Application - Faith "*" indicates required fields Step 1 of 13 7% Welcome to a simplified application process We have simplified the process of completing an insurance application by tailoring the questions asked to get a better understanding of your organization. We understand you may want to add additional context to your responses, there are optional areas to do so throughout. You have the ability to save your progress and return to it later by selecting the Continue Later button at the bottom right of the form. After you've submitted the application, you’ll receive a completed application with your responses within a few minutes. Your privacy is important. Click here to view our full privacy and security policy. About You What is your role in the process?* I am the applicant I am an insurance broker completing with/​for the applicant Is your organization represented by an insurance broker?* Yes No Name of brokerage* Email* The Applicant Applicant RepresentativeFirst Name* Last Name* Position* Email* Phone* Applicant OrganizationFull name of organization* Website Organization Mailing AddressMailing Address* Street Address Address Line 2 City Province/Territory AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Did you know... We have multiple offices across the country located in Vancouver, Calgary, Toronto and Halifax. Our specialists understand regional differences and will work with your broker to provide you with exceptional service and responsiveness. Activities and Services Tell us more about the OrganizationWhat is the Organization's religious affiliation?*AnglicanBaptistBuddhismCatholicismChristianityChristian OrthodoxHinduismJudaismLutheranIslamPentecostalPresbyterianSikhismUnited ChurchOther (not listed)Since you selected a religion not listed, please tell us below What types of operating activities does the organization conduct?* Religious service and worship Fundraising events Youth groups Facility rentals Day school Athletic activities Child daycare Crematorium Camps Real estate development Please describe other operations not captured aboveAverage number of worship attendees*Please enter a number from 0 to 99999.Number of students*Please enter a number from 0 to 99999.Are the child daycare operations licensed?* Yes No Number of children*Are any activities conducted outside of Canada?* Yes No Operations Outside of CanadaAre any operating activities conducted in countries with sanctions imposed by the Government of Canada?* Yes No Click here to view the countries with active sanctions.Are any operating activities conducted in countries with an active travel advisory issued by the Government of Canada for all or non-essential travel?* Yes No Click here to view the countries with active advisories.Please describe activities outside of Canada* This description should include the: country, number of employees/volunteers, activity, frequency, and associated revenue. Fundraising EventsAre athletic races, aquatics, fireworks, or motorized vehicles used in any event(s)?* Yes No Are more than 1,000 attendees anticipated for any event(s)?* Yes No Is alcohol served at any event(s)?* Yes No Are any employees or volunteers anticipated to serve alcohol at any event(s)?* Yes No Please provide basic details of any event(s) with the above characteristics* Did you know... We insure a wide variety of faith organizations across Canada. As a specialist insurer, you can count on us to understand your organization's activities. In the next section, we'll take a closer look at the structure of your organization. Organization Structure How does the organization operate?Operating basis* For Profit Registered Charity Non-Profit, other than a Registered Charity Year established* Does the organization act as a licensing or regulatory body for its members?* Yes No I'm not sure Does the organization have any subsidiaries or affiliated entities?* Yes No I'm not sure Please provide details of subsidiaries and affiliated entities* Details should include the relationship between organizations and the operations of the subsidiary or affiliated entity. Operating as a Registered CharityCharitable registration number Has the organization's charitable status ever been revoked or the subject of review?* Yes No OptionalAdditional CommentsBelow is a space to write any additional comments Did you know... Ecclesiastical Insurance is owned by a charitable trust. All available profits are donated to charitable organizations. Now we'll gather some information about the people who keep your organization running - your employees and volunteers. Employees and Volunteers Organization WorkforceHow many of the following does the organization have?Full-time employees*Please enter a number from 0 to 9999.Part-time employees*Please enter a number from 0 to 9999.Volunteers*Please enter a number from 0 to 9999.Does the organization have any employees or volunteers in a position of authority?