Quotation Charity Insurance Enquiry Step 1 of 6 16% Basic Charity DetailsName of Organisation*Your Name* MrMrsMissMsDrProf.Rev. Prefix First Last Organisation Status*Non Profit OrganisationRegistered CharitySocial EnterpriseCo-operativeCommunity Interest CompanyCompany Ltd by GuaranteeVoluntary GroupOtherPlease select the option that best describes your constitutionPlease describe the organisational statusRegistered Charity NumberCan you confirm that the statement below is correct?*YesNo (We need to make declarations)Can you confirm that the Proposer and the organisation or any director, manager, partner or trustee of theirs or any person insured or proposing for insurance have never; 1. been convicted, or charged but not yet tried, of any criminal offence other than a motoring offence? 2. been declared bankrupt, disqualified from acting as a company director, gone through insolvent liquidation or been the subject of receivership or an administration order? 3. had an application declined by an insurer, had a renewal declined, or had similar insurance cancelled or made subject to special conditions? 4. been made aware, after enquiry, of any investigation, circumstance or incident that they have reason to suppose might afford grounds for any future claim?Please provide details regarding the above declarationAddress of Premises Used Address Line 1 Address Line 2 Address Line 3 Address Line 4 Postcode Is this address also the correspondence address?YesNoCorrespondence Address Address Line 1 Address Line 2 City County Postcode Email* Phone Number*Year Established*What year was your organisation establishedIs the Organisation Currently Insured?YesNoYour Renewal Date Your Current InsurerWhen Would You Like Cover to Commence? Your Goals and ActivitiesPlease describe the aims of your organisation*Please describe as fully as possible your organisations activities*Please include details of all activities including how often each is undertaken, approximately how many people are involved and the age range of those involvedWill any of your activities ever involve fireworks?*YesNoAre you registered with any regulatory authorities?*YesNoFor example Ofsted or the Care Quality CommissionWhich regulatory authorities are you registered with?Please confirm that there are no outstanding issues with such regulatory authority which might affect your ability to continue to operate and that you anticipate that no such issues will arise within the proposed period of insurance? There are no unresolved or pending objections to any application for, or renewal of, registration You are not aware of any complaints lodged with the regulatory authority in respect of your activitiesYes, I can confirm the aboveNo, I cannot confirm the aboveDo you undertake any higher risk activities?*YesNoExamples of higher risk activities include: Contact sports, adventure activities, archery, ballooning, clay-pigeon shooting, dry slope skiing, gliding, mountaineering, climbing, parachuting, pot-holing, sailing or canoeing, outdoor swimming, abseiling, BMX, mountain biking, winter sports, parkour, BASE jumping, pole climbing, elastic rope activities, motor based activities, hang gliding, flying, equestrian activities, animal rides, jet skiing, raft racing, white water activities, water skiing, diving, quad biking, martial arts, paintballing, road rallies, fireworks events, bonfire events, or shooting. If in doubt, click yes and input any activities that may be higher risk.Please provide details of any higher risk activitiesDo your activities ever involve working ‘at height’?*YesNoSome insurers define this as activities more than 3 metres above the ground. Please provide details of work 'at height'Please include details of the activities, who carries them out, how often and what risk assessments and equipment are in place to reduce the risk.Do your activities involve working with power tools, powered machinery or similar?*YesNoPlease provide details of the tools and machinery that your activities involve.Please include details of the machinery or tools, who uses them, the safety equipment in place and how often such activities are undertaken. Are your activities undertaken solely within the UK?*YesNoPlease describe your overseas activitiesAre any of your activities undertaken away from the insured address?*YesNoPlease detail any activities away from the insured addressAre you planning any events?