Club Enquiry Form FTQ - Access Insurance

1 Your Group 2 Insurance Cover
3 Contact Details

Eligibility

The organisation has not:

been refused insurance cover
had cover cancelled
had special terms applied by an insurer

None of the organisation's trustees, directors, partners, management committee etc. have:

ever been convicted of a criminal offence other than motoring offences
ever been declared bankrupt
any unsatisfied County Court Judgement against them
been the subject of a prosecution, or notice of intended prosecution, under any health and safety at work, consumer protection or environmental legislation or investigation in the last three years by the Charity Commission, Revenue & Customs or any other regulatory body,
been the subject of any adverse publicity in the last 3 years, or anticipate being the subject of any adverse publicity in the next 12 months.

Please confirm these statements are true*

I confirm

Your Organisation

Group Name*

Legal entity type*

When was your group formed?*

DD slash MM slash YYYY

Insurance start date

Enter the date you would like your policy to start*

DD slash MM slash YYYY

Income & People

Group Annual Income*

How is your income raised?*

e.g. grants, donations, legacies, activities, retail, membership fees, rental income, sales

How many members do you have?*

How many volunteers do you have?*

Do you have any staff?*

How many full time staff?

How many part time staff?

Total wage roll

Your Activities

What best describes what your organisation does?*

Other type of group

Group Aims & Activities*

If you run fundraising events, what is the maximum attendance?*

Do you undertake any visits or work abroad?*

No: no work abroad
Clerical: trips to attend meetings or conferences
Non-clerical/Non-manual: trips with activities such as visiting projects or communities to review/monitor work
Manual: trips which include manual work, such as building a school

Does anyone undertake any unsupervised work with children or vulnerable adults?*

Risk Management

Please select which of the following risk management policies/measures you have in place. Select N/A if not applicable or leave blank if you are unsure.

Health & safety policy*

Child protection policy*

Vulnerable adults policy*

Manual handling policy*

Lone working policy*

DBS/PVG/Access NI checks*

Accident book*

1 Your Group 2 Insurance Cover
3 Contact Details

History

Have there been any claims or incidents that may give rise to a claim, whether insured or not, within the last five years?*

Are you insured now, or have you ever been insured, for the cover you are looking for under this policy?*

Location

Where do your activities take place?

Where do your activities take place?*

Postcode

9VZ2-JSWC-S4HE-3RNU

DaviDoyle882157

Select an address:

Name/Number and Street Address Line 2 Town/City County

Employers (Volunteers) Liability*

Trustee Indemnity*

Sum Insured*

Professional indemnity*

Sum Insured*

Legal Expenses*

Sum Insured*

Portable Equipment*

Sum Insured*

What portable equipment will be covered?*

Other covers required

1 Your Group 2 Insurance Cover
3 Contact Details

Contact Details

First name*

Surname*

Mobile Phone Number*

Alternative Contact Number

Email*

How did you hear about us?*

Receive occasional emails with insights and resources on risk management

Note: By submitting this quote request you allow for Access Insurance to process your data in accordance with their privacy policy

Club Insurance Quote

You face unique risks, so we build specific policies – you’ll only pay for the cover you need.

Step 1 of 3

Eligibility

Your Organisation

Insurance start date

Income & People

Your Activities

Risk Management

History

Location

Where do your activities take place?

Contact Details