Proposer's Full Name(s):(enter sole trader's name or all partner's names if a partnership)
Contact Name:(if different to proposer's name)
Limited Company Name:(if operating as a Ltd. company)
Trading Name:(if different to the above)
Trading Status:
- - - - - - - Please Select - - - - - - -
Charity
Sole Trader
Partnership
Private Limited Company (LTD)
Public Limited Company (PLC)
Limited Liability Partnership (LLP)
Unincorporated Association
Club Address:
Club Postcode:
Is there a different correspondence address? Yes No
Correspondence Address:
Correspondence Postcode:
Daytime Telephone No.
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
Have you, or any other partner or director ever been convicted of or charged with any criminal offence? Yes No
If yes, please provide details:(i.e. date of conviction, type of conviction, length of custodial sentence, etc.)
Have you, or any other partner or director ever been declared bankrupt, insolvent or been the subject of a County Court Judgement (or Scottish equivalent)? Yes No
If yes, please provide details:(i.e. date of bankruptcy/insolvency, amount of bankruptcy/insolvency, whether discharged or not, etc.)
Has any insurer ever refused, declined, cancelled or imposed special terms in respect of your club insurance? Yes No
If yes, please provide details:(i.e. name of insurer, reason for refusal/special terms, etc.)
Have you, or any other partner or director ever been prosecuted or received notice of intended prosecution under the Consumer Protection Act, Food Safety Act, Health & Safety Act or similar legislation? Yes No
If yes, please provide details:(i.e. date of prosecution, reason for prosecution, etc.)
Business Description / Years Trading
Full description of the club's activities:(e.g. social club, snooker club, etc.)
Please state the number of years trading under current management:
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
30+
year(s)
What's the maximum permitted attendance at the club? persons
Is a membership system in place? Yes No
Number of members:
What are the opening hours of the club?
How many days a week is the club open?
0
1
2
3
4
5
6
7
Entertainment
Do you employ door supervisors? Yes No
Are they agency (sub-contract) SIA door staff only?(Agency staff only are acceptable; Directly employed or a combination of Agency only and Directly employed are not acceptable) Yes No
Is there any live entertainment at the premises?(e.g. Karaoke, disco's, bands, etc.) Yes No
If yes, please confirm the type of entertainment:(e.g. disco, bands, karaoke, etc.)
How many times per week is the entertainment held?
1
2
3
4
5
6
7
Is an entry fee charged? Yes No
Is there a dance floor? Yes No
If yes, please state the maximum capacity of people on the dance floor area: persons
Functions
Do you carry out any private functions at the club? Yes No
If yes, do you have a separate function room? Yes No
If yes, please provide details:(i.e. type of events held and number of events held per annum)
Are staff present at the functions? Yes No
Are Risk Assessments carried out? Yes No
Is there a written spillage policy in place to help avoid slips and trips? Yes No
Is there an Accident Book? Yes No
Do you arrange activities for children aged below 16 years old? Yes No
If yes, please confirm the type of activities and how frequently they are carried out:
Cooking
Is any cooking carried out at the premises? Yes No
If yes, please confirm whether or not you provide bar meals only or have a separate restaurant:
- - - - - - Please Select - - - - - -
Bar Meals Only
Restaurant Area Only
Bar Meals + Restaurant Area
Not Applicable
Do you carry out Deep Fat Frying? Yes No
If yes, please state type of frying equipment:
- - - - - - - - - - - - Please Select - - - - - - - - - - - -
Shallow Pan Frying (incl. woks & frying pans)
Freestanding-6 litres capacity or less
Freestanding-40 litres capacity or less
Freestanding-More than 40 litres capacity
Full Frying Range
Club Construction Details
Is the property in a good state of repair? Yes No
Construction of Walls (e.g. brick, stone, etc.) :
Construction of Roof (e.g. tile, slate, felt, etc.) :
If there any flat roofing? Yes No
Please confirm percentage Flat Roofing: %
Please confirm the type of flat roofing:(e.g. 'felt/bitumen on wood' or 'concrete flat roof')
Construction of Floors:
Both Wooden And Concrete
All Concrete
All Wooden
Other
Does the property have walls or roofing with any composite panels or combustible linings? Yes No
If yes, please provide details of the core:(e.g. PUR, PIR, Rock Wool, etc.)
Are there any outbuildings? Yes No
If yes, please provide details:(e.g. type of outbuilding(s) and approximate value of the outbuilding(s))
Approximately, what year was the club built? (yyyy)
Is the property a grade listed building?(i.e. grade I, II, etc.)
