Event Insurance

Have any claims for personal injury or damage to property by thired parties or employess been made against the Insured in the past 5 years?

Yes No

Does the Insured have any assets in the USA?

Yes No

Declaration

The Insured Declares that they

have never been prosecuted under the Health and Safety at Work Act or other Statute or regulation
have not been convicted of any criminal offence (other than minor driving offernces not resulting in disqualification) in the last 5 years
have not been declared bankrupt nor been involved in a company or business whicj has gone into liquidation, receivership or come to an arrangement with creditors in the last five years.

Yes No

Do you require Employer's Liability?

Yes No

How many employees/volunteers are to be covered at this event?

Do any employees/volunteers carry out work at height in excess of 5m or depth of 2m?

Yes No

Do any employees/volunteers carry out work involving the application of heat, other than the preparation of food and drink?

Yes No

Do you have steps in place to ensure that you comply with all applicable rules and guidelines for the safety at work of employees in connection with communicable diseases, including any current government rules and guidelines relating to coronavirus (COVID-19)?

Yes No

Have you carried out and documented a risk assessment and a health and safety plan, with regards to safty at work for employees in respect of communicable diseases, including bit not limited to, coronavirus (COVID-19)

Yes No

Are you exempt from providing an ERN reference?

Yes No

Please enter your ERN?

Do you require Event Cancellation Insurance?

Yes No

Event Cancellation Limit

Will all contractual arrangements necessary for your involvement in each Event be made and confirmed in writing in a prudent timely manner prior to the start of the Event?

Yes No

Has your involvement in any event to be insured had any incidents that could have resulted or did result in a loss which would have been covered under this insurance suring the past 5 years?

Yes No

Is the Insured aware of any matter, fact, circumstance or incident existing or threatened that could possibly affect any Evant and might result in a claim under the proposed Insurance

Yes No

Declaration

I/we (the Insured) declare that the information disclosed on this proposal, is to the best of my/our knowledge and belief both accurate and complete. I/we have taken care not to make any misrepresentation in the disclosure of this information and understand that all information provided is relevant to the acceptance and assessment of this insurance, the terms on which it is accepted and the premium charged.

I/we understand that I/we must tell the you (the Insurer) as soon as possible about any changes to the information I/we have provided which happens before or during any period of insurance.

I/we understand that such changes may affect my/our insurance and may result in revised terms and/or changes to the premium being applied to my/our policy.

I/we understand that if I/we do not inform you (the Insurer) about a change it may affect any claim I/we make or could result in my/our insurance being invalid.

I/we understood that the acceptance of this non-binding indication does not bind you (the Insurer) to complete or I/us to accept this Insurance, but I/we agree that, should a contract of insurance be concluded, this non-binding indication and any supporting information shall be incorporated into and form the basis of the contract.

I/we accept these conditions as the Proposed Insured or agent of the Proposed Insured and understand that any subsequent insurance will become null and void if any of the foregoing conditions are breached

Yes No

Do you require Loss of money insurance?

Yes No

Loss of money Limit

About You

Public Liability

Public Liability Declaration

Employers Liability

Event Cancellation

Event Cancellation Declaration

Policy Period

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Event insurance

About You

Public Liability

Public Liability Declaration

Employers Liability

Event Cancellation

Event Cancellation Declaration

Policy Period