Please answer the following questions and press "Send". All fields are mandatory

1. Broker Details

Broker Name
Broker Contact
Broker Phone Number
Broker Email Address

2. Club Details

Full name of Club
Address/PostCode
Club Web Site
No of years trading
Type of Club    Indoor
Outdoor
Both
Open period for Club:    From:
To:
Will the club be left unoccupied for any closed period
Has the site or surrounding area any history of flooding
Is the site in an exposed area susceptible to storm damage
Does the Premises have an Intruder Alarm (please give details)
Renewal Date
Current Premium

3. Risk Details

Public/Products Liability    £1,000,000
£2,000,000
£5,000,000
Not Required
Employers Liability    Yes
No
Please provide total annual wageroll:    Clerical
All others
Please provide total annual turnover
Material Damage    Fire and Perils
AD
Subsidence
Not Required
Please Provide sums insured for:    Buildings
Constructed of
Stock
Wines & Spirits & tobacco
Grass Bowling Greens
Indoor Bowling Greens
Floodlighting
All Other Contents
Cups & Trophies (All Risks UK Wide)
Loss of Revenue:    12 months
18 months
24 months
Revenue
Loss of License - Sum Insured
Money - Please State Maximum Value:    In Transit
In Premises
In Safe
Frozen Food - Sum Insured

4. Claims Experience

Please provide details of any claims or incidents likely to give rise to a claim in the past 5 years whether a claim has been made or not.

5. Material Facts

Please provide any additional information you feel will be relevant to this enquiry (If in doubt as to whether or not it is material please disclose it anyway).

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