Sports and Social - Proposal Form
1. Full name of Proposer including all trading names, group companies and subsidiaries that are to be covered by the policy
2. Address
Post code
Telephone Number
Fax Number
E-Mail Address
Please list names and dates of birth of all Directors/Partners
If you require Employers’ Liability cover, please supply your Employer PAYE Reference(s). (This information is required for us to provide Employers’ Liability cover. Where you have more than one PAYE Reference, please advise each one making it clear which company they apply to)
If you do not have a PAYE Reference, please confirm that you are exempt and give the reason.
3. Full description of Clubs Activities
The Premises
1. Address of premises to be insured (if different from above)
2. Are the premises constructed of brick, stone, concrete and roofed with slates, tiles, concrete or asphalt and in a good state of repair?
Yes  No
Are there any outbuildings?
Yes  No
If yes, please give details
3. Age of premises
4. In what type of area are the premises situated?
  a) Residential
Yes  No
  b) Industrial
Yes  No
  c) Commercial
Yes  No
  d) Rural
Yes  No
5. Number of Storeys
6. Is there a cellar or basement?
Yes  No
7. Do you occupy the whole of the premises?
Yes  No
If no,
 
a) what parts do you occupy?
 
 
b) what is the occupancy of the other parts?
 
8. Has there been any history of flooding in the area?
Yes  No
9. How far are the premises from a full time Police Station?
10. How far are the premises from a full time Fire Station?
11. How are the premises heated?
   
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