*YesNoPlease describe the events that you are planning to runPlease include the maximum attendance at any event and a description of the types of events you are planning.What will be the maximum total attendance at a single event?How many events will you run this year? Your Income and PeopleYour Annual Turnover*If the exact income is not known, please provide an estimation. Please include all income, including any grants, funding and donationsDoes your organisation have:* --- Employees --- Volunteers --- Members --- None of the Above Employees would include any sub contractors, apprenticeships, work placements, self employed individuals and freelancers.Your Annual WagerollNumber of EmployeesNumber of VolunteersNumber of Members Your Risk ManagementHealth & Safety* --- None of the below --- We have a health and safety policy in force --- We have a nominated health and safety officer --- We provide provide adequate health and safety training to employees and volunteers --- We undertake risk assessments --- We undertake workplace inspections You can select multiple statements that apply to your approach to health and safety.Does your organisation work with children or vulnerable adults?ChildrenVulnerable AdultsBothNeitherDo you work in the service users home?YesNoDo you have a child protection or safeguarding policy in place?Yes - We also update it at least annuallyYesNoAre all volunteers and employees DBS checked?YesNoDo you sell, work upon or supply anything other than free literature or food and drink consumed on your premises?YesNoPlease indicate the income derived from these salesPlease describe the products that you sell or supply The Cover you RequirePublic Liability Insurance£1,000,000£2,000,000£5,000,000£10,000,000We would recommend £5,000,000 for organisations that work with children or vulnerable adultsProducts Liability InsuranceRequiredNot RequiredYou indicated that you supply or sell products and services and. We would recommend that you include Products Liability Insurance.Employers Liability*No cover required£10,000,000You have volunteers in your organisation. Insurers treat volunteers as employees and so Employer Liability insurance is recommended for you.Since you have staff, employers liability insurance is a legal requirement for your group.Professional Indemnity Insurance*No Cover Required£100,000£250,000£500,000£1,000,000£2,000,000£5,000,000Important for organisations that provide professional services or advice.Do you have any contracts in excess of £5,000 in value?YesNoPlease describe the value and the nature of the contractTrustee Indemnity Insurance*No Cover Required£100,000£250,000£500,000£1,000,000£2,000,000£5,000,000Protection for trustees and the management committeeDo you require contents insurance?*YesNoAll Risks CoverPlease indicate the value of items you might regularly remove from your premisesComputer and Electronic EquipmentPlease indicate the value of your computer and electronic equipment cover.StockPlease indicate the value of any stock you might have on the premisesOther Contents (£)Please indicate the value of any other contents that your group ownsDo you require buildings insurance?*YesNoBuilding Sum Insured (£)This should represent the full rebuilding costs which would include professional fees and site clearance costsPlease select any other cover sections that you require --- Legal Expenses --- Business Interruption --- Personal Accident --- Money --- Loss of Rental Income --- Goods in Transit --- Cyber and Data Cover Property and Claim DetailsWhat year was the building constructed?Construction of WallsBrickStoneConcreteMetalTimberOtherConstruction of RoofTileSlateFeltConcreteSheet MetalOtherDoes the building have any flat roofed areas?YesNoWhat % of the roof area is flat?Do final exit doors have 5 lever mortice deadlocks complying with BS3621?YesNoDo all accessible opening windows have key operated locks?YesNoDo you have an alarm system on the building?YesNoDoes your alarm have a signalling mechanism?RedcareDigital CommunicatorCentral Police StationDon't KnowDo you operate a CCTV system for your premises?YesNoDo you have an automatic fire alarm linked to a Central Station and fully maintained fire extinguishers?YesNoDo you live on or adjacent to the premises?YesNoPlease provide any other security details that you feel are relevantShutters or other security featuresHave you made any claims or suffered any losses (of any nature) in the last 5 years?YesNoPlease describe the circumstances of your loss or claimPlease include the date, circumstances and financial lossBefore entering into a contract of insurance, it is your statutory duty to make a fair presentation of your risk. You must disclose all material circumstances about your risk that might affect the judgement of a prudent insurer in deciding whether to accept your risk or not. Should you require additional explanation of what constitutes a material circumstance, please contact us immediately. You must make reasonable enquiries before presenting your risk and ensure that all individuals holding knowledge about the risk have been approached in the compilation of this information. You must complete any proposal forms or fact finds provided to you, honestly, accurately and in good faith. Any deliberate or reckless misrepresentation may involve part or your entire claim being declined and in some circumstances; the Insurer may be entitled to retain your premium whilst avoiding the policy or apply additional terms to your policy.Do you feel that the details you have entered are a fair presentation of your insurance risk?YesNoIf in any doubt, please select no and complete details in the box below.Please detail any additional facts or circumstances.CommentsThis field is for validation purposes and should be left unchanged.