* Yes No A position of authority is any role where an individual is able to exercise significant influence of another person. Some examples include: pastors, imams, rabbis, teachers. ScreeningEmployee and volunteer screening helps ensure the safety of others. Below are standard screening measures: Written applications, Reference checks, and Police records checks with re-checks at least every five (5) years.Which of the following screening measures are completed for all employees and volunteers? Written applications Reference checks Police records checks with re-checks at least every five (5) years Select AllAre vulnerable sector checks completed for all employees and volunteers in a position of authority prior to engagement of duties?* Yes No I'm not sure OptionalTrainingIs abuse prevention training delivered to all employees and volunteers prior to the engagement of their duties and annually thereafter?* Yes No I'm not sure OptionalEmploymentIf any employees have been dismissed, enter the number below*Please enter a number from 0 to 9999.Is legal counsel consulted prior to employee dismissals?* Yes No Additional CommentsOptionalAdditional Comments Did you know... We insure many organizations like yours that rely considerably on volunteers. As someone once said, "Volunteers don't get paid, not because they're worthless, but because they're priceless." Now we'll move onto some questions about transportation. Transportation Commonly Used Methods Private passenger vehicles are motor vehicles designed to carry less than 8 passengers. Passenger vans are motor vehicles designed to carry between 8 and 15 passengers Buses are motor vehicles designed to carry more than 15 passengers Does the organization use private passenger vehicles in its operations?* Yes No Number of owned private passenger vehicles:*Please enter a number from 0 to 9999.Does the organization use passenger vans in its operations?* Yes No Number of owned passenger vans:*Please enter a number from 0 to 9999.Does the organization use buses in its operations?* Yes No Number of owned buses:*Please enter a number from 0 to 9999.Do employees or volunteers use their personal private passenger vehicles when carrying out their duties for the organization?* Yes No Less Commonly Used Methods in Remote AreasDoes the organization use watercraft in its operations?* Yes No Please explain below what activities involve the use of watercraft*Does the organization use aircraft in its operations?* Yes No Please explain below what activities involve the use of aircraft*Additional CommentsAdditional Comments Did you know... All Ecclesiastical policyholders receive unlimited access to our complimentary value-added services. Some of the available services include confidential access to experienced lawyers, qualified counselors and human resource professionals through our LegalConnex, ProfessionalAssist and HRAssist services available on our website. Managing Risk Common Risk Management ProceduresIs proof of insurance required from contractors?* Yes No Contractors are most commonly used for work including: snow removal, landscaping, and construction/renovation work. Are written accident/​incident reports completed for instances of reported injury?* Yes No Is Workers' Compensation coverage purchased for all employees?* Yes No I'm not sure Managing Transportation RiskIs a minimum of $1 Million third-party liability insurance confirmed for all operators of private passenger vehicles?* Yes No I'm not sure Is a minimum $2 Million third-party liability insurance limit confirmed for operators of passenger vans?* Yes No I'm not sure Is a minimum $5 Million third-party liability insurance limit confirmed for operators of buses?* Yes No I'm not sure Is a minimum of $1 Million third-party liability insurance confirmed for all employees and volunteers using their personal vehicles in the course of their duties?* Yes No I'm not sure Managing Fundraising RiskIs a minimum $1 Million liquor liability limit confirmed for third parties serving alcohol at events? * Yes No Are all employees and volunteers serving alcohol certified to do so?* Yes No Are signed waivers obtained from fundraising event participants?* Yes No Managing Facility Rental RiskIs proof of insurance required from renters?* Yes No Is the renting party required to add your organization as an additional insured?* Yes No Is the renting party required to sign a written rental agreement?* Yes No OptionalManaging Abuse RiskDoes the organization have a written abuse prevention policy in place?* Yes No Which of the following form part of the organization's abuse prevention policy The organization's commitment to keeping children and vulnerable persons safe Definition of roles and responsibilities of all personnel with respect to abuse prevention Approved code of conduct for acceptable staff/volunteer behaviour Procedures for reporting and recording incidents of abuse Procedures for responding to incidents of abuse Supervision of newly appointed employees/volunteers Annual review of abuse prevention policy Select AllDoes the organization indefinitely retain the following documents: Employee/Volunteer applications, Employee/Volunteer references, Police records checks, and Vulnerable sector checks (if applicable)Which of the following documents does the organization indefinitely retain: Employee/Volunteer applications Employee/Volunteer references Police records checks Vulnerable sector checks (if applicable) Employee training records Liability insurance policies Select AllOptionalAdditional CommentsBelow is a space to write any additional comments Did you know... We have a section of our website called the Risk Hub which includes various sections all dedicated to helping you manage risk. We offer risk guidance through bulletins, white papers etc., The Ecclesiastical Specialist School which offers a series of online courses and our ERM page with resources to assist you in navigating the volatile risk landscape. Financials FinancesProjected revenue for upcoming 12 months*Please enter a number from 0 to 999999999.Total employee payroll*Please enter a number from 0 to 999999999.Is an independent financial audit completed annually?