Sports Public Liability Quotation PROPOSAL FORM 1CONTACT DETAILS2BACKGROUND INFORMATION3WRITTEN POLICIES4CLIENT DETAILS5DETAILS OF INSURANCE6COVERAGE TYPE7HISTORY8SUBMIT TO UNDERWRITING HiddenSubmission URL 1. Team/Club Details:Club/Client name(Required) Trading name Company registration number Activities undertaken(Required) Are you affiliated to a governing body?(Required)YesNoPlease provide details(Required)2. Contact Details:Contact name(Required) Email address(Required) Website Mobile phone(Required) Business phone 3. Address Details:Club address(Required) Street Address Address Line 2 City County / State / Region ZIP / Postal Code Postal address(Required) Same as above Street Address Address Line 2 City County / State / Region ZIP / Postal Code 1. Background Information:Insurance refusal(Required)Has any insurer ever declined, refused to renew or has imposed special terms and conditions to any insurance policy/renewal or application for insurance held or made by the club? Yes No Please provide details(Required)Risk management(Required)Has any member of your Club completed a Risk Management course? Yes No Please provide details(Required) 1. Written policies:Do you have a written policy for risk management:(Required) Yes No Do you have a written policy for alcohol service:(Required) Yes No Do you have a written policy for blood spillage:(Required) Yes No Do you have a written policy for discrimination:(Required) Yes No 1. Current arrangements:Are you currently insured?(Required) Yes No Please provide details of insurer(Required)2. Your/directors status:a) I/we have not had an insurance proposal declined, cancelled or refused;b) I/we have not had any renewal refused;c) I/we have not had any special terms or conditions imposed;d) I/we have not been convicted or charged (but not tried) or been given an Office Policy Caution, in respect of any criminal offence;e) I/we have not been the subject of any County Court Judgement or Sheriff Court Decrees;f) I/we have not been declared bankrupt or insolvent or been disqualified from being a company director or been involved as owner Director or partner with any company which went into receivership, administration or liquidation;g) I/we have been a UK resident for the past 12 months.Please confirm that the above statements are all true(Required) I/we confirm the above statements are true 1. Period of insurance:Start Date(Required)The start date must either be today or a date in the future (within 30 days). All policies run for 12 calendar months. DD slash MM slash YYYY 2. Insurance Type:Select your requirements:(Required) Sports Club/Team Public Liability Coaching Liability 3. Select the sports/activities that your client undertakes:Do you require single or multi-sport cover?(Required) Single Sport Multi-Sport Select your sport(Required)AerobicsAikidoAqua AerobicsAqua CyclingAqua ZumbaAthleticsAxemanBadmintonBalletBaseballBasketballBilliardsBocceBowlsBoxercise (non-contact)Boxing (amateur)CalisthenicsCircuit TrainingClay Pigeon ShootingCricket (indoor)Cricket (outdoor)CroquetCrossfitDancingDartsDiving (board)FloorballFootball (Soccer)GolfGym InstructorHandballHockey (field)Hockey (inline)Inline SkatingJu JitsuJudoKarateKettlebellsKorfballMarching GirlsNetballOctopushOrienteeringPetanquePilatesPole FitPower LiftingRacquet BallRoller SkatingRowingRunningShotakanSkateboardingSnookerSoccer (indoor)SoftballSpinningSporting ShootersSquashSurfingSwimmingTable TennisTae Kwon DoT-BallTen Pin BowlingTennisTouch FootballTouch RugbyUltimate FrisbyVarious SportsVolleyballWater PoloWeightliftingWindsurfingYogaZumbaPlease provide details of sports your want to insure(Required) 1. Coverage Type:Public liability(Required)£1 million£2 million£5 million£10 millionProfessional indemnity(Required)£1 millionEmployers liability(Required)Not RequiredRequiredNumber of Employees(Required) Number of Volunteers(Required) ERN(Required)What is an Employers Reference Number (ERN)? Click here for more information. Wageroll:Clerical/Managerial(Required) Coaches/Instructors(Required) Players/Participants(Required) Caretakers/Cleaners(Required) Bar/Catering/Retail(Required) Ground Staff/Greenskeeper's(Required) Maintenance/Security(Required) All others(Required) 2. Risk Information:a. Number of players/members(Required)b. Number of non-playing officials(Required)a. Maximum number of sessions per week(Required)b. Maximum participants per session(Required)c. Maximum length of sessions (hours & minutes)(Required) Club turnover(Required)Please tell us your total turnover, this should include the past 12 months income you have received as a club. If you have zero income please enter 0 1. History:1. Have any claims been made by you or associated directors in the past five (5) years?(Required) Yes No Please provide details(Required)2. Have there been any incidents in the past five (5) years that may result in claims against you or associated directors?(Required) Yes No Please provide details(Required) 1. Submit to underwriting:I/we declare that all the submitted information with this online proposal form is true and accurate at the time of submission. I/we also accept that underwriters may seek further information based on the information I/we have submitted and will assist to allow the underwriters to accurately assess the risk.Please confirm that you have read and understood the above statements(Required) I/we understand