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Leisure and Activity Insurance

Proposer Information

Name ^*

Address ^*

Eircode ^*

Phone ^*

Email ^*

Risk Information

Business Description ^*

Activities Offered to the Public ^*

Years Trading ^*

Details of Experience / Qualifications or Company History ^*

Required Covers

Public Liability Limit of Indemnity ^*

Projected Annual Turnover ^*

Do you Require Employers Liability Cover ^*

Material Damage Cover Required ^*

For example: Buildings, Contents, Stock etc..

Building Sums Insured of Property

Contents Sums Insured of Property

Stock Sum Insured

Tenants Improvements

Computer Equipment

Glass

Fire Brigade Charges

Building of Standard Construction

100% built of Brick, Stone, or Concrete and metal clad and is roofed with Tiles, Slates, Concrete, Metal or Asbestos, with no combustible internal panels

Year of Construction ^*

History of Flooding ^*

Evidence of Subsidence ^*

Security Details ^*

5 Lever Mortice Locks
Monitored Burglar Alarm
Bell Burglar Alarm
Shutters or Bars
CCTV

Fire Protection ^*

Monitored fire alarm
Bell Alarm
Smoke detectors
Sprinklers
Fire Extinguishers

Insurance Details

Have you made any Claims in the past 5 years ^*

Currently Insured ^*

Leisure and Activity Insurance

Proposer Information

Risk Information

Required Covers

Insurance Details

Personal

Business

Existing Customers

Company

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