Not Listed
Grade I
Grade II
Grade II*
Grade A
Grade B
Grade C
In what type of area are the premises situated?(please tick all those that apply) Residential Area Industrial Area Commercial Area Rural Area
Number of storeys:
1
2
3
4
5
5+
If there a cellar or a basement? Yes No
Do you occupy the whole of the premises? Yes No
If no, what parts do you occupy?
If no, what is the occupancy of the other parts?
Is your portion of the premises self-contained with it's own lockable entrance? Yes No
Please indicate the distance to the nearest water:(e.g. 250m from river, canal, lake, coast, etc.)
Has the property ever previously suffered from subsidence or flood damage? Yes No
If yes, please provide details:(i.e. date of damage, amount of damage, type of damage, etc.)
How far are the premises from the nearest full-time Police Station?(e.g. 3 miles, etc.)
How far are the premises from the nearest full time Fire Station?(e.g. 3 miles, etc.)
Heating
Is the property heated only by fixed gas or oil central heating, electric storage heaters, fixed gas or electrical appliances, or other forms of fixed heating and not by any portable heaters? Yes No
If yes, type of heating fuel:
Please Select
Electricity
Gas
Bottled Gas
Heating Oil
LPG
Natural Gas
No Heating
Paraffin
Solid Fuel
Waste Oil
Wood
Please provide details of 'Other' or 'Portable' heating:(i.e. description of 'other' heating or type of portable heaters, e.g. electric fan heaters, etc.)
Number of 'Other' or 'Portable' heaters:
Security
Are all your external doors fitted with a minimum of 5 lever mortise deadlocks (BS3621) or equivalent? Yes No
Are all opening windows fitted with key operated window locks? Yes No
Is the club occupied by a manager or employee overnight? Yes No
Is the club protected by an intruder alarm? Yes No
If yes, is the alarm NACOSS / NSI approved?
Please Select
No
Yes
Not Sure
Method of intruder alarm signalling:
- - - - - - Please Select - - - - - -
Audible - Bells or Siren
Monitored - Central Station
Dialler - To Principal
BT REDCARE - To Central Station
Is the alarm maintained annually? Yes No
Name of installation company of alarm (if known) :
Do you have CCTV at the premises? Yes No
What level of CCTV coverage protects the premises?
Internal Only
External Only
Internal & External CCTV
External Local Authority CCTV
Own CCTV & Local Authority CCTV
Details of CCTV storage:
Live CCTV Only - Not Recorded
Recorded to Hard Disk - At Premises
Recorded to Hard Disk - Off Premises
Cloud Based Recording
How many days is the recording kept for?
Please provide details of any other security arrangements:(e.g. window grilles, etc.)
Is there an A.T.M. (cash machine) on the premises? Yes No
Fire Precautions
Do the premises have fire extinguishers to scale that are serviced annually? Yes No
Is a fire alarm fitted at the premises? Yes No
Does the fire alarm include 'break glass' boxes in all parts of the premises? Yes No
Does the fire alarm include automatic fire detection?(i.e.smoke detectors) Yes No
Is the fire alarm connected to a central station for monitoring? Yes No
Is there a sprinkler system in the club? Yes No
If yes, please provide details:
- - - - - - - - - - Please Select - - - - - - - - - -
Yes-Specification Unknown
Yes-28th Edition
Yes-29th Edition
Yes-BS 5306
Yes-BS EN 12845
Has a Fire Risk Assessment been carried out within the last 12 months? Yes No
If yes, who was it undertaken by and what position do they hold within the business?
Is there a current IEE Electrical Certificate?(i.e. within the last 5 years) Yes No
Management of Club
How many years management experience does the owner/manager have in running a club?
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
20+
year(s)
How many incidents have occurred during the last three years resulting in a police visit or warning to the premises?
Do you actively promote employees to become qualified 'First Aiders'? Yes No
What measures are undertaken in the event of injury?
Do you have dedicated glass clearers? Yes No
Licensing
Who is the Licensee of the club?
Has the Licence been transferred during the current period of insurance? Yes No
To your knowledge, has there been any formal objections to the Licence during the last five years? Yes No
If yes, please provide details:
Has the present owner(s) or manager(s) been refused a Licence at any time? Yes No
If yes, please provide details:
Are there any circumstances known to the proposer which might prejudice the continued holding of the licence? Yes No
If yes, please provide details:
Key Security Management
Can you confirm that all keys to final exit door(s), safes and alarms are removed from the premises when closed for business? Yes No
Claims History
Have you, or any other director or partner (in this or any other trading name) suffered any loss or had any claims made against you in the last 5 years? Yes No
If yes, please provide details:(i.e. date of claim, description of claim, amount claimed, etc.)
