongful Act is excluded from coverage.The Applicant’s submission of this application does not obligate the Applicant to buy insurance nor is the Insurer obligated to sell insurance or to offer insurance upon any specific terms requested.

APPLICATION FORMS PART OF POLICY The statements and answers made in this application form, including all materials submitted with and attached to this application form, and all information provided or made available by the Applicant to the Insurer in connection with the underwriting of the proposed insurance, shall constitute the Application. If the policy applied for is issued, the Application will be deemed attached to and will form a part of the policy.

CLAIMS MADE NOTICE: CERTAIN COVERAGE PARTS OF THE POLICY FOR WHICH THE APPLICANT IS APPLYING PROVIDE COVERAGE ON A CLAIMS-MADE BASIS, WHICH APPLIES ONLY TO CLAIMS FIRST MADE AGAINST THE INSUREDS DURING THE POLICY PERIOD, OR A CLAIMS-MADE AND REPORTED BASIS, WHICH APPLIES ONLY TO CLAIMS FIRST MADE AGAINST THE INSUREDS AND REPORTED TO THE INSURER DURING THE POLICY PERIOD OR ANY APPLICABLE EXTENDED REPORTING PERIOD. PLEASE READ THE POLICY CAREFULLY.

DEFENSE COSTS WITHIN LIMIT NOTICE: CERTAIN COVERAGE PARTS OF THE POLICY FOR WHICH THE APPLICANT IS APPLYING PROVIDE THAT THE LIMITS OF LIABILITY AVAILABLE TO PAY JUDGMENTS OR SETTLEMENTS WILL BE REDUCED AND MAY BE COMPLETELY EXHAUSTED BY THE PAYMENT OF DEFENSE COSTS, AND IN THE EVENT SUCH LIMITS OF LIABILITY ARE EXHAUSTED, THE INSURER SHALL HAVE NO FURTHER OBLIGATION FOR ANY LOSS UNDER THE POLICY. PLEASE READ THE POLICY CAREFULLY.

I understand and agree*
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