Annual Policy Quotation
Wise Insurance Services Limited
168 Croydon Road
Beckenham
Kent
BR3 4DE

020 8663 3939

PROPOSAL FORM

Title:
First name:
Surname:
Company name:
Address:
 
 
Post code:
Telephone:
Email:
Fax:
Venue name:
Venue address:
 
 
Post code:
Name of event:
Cover start date:
Cover end date:
Gross annual turnover:
Type of event:
Total events per year:
Event visitors (duration):
Event visitors (day):
Public liability level:
Public liability cover:
Employers liability cover:
GENERAL QUESTIONS
YES
NO
1.
Whilst organising or participating in an event, have you, any official, committee member or co-organiser:
a)
Sustained any loss or damage or liability during the last 5 years, whether insured or not:
b)
Had any insurance declined or cancelled or special terms imposed?
2.
Have you, any official, committee member or co-organiser ever been convicted or charged but not yet tried for an offence other than a driving offence. If YES, please provide full details below:
3.
Are there any dangerous activities going to be undertaken at the event? If YES, please provide full details below, including whether the activity is under your sole control, or is provided independently by third parties with their own Public Liability Insurance:
(Activities entailing a forseeable risk of damage to property or bodily injury, unless reasonable precautions are taken or activities for which a disclaimer is used, must be signed by the participants)
4.
Will adequate first aid be provided and if so will suitably qualified staff be in attendance?
5.
Has the permission of the local authority been sought and granted?
6.
Has the advice of the police or fire authority been sought, and will either be present at the staging of the event?
7.
Will staging and seating be erected, and if so will this be carried out by suitably qualified professionals with their own insurance?
8.
If the event is staged over a number of days, has 24 hour security of the site been arranged?
9.
If hired in event property is to be insured, please provide accurate breakdown of property and individual values.