Please complete the following Club Enquiry form


General:
Club Name:
Address 1:
Address 2:
Post Code:
Telephone No:
E-mail:
Business description:

Type of Firm: Limited Company
Registered Charity
Other
If 'Other' please specify:
When established:    
Annual Turnover: £
Have you had any claims in the last 5 years: Yes   No
If Yes, please give details:
Premises:
Are premises occupied only by you? Yes   No
Do you have Sports Grounds or Facilities? Yes   No
If Yes, please give details:
Are your premises detached? Yes   No
Non combustible construction? Yes   No
Combustible roof %     
Combustible Linings %
Are fire extinguishers regularly serviced? Yes   No
Do you have a fire alarm? Yes   No
Do you have an intruder alarm? Yes   No

Type of signalling -
Redcare
Other Monitored
Dialler
Bells only
Do you have portable heaters -
In office areas only Yes  
No
Elsewhere Yes  
No
Is your electrical system regularly checked? Yes   No
Do your premises have an IEE Certificate? Yes   No
Sums Insured:
Buildings £
Stock of High Risk Items
(Cigarettes, tobacco, wines, spirits) 		£
Other Stock £
Computers & Electrical Office Equipment £
Other Business Equipment £
12 Months Gross Profit £
Do you require a longer indemnity period?    
Loss of licence indemnity £
Annual amount of cash in transit £
Maximum amount on premises or in transit £
Maximum amount in safe £
Maximum amount in gaming machines £
Number of gaming machines operated by you    
Public Liability limit of indemnity required    
Activities:
Number of employees    
Annual wage roll £
Number of officials    
Total number of members    
Number of active members    
Do you have a written Health and Safety Policy? Yes   No
Do you require Fidelity Guarantee Cover? Yes   No
Limit of indemnity for:-
Steward £
Secretary £
Treasurer £
Do you require Personal Accident cover? Yes   No
Amount of weekly benefit for:-
Officials £
Staff £
Members £
(Leave section blank if part cover required)
Your name: Position: