GENERAL AND CONTACT INFORMATION

* Please state the name of the church:

* Your Contact Name:

* Your Main Contact Number:

Your Evening Contact Number:

Your Mobile Contact Number:

* Your contact e-mail:

* How many years has the church been established?

On what date do you require the insurance to start?

Please specify the address for the church:

Post Code:

Correspondence Address if different:

Post Code:

Web Site:

Your charitable status:

Please select Registered Charity Voluntary Organisation Committee for the Time Being Applying for Charity Status Recognised Charity (Scotland NI) Non Profit Company/Organisation

Charity Registration No:

Do you rent, hire (short term), or own your own premises?:

Please select Owned Rented Hired on short term basis

The number of  members in the church:

BUILDINGS

Buildings cover required?

  No Yes - Standard and Accidental damage cover Yes - Standard cover

Rebuilding Sum Insured:
Cost of totally rebuilding including professional fees

Church

Post code

Post code

Do you require stained glass cover in excess of £10000?  If so please state amount required:

Do you require theft of external metalwork in excess of £25000?  If so please state sum insured required:

If No, please specify the construction and which location it applies to:

Age of all the  buildings:

How long have you occupied the buildings?

CONTENTS

Contents:

No Yes - Standard and Accidental damage cover Yes - Standard cover

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

Tenants Improvements Sum Insured:

Value of General Contents Fixtures and Fittings:

Value of Fixed Contents - staging, baptistery etc:

Electronic equipment: computer, audio, video, PA equipment:

Church records, books, communion sets etc:

Musical equipment:

Stock in a bookshop, cafe, community facility run by you:

Contents in Church hall:

Contents in Office or other building:

All Risks:
Cover for items taken out of the premises.

All Risks Value:

Where taken and used:

Select Premises only UK Worldwide

Security Details

Please detail for all locations

Doors:

Windows:

Alarm System including signalling details:

INTERRUPTION INSURANCE

Do you require additional Interruption Insurance?

No Yes

Total cover required if in excess of £25000:

LIABILITY INSURANCE

Normal Standard Liability covers:

Employers Liability £10m; Public, Products and Property Owners Liability £5m.  Options for Trustee and Professional Risks

Please confirm the Level of Public Liability Insurance required:

Please Select £5,000,000 - standard cover £10,000,000

Trustee Indemnity:

Select Not Required £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £3,000,000 £5,000,000

Gross annual income:

Type of manual work away:

 e.g. litter picks, community work - e.g. gardening etc.

Please detail any youth work in which you are engaged:

Maximum number of children at any one time:

Do you have a written child protection policy?

Yes No

Please detail any other activities or community services:

Total number of man hours per week spent on this work:

OTHER COVER AND DETAILS

Subsidence (usually only available if built since 1980):

Select Yes No

Terrorism:

Select Yes No

Money + Personal Accident Assault:

Maximum cash in Transit:

Maximum cash in safe:

Boiler and heating installation: Cover for sudden and unforeseen damage:

Lift or other plant:  Detail make, model, capacity and cost:

Frozen Foods:

Any other comments or any special requirements. Please include any non-standard church activities like exercise classes, firework displays, one off events or conferences:

Are you now or have you previously been insured against any of the risks proposed?

Select Yes No

Existing Insurer and policy number:

Current Premium and Terms:

Details, including cost, circumstances and dates of any loss, damage or liability incurred whether insured or not in the last 5 years:

LTU required:

Select Yes - 5 years Yes - 3 years No

Date of expiry of current  LTU:

Best time to contact: