Details
1. Please provide full details of your classes / activities:
2. Do you hold, or have you previously held, Public Liability? —Please choose an option— Yes No
If yes, please provide the name and address of the insurer and the renewal date of the policy.
Name:
3. Which of the following best describes your business.—Please choose an option— Art Classes Craft Classes Dance Classes Music Classes Entertainer/Performer Classes Lego Classes Cooking Classes Other
If not mentioned above or you have more than one type of class, please provide details.
3(b). Does your class activities exceed 1.5m in height? —Please choose an option— Yes No
4. Please advise the number of classes at any one time.
5. Please confirm if, your class/workshop activity involves participants using power tools, sharp bladed implements, hazardous materials (i.e. acids) or involve the use of heat/naked flame? —Please choose an option— Yes No
If Yes, what is involved?
6. Location of class(s), please provide name(s).
7. Length of cover required. —Please choose an option— Annual 12 months 6 weeks 4 weeks 5 days 3 days 2 days 1 day
8. Date you would like cover to be effected from:?
9. Do you have a written Safety Statement/ risk assessment? —Please choose an option— Yes No
Declaration
10. Please confirm the cover required.
Public Liability —Please choose an option— Yes No
Products Liability – food and drink products only —Please choose an option— Yes No
Product Liability for none Food Products (available only with Public Liability)
Non-food Products Liability – available for other products. Please provide full details so this can be considered.
Employers Liability (not included in cost of Public Liability) —Please choose an option— Yes No
If yes, please state the maximum amount of employees/helpers at any one time. (cover is recommended).
1. Have you ever been convicted/ charged with a criminal offence (excluding motor)? —Please choose an option— Yes No
If yes, please provide details.
2. Has any insurer ever declined a proposal, cancelled or refused renewal or required special terms on any of the insurances for which you are now proposing? —Please choose an option— Yes No
If yes, please provide details.
3. Have you suffered any claim or loss (whether insured or not) in connection with Employers, Public or Products Liability over the last 3 years? —Please choose an option— Yes No If yes, please provide details.
Our limit of indemnity for Employers Liability is € 13,000,000.Our limit of indemnity for Public or Products Liability is € 13,000,000.Products Liability €13,000,000 automatically applies to food and drink.
*Please Agree to Proceed
I/we confirm that I/we am/are giving my/our permission for the information we provided in this form to be used for the purposes set out in the Data Protection section https://www.iomst.ie/iomst-privacy-policy .
Please note that the details you are being asked to supply may be used to provide you with information about other products and services from third parties. The fact that you choose not to receive such information will not affect any aspect of the facilities that are provided to you now or in the future.
Please note:
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