Level of cover required?
- - - - - - - - - Please Choose - - - - - - - - -
Standard Cover (fire, theft, flood, etc.)
Standard Cover & Accidental Damage
Is terrorism cover required? Yes No
Buildings / Tenants Improvements
Buildings Sum Insured:(including outbuildings, rebuilding architects' fees, removal of debris, etc.)
Do you require cover for subsidence, heave or landslip? Yes No
If you are a tenant, do you require cover for any improvements you have made to the property? Yes No N/A
If yes, please state the sum insured:
Club Contents / Fixtures & Fittings
Electronic / Computer Equipment Sum Insured:(e.g. tills, TV's, etc.)
Gaming Machines / Entertainment Equipment:
All Other Fixtures & Fittings / Contents Sum Insured:
Stock
Wines and Spirits (excluding beer) Sum Insured:
Tobacco, Cigarettes & Cigars Sum Insured:
All Other Stock Sum Insured (including beer/food) :
Deterioration of Frozen Food (if required)
Deterioration of Frozen Food Sum Insured:
Glass Cover (if required)
Fixed External Glass & Signs Sum Insured:
Money
Money Sum Insured:(during working hours / in transit)
£0
£500
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
Money Sum Insured:(out of working hours and in a safe)
£0
£500
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
Money in Gaming Machines Sum Insured:
£0
£500
£1,000
£2,000
£3,000
£4,000
£5,000
£6,000
£7,000
£8,000
£9,000
£10,000
Please confirm your estimated annual carryings of money to the bank:
Is there a safe or safes? Yes No
If yes, make and model of safe (if available) :
Is the safe bolted to the floor? Yes No
Good In Transit
Goods In Transit Sum Insured (if required) :
£0
£500
£750
£1,000
£1,250
£1,500
£1,750
£2,000
£2,500
£3,000
£3,500
£4,000
£4,500
£5,000
Do you require business interruption cover?(i.e. loss of profit following an insured event) Yes No
Please confirm the Annual Gross Profit of the Club:
Please advise the period of time you wish the cover to extend?(allow sufficient time for rebuilding/refurbishing and further time to resume normal trading) 12 months 24 months 36 months
Do you require cover for loss of liquor licence?(i.e. depreciation of the value of the premises) Yes No
If yes, please confirm the sum insured required:
Do you require cover for loss of Book Debts? Yes No
If yes, please indicate the maximum amount of Debit Balances outstanding at any one time:
Public / Product Liability limit of indemnity:
£1,000,000
£2,000,000
£5,000,000
Annual Turnover
Please confirm the Annual Turnover of the Club:(i.e. the total income of the club before deductions)
Employers' Liability Cover (compulsory by law if you have direct employees or use volunteers)
Do you require Employers' Liability cover?(£10 Million limit of indemnity) Yes No
Please confirm total number of manual employees:
Please confirm the total annual wages of manual employees: per annum
Please confirm total number of clerical employees:
Please confirm the total annual wages of clerical employees: per annum
Employers' Reference Number (optional)
Employers' Reference Number (if available) : (e.g. 123/AB12345 or 'Exempt')
Business Legal Expenses Cover (optional)
Is Business Legal Expenses cover required?(£100,000 legal defence costs for contract disputes, employment disputes, VAT investigations, etc.) Yes No
Has the business and/or its directors been involved in any legal dispute, tax investigation or any other court or tribunal action in the last 5 years? Yes No
Please provide details of the dispute including dates:
Directors & Officers Cover (optional)
Is Directors and Officers cover required?(Cover for any 'wrongful act' of a trustee, director or officer) Yes No
Please confirm the limit of indemnity required:
£100,000
£250,000
£500,000
£1,000,000
£2,000,000
£5,000,000
Can you confirm that the company is domiciled in the UK; is privately held; has not raised any funds from external parties; has been in operation for more than 12 months; has its financial statements prepared by a qualified accountant, shows a profit and are not subject to any concerns by the auditors; derives at least 50% of all its turnover from clients within the UK and EU; has not acquired any companies which have increased its total assets by 50% or more; and has no mergers or acquisitions planned and has not had any claims made against it or its directors and is not aware of any circumstances that could give rise to such claim? Yes No
If no, details:
If there is any additional information that you wish to disclose or cover that you wish to include, please provide details:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Cover Start Date / Renewal Date:
Current Annual Premium / Best Quote to Beat: This may help us to get you a better quote
Name of Current / Previous Insurer: e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.