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    * Required

    Personal Details




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




    *



    Trading Details

    Please include age group of attendees: *

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

    Name: Expiry Date:

    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?
    If Yes, what is the maximum height of activities during classes.


    You may 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.


    If Yes, what is involved?



    .

    If other, please advise.

    * Please note cover cannot be back dated.
    (If ‘Yes’, please supply a copy.)
    Safety Statement:

    Public Liability

    Products Liability - 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?
    Please provide full details so this can be considered.

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


    If yes, please provide details.
    If yes, please provide details.
    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.

    I/we declare that the statements and particulars given in this proposal are, to the best of my/our knowledge and belief, true and complete and that this proposal will form the basis of my/our membership of IOMST.*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.