* Please state the full legal title of the charity or group:

* Your Contact Name:

* Your Main Contact Number:

Your Evening Contact Number:

Your Mobile Contact Number:

* Your contact e-mail:

* How many years have you been established?:

On what date do you require the insurance to start?

Please specify the main risk address for the charity:
If there are any other locations please go to the end of the form and fill in details of the other locations.

Post Code:

How long have you occupied these premises?

Elsewhere?

Correspondence Address if different:

Post Code:

Web Site:

Your charitable status:

Please select Registered Charity Recognised Charity (Scotland NI) Applying for Charity Status Voluntary Organisation Social Enterprise Community Interest Company Non Profit Company/Organisation

Charity or Company Registration No:

List here the aims of the organisation:

Activities:
Please give full details of all activities undertaken to achieve aims including any high risk activities such as "rock climbing, horse riding or water sports"

Fund raising:
Please give full details as to how funds are raised, including desk based grant applications through to any high risk activities.

Buildings cover required?

Yes No

Rebuilding Sum Insured
Cost of totally rebuilding including professional fees

Location:

Occupied as: *

Construction: *
Multiple selection allowed - press and hold down the Ctrl key

*Walls: Walls built of Brick Stone Concrete Timber Metal sheeting

*Roof: Roofed with Tiles Slates Concrete Flat asphalt roof Roofing felt on timber Thatch

Age of the buildings: *

How long have you occupied the buildings? *

Any outbuildings:

Contents:

Yes No

If contents cover required please complete the questions marked * in the buildings section above

Tenants Improvements Sum Insured
If you do not own the building, but have made it fit for your use

Value of General Contents Fixtures and Fittings:

Computer & Electronic equipment:

Stock:

All Risks:
List here items such as Laptops, projectors, cameras and other items taken out of the premises

Value:

Where used

Select Premises only UK Worldwide

Security Details

Doors:

Windows:

Alarm System including signalling details:

Interruption Insurance

Yes No

Indemnity Period:
How long it will take to get you back to the pre loss position

Select 12 months 18 months 24 months 36 months

Extra Expenses:

Loss of Income:

Gross Profit:

Liability covers:

Select Yes No

It is usual for most policies to include Public Liability

Employers Liability:

Standard Limit is usually £10,000,000

No Yes

Public Liability:
We suggest £2m as a minimum

Select £2,000,000 £5,000,000 £5,000,000 + Not Required £1,000,000

Products Liability: You may require this cover if you sell goods

Select £2,000,000 Not Required £5,000,000 £1,000,000

Property Owners Liability:
Select this if you own buildings.

Select £2,000,000 Not required £5,000,000 £1,000,000

Professional Indemnity: (arising out of advice given)

Select Not Required £250,000 £500,000 £1,000,000 £2,000,000 £3,000,000 £5,000,000 £5,000,000 +

Trustee Indemnity:

Select £250,000 £500,000 £1,000,000 £2,000,000 £3,000,000 £5,000,000 £5,000,000 + Not Required

Total Number of Volunteers Listed:

Number of Active Volunteers at any one time:

Number of Full time employees:

Number of Part time employees:

Total number of Membership:

Number of members who are active in running the organisation:

Gross annual income:

Total gross assets:
Value = fixed and current assets + investments shown in the last balance sheet

Total payroll:

Work away from premises:

Select Yes No

Percentage of work away:

Select Nil Less than 25% 25% to 50% 50% to 75% Over 75%

Manual work away:

Select Yes No

Type of manual work away:

Please detail any youth work in which you are engaged:

Maximum number of children:

Do you have a written child protection policy?

No Yes

Please detail any other activities or community services:

Do you require any additional covers?

Please select below or overtype here additional covers required

Subsidence:

Select Yes No

Terrorism:

Select Yes No

Money + PA Assault:

Transit/working hours:

Safe Limit:

Book Debts:

Frozen Foods:

Goods in Transit:

- no. of vehicles:

Legal Expenses:

Select £50,000 £100,000 Not Required

Loss of Rent:

Motor Policy Excess Protection:

Select Yes No

No. of volunteer drivers:

Personal Accident: Death and Capital Benefits

Select Not Required £10000 £20000

Weekly benefits:

Select Not Required £100 £200

Any other comments or any special requirements:

Existing Insurer

Current Premium and Terms:

5 Year Claims History:

LTU required:

No Yes

Best time to contact: