Classes

Personal Details

Name in Full: *

Trading Name:

Company Name:
(fill this box in only, if you have a LTD Company)

Address: *

Phone/Mobile: *

Date of Birth: *

Email: *

Where did you hear about us: *
---From a FriendI was a memberOnlinePart of a GroupEvent OrganisersOther

If not mentioned above, please provide were you heard about us.

Please email or attach an id photo of (yourself) the insured member, the image should be similar to the sample image below.

(Please note: If the photo size is to big the form will not send. Please resize or attach in a separate e-mail to info@iomst.ie).

Photo ID:

Trading Details

1. Please provide full details of your classes / activities. Please include age group of attendees: *

2. Please provide, projected turnover per annum.

3. Do you hold, or have you previously held, Public Liability? * ---YesNo

If yes, please give the name and address of the insurer and the renewal date of the policy.

Name: Expiry Date:

4. Which of the following best describes your business. ---Art ClassesCraft ClassesDance ClassesMusic ClassesEntertainer/Performer ClassesLego ClassesCooking ClassesOther

If not mentioned above or you have more than one type of class, please provide details.
Does your class activities exceed 1.5m in height? ---YesNo
If Yes, what is the maximum height of activities during classes.

5. Please advise the number of classes at any one time.
You many have more than one class a day however, if you have a second class on at the same time you would require 2 classes covered under the policy.

6. 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? ---YesNo
If Yes, what is involved?

7. Location of class(s), please provide name(s).

8. Length of cover required. ---Annual 12 monthsother.

If other, please advise.
9. Date you would like cover to be effected from:? * Please note cover cannot be back dated.
10. Do you have a written Safety Statement/ risk assessment? ---YesNo (If ‘Yes’, please supply a copy.)
Safety Statement:

11. Please confirm the cover required.

Public Liability ---YesNo

Products Liability ---YesNo- Applies automatically to food and drink products only. Are you providing any Food or Drink?

Products Liability is available for other products.
If Product Liability is required, where are your goods sourced from? ---Within the EUUkOutside EU
Please provide full details so this can be considered.

Employers Liability. ---YesNo (not included in cost of Public Liability)
If yes, please state the maximum amount of employees/helpers at any one time. (cover is recommended).

12. Have you ever been convicted/ charged with a criminal offence (excluding motor)? *

---YesNo If yes, please provide details.
13. 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? * ---YesNo If yes, please provide details.
14. Have you suffered any claim or loss (whether insured or not) in connection with Employers, Public or Products Liability over the last 3 years? *---YesNo 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. Other products can be included where agreed by insurers.