Market Organiser

Personal Details

Name in Full: *

Trading Name:

Company Name:

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.

Trading Details

1. Please list the name(s) of the market(s) organised by you include day of market and location: *

2. Please advise the number of markets organised/ operated by you.(per year): * ---Once off marketWeekly marketsMonthly marketsAnnual MarketOther *
If other, Please give details.

3. Please advise the maximum number of traders at any one market: *
4. Please advise the Maximum attendance at any one time (customers):
5. Which of the following best describes your Market. * ---General MarketFood MarketCraft MarketFarmers MarketFairCountry MarketCar-Boot SalesOther

If other, please advise.
6. Length of cover required: ---1 Day2 DayAnnualOther
If you know the date you would like cover to be effected from, please advise. Please note cover cannot be back dated.

Liability Details

1. 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:
2. 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).

Other Details

1. Will your market be located on private or public grounds? * ---privatepublic
2. Has permission or a licence been granted? ---YesNoNot Yet
3. Have provisions for First Aid been made? ---YesNo
4. Please advise the number of Stewards/Helpers provided.
5. Have you prepared a Safety Statement? ---YesNo

6. Have you appointed a Market/event Safety Officer? ---YesNo
7. Do you use a professional security company to provide crowd control, stewarding/security? ---YesNo

If yes, please give details.

Amusements & Attractions

1). Is there a funfair forming part of your market? ---YesNo *

2). Is there any mechanical rides forming part of your market? ---YesNo *

3). Is there any bouncing castles forming part of your market? ---YesNo *

4). Is there any Alcohol forming part of your market? ---YesNo *

If yes, please note that the above are not covered by this proposed insurance. If any of the above will be provided at your market/event we would require insurance certificates from the owners and engineers report for each ride/attraction.

Declaration

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