Aurora Entertainment Pty Ltd

Animania - Insurance Policy

[Last updated 08/06/2004]

INDEMNITY

Artists, Clubs or Vendors (hereinafter refer to as “Stallholders”) agrees to indemnify and hold harmless
Aurora Entertainment Pty Ltd, its officers, directors, staff and volunteers from any losses, damages,
costs or expenses resulting from any third party claim or allegation (hereinafter referred to as “Claim”)
arising out of or relating to public liability and insurance matters that arise whether intentional or
unintentionally inflicted or caused by the Stallholders, including any Claim that arises. This obligation
shall survive termination of this Agreement.

PUBLIC LIABILITY INSURANCE

Do you, the Stallholder have current public liability insurance and will have during the period of the
Convention?
If NO, please proceed to “Declaration”.
If YES, please fill in the sections below and proceed to “Declaration”.

I (please print full name) ________________________________________ on behalf of (please print

Stallholders official name) ___________________________________________________________
hereby state that we, the Stallholder currently have public liability insurance policy and will have the
said cover effective during the period of the Convention. A copy of the insurance policy is attached /
will be made available (please delete non-applicable phrase) for Aurora Entertainment Pty Ltd. We,
the Stallholder’s declare that our insurance policy number is ___________with provider being
___________________________.

DECLARATION

I (please print full name) ________________________________________ on behalf of (please print

Stallholders official name) ___________________________________________________________
solemnly declare that the above details provided to be true and accurate. I understand the
consequence (punishable to the full extent of the law) for making false and misleading statements and
would be responsible or indemnify the Organiser, Aurora Entertainment Pty Ltd, its officers, directors,
staff and volunteers for reliance on such statements. I have read, understood and agree fully with all of
the above.

Signature: _____________________________________________Dated: _____________________

Witness’s Full Name: _______________________________________________________________

Witness’s Address: ________________________________________________________________

Witness’s Signature: ____________________________________Dated: _____________________

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