Entertainers & Performers

Personal Details

Name in Full: *

Trading Name:

Company Name:

Address: *

Phone/Mobile: *

Date of Birth: *

Email: *

If you wish to receive our membership/insurance card you need to email 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 activities: *

2. 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.
---Entertainer/PerformerEntertainer/Performer (inc Fire)Group Entertainer/PerformerDrama/theatre groupChildrens partiesEntertainment/Performance OrganiserEntertainment OrganiserOther

If other, please advise.

5. Will you be providing classes? ---YesNo *
If Yes, please describe the class activities:

Does your class activities exceed 1.5m in height? ---YesNo
If Yes, what is the maximum height of activities during classes.

6. Please advise the number of Entertainers & Performers including you in your performance.
7. Length of cover required. ---Annual 12 monthsother.

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

10. Are any of the following used by you or any members in connection with your business? *

A. Woodworking or power driven machinery or tools? *
YesNo
B. Any heat producing machinery,naked flame, fire or form of incendiary? *
YesNo
C. Blades, knives or other sharp cutting implements? *
YesNo
D. Any other mechanical/electrical plant? *
YesNo
E. Processes involving a noise level in excess of 85 dB(A) ? *
YesNo If ‘Yes’, are noise assessments carried out?
F. Will you be using Asbestos, silica, PCB’s or lead ? *
YesNo If ‘Yes’, are noise assessments carried out?
G. Will you be using Heat (oxyacetylene or similar welding or cutting equipment, blow lamps, blow torches, flamed guns, hot air guns or other heat producing equipment? *
YesNo If ‘Yes’, are noise assessments carried out?

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.