This offer is fully endorsed by QRL and is open to all rugby league clubs and associations affiliated or playing league in Queensland competitions.
 

Complete form and press submit for it to be sent direct to OAMPS, or print the form, complete and Fax / Post to OAMPS
General Details  
   
Name Club:
Address:
  State P/C
Postal Address
 
  State P/C
Contact Person:
Contact Details  Phone:
   Email: 
Insurance Expiry Date
   
Insurance Package  
   
Buildings $
Contents $
Stock $
Other $ Description: 
Other $ Description: 
Other $ Description: 
   
Quote for Additional Covers

Mobile Machinery Section (Tractors / Movers etc)
 
Machine Value $   Description: 
Machine Value $   Description: 
Machine Value $   Description: 
Machine Value $   Description: 

Machinery Breakdown Section 
 
Type Yes in the Box for Machinery Breakdown Quote:     

Please provide details in the box below of any other Insurance requirements and we will contact you

To send form via email press submit:

Fax: Attention Mathew Lethborg,  (07) 3367 5120

Or Post: GPO Box 1113 Brisbane QLD 4001