* Yes No Financial BreachesHas the organization been in breach of its debts, covenants, or loan agreements in the past five (5) years?* Yes No Is the organization in arrears of payment owed to Canada Revenue Agency or the provincial ministries of revenue (including HST or RST)?* Yes No OptionalAdditional CommentsBelow is a space to write any additional comments Almost there... Whether you own or rent the building you operate out of, the management of your assets is essential to the function of your organization. Let's take a look at your insured assets in the next section. Property Please complete the following information below about the organization's property.Locations Address Usage Actions Edit Delete There are no Locations. Add Location Maximum number of locations reached. Use the 'Add Location' button to add multiple locations or buildings. Requested Coverages Please indicate which of the following coverages the organization would like to apply for:PropertyIs Property Coverage Required? Physical property Is Business interruption coverage required? Business interruption Is Equipment Breakdown Coverage required? Equipment breakdown Is Crime Coverage required? Crime General LiabilityIs commercial general liability coverage required? Commercial general liability Commercial general liability limit*TBD$2,000,000$5,000,000Is employers liability coverage required? Employers liability Is Non-Owned Automobile coverage required? Non-owned automobile Abuse LiabilityIs physical and sexual abuse coverage required? Abuse liability Abuse liability limit*TBD$1,000,000$2,000,000Claims-Made Retroactive date (if applicable) DD slash MM slash YYYY Management LiabilityIs Directors and Officers Coverage required? Directors & officers Directors & officers limit*TBD$1,000,000$2,000,000Is employment practices liability coverage required? Employment practices liability Umbrella LiabilityRequested Umbrella Coverage Umbrella liability Umbrella liability limit*TBD$3,000,000$5,000,000Current InsuranceWhen does the organization need insurance? DD slash MM slash YYYY Current insurance provider*AvivaIntactNorthbridgeSovereignWynwardOtherPrefer not to saySince you selected other, feel free to include this information below. OptionalAdditional CommentsBelow is an optional space to write any additional comments Did you know... Ecclesiastical Insurance received the award for Excellence in Claims Service at the Insurance Business Canada Awards for 2022. We understand that sometimes things don't always go to plan, but rest assured we will be here to help you every step of the way. Experience Has any insurer cancelled or declined to renew an insurance policy for the organization?* Yes No Please provide details of the cancelled or declined insurance:*Are there any pending or past claims or actions, or known circumstances which could result in such, against the organization, or any person(s) proposed for insurance in the capacity of director, officer, employee, or committee member of the organization which, if insurance had been in force similar to that now proposed, would have fallen within the scope of such insurance?* Yes No Please provide details of any such known or pending claims:*Has the organization suffered any property damage or been the subject of any lawsuits?* Yes No Please provide details of such damage or lawsuits:* Signed Understanding The undersigned authorized officer of the organization declares that, to the best of his/​her knowledge, the statements set forth herein are true. Signing of this application does not bind the insurer to offer, nor the applicant to accept insurance, but, it is agreed that this form shall be the basis of the contract should a policy be issued. The undersigned, on behalf of the insured organization, acknowledges that any personal information provided in connection with this application (including but not limited to the information contained in this form) has been collected in accordance with applicable privacy legislation and this information shall only be used or shared by the insurer to assess, underwrite and price insurance products and related services, administer and service insurance policies, evaluate and investigate claims, detect and prevent fraud, analyze and audit business results and/​or comply with regulatory or legal requirements. For purposes of the Insurance Companies Act (Canada), this document was issued in the course of Ecclesiastical Insurance Office plc’s insurance business in Canada.Signature* 21-December-2024 Once signed and submitted, we will send a copy of the completed application to you and/or your broker at the emails provided. The email should be received within a few minutes. PhoneThis field is for validation purposes and should be left unchanged.
