Step 1

School District Details

School Details

School District *
Contact *		Email Address *
Position *		Telephone Number *

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Number of staff to be insured *		Number of schools in district *
Total accumulated sick days *		Student days per annum *

Absence history that required substitute

Total No of Substitute Staff Days excluding professional/school business:

Absence history that required substitute

2011

*

2010

*

2009

*

Step 2

Policy cover required

Please select one of the following three options below:

Policy cover require

Option 1	Excess Days per claim
Option 2	School District Staff Days for year
Option 3	Please quote me for both options 1 & 2

Daily payment required

Please select between $80 - $175:

Daily payment required

*

Excess days per claim

Please tick as many as required:

Excess days per claim

3 days

5 days

10 days

20 days

Average School District Absence days

What is your School District average absence per employee? For example if you take your total annual absence days and divide by the number of staff.

Average School District Absence days