Club Insurance

This form should take no more than a few minutes to complete, it's important that you provide all the information so that we can work out a quote for you. Once you have completed the form simply submit it, and once we have received the form on our system we can quote within 2 working hours. We will email the quote to the email address you have provided in the form.

If you have any queries or problems with the form then please give us a call on 01494 887909 and a member of our team will be happy to help.

Our business hours are Monday to Friday 9am – 5:30pm.

Disclosure

Please confirm you have read and accept the disclosure section. If you need any help call us on 01494 887 909.

The Application Form should be completed to the best of your knowledge and belief and all material facts should be disclosed (these are facts which are likely to influence the insurer’s acceptance or assessment of your application). If you are in any doubt about facts considered material you should disclose them.

The proposer(s), or any partner or director has never:-

(i) Had any proposal for insurance cancelled or declined for renewal or required increased premium or imposed special terms
(ii) Been prosecuted and there are no prosecutions pending under the Health and Safety at Work Act or any other statute or regulation
(iii) Been convicted of, prosecuted for and there are no prosecutions pending for any criminal offence (other than motoring convictions)

If you are unable to agree with the statement above please contact us on 01494 887 909

Any business or individual must confirm the following:

Internal Use Only

Correspondence Details

Please provide your contact details:

Your Clubs Details

Please tell us about your club:

Trampolining/Gymnastics: Public Liability exceeding £10m requires referral

Public Liability

Professional Indemnity

Employers' Liability

Do you need to supply an Employer Reference Number?
Unless all of your employees are paid below the PAYE threshold, you will have been supplied an Employer Reference Number (ERN) by HMRC. Businesses are required to provide their ERN when taking out Employers’ Liability insurance.
Important
You must contact us with your ERN as soon as HMRC have issued it. If we do not hear from you within 8 weeks of purchase we may cancel your Employer's Liability Insurance
Important
We will contact you for your ERN shortly after you purchase your policy. If you are unable to supply an ERN within 8 weeks of purchase we may cancel your Employers' Liability insurance

Sports Equipment

Personal Accident

Personal Accident Benefits (per member)
Cover Excess
Death
Adults £50,000 Nil
Children (under 16) £10,000 Nil
Loss of eye/limb/speech/hearingAny occupation £50,000 Nil
Permanent Total DisablementAny occupation £50,000 Nil
Permanent Total Extension - Dental ExpensesSubject to appropriate mouth protection being worn when participating in contact sports £250 £50
Medical Expenses £1,000 £50
HospitalisationMaximum Duration: 8 weeks £30 per 24 hours Nil
ConvalescenceMaximum Duration immediately after 4 or more nights in hospital: 4 weeks £70 per week Nil

About Your Club

Please confirm the proposer(s), or any partner or director or committee member has never:

Declaration

The information provided in connection with this proposal form is true and I/We have not withheld any material facts.

I/We understand that non-disclosure or misrepresentation of material facts will deem the Contract of Insurance void.

I/We understand that the signing of this proposal form does not bind me/us to complete the Contract of Insurance. However, I/We agree that should a Contract of Insurance be completed, then this Proposal Form and the Declaration shall form an integral part of the basis of the Contract of Insurance.

It is understood by the assured that any information provided to the Underwriters regarding the Assured will be processed by the underwriters, in compliance with the provisions of the Data Protection Act 1998, for the purpose of providing insurance and handling claims, if any, which may necessitate providing such information to third parties.

I/We understand that any change in information must be notified immediately and no cover exists until such change has been approved by Underwriters.

Endorsements

Voucher Code