Full Name of the Club

Correspondence Address




Post Code


Address of Main Premises to be Insured  





Post Code

Contact Telephone Number

Fax Number


Contact E-mail Address


 Name of Current Insurer

Date cover to commence

Please describe fully all sporting activities carried out at the club

General Questions/Club Activities

If you answer "YES" to any of the above questions, please supply additional information in the box below

Asset Protection & Theft: Tick if this cover is required

Are the buildings and ground which you occupy

Business All Risks: Tick if cover required

Specified Items – Items usually kept in the open or likely to be taken away from the Club Premises can be insured on an All Risks Basis as a specified item.

Goods in Transit Tick if cover required

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.

Money and Assault : Tick if cover required

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.

Glass : Tick if cover required

Frozen Food : Tick if cover required

Business Interruption : Tick if cover required

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.

Cover is included for loss of trading profit for up to 12 months from the date of damage at your premises which causes business interruption, provided we accepted a claim for such damage under the Contents or Buildings Sections of the policy.

Loss of Licence : Tick if cover required

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.

General Liability : Tick if cover required

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.
Note: For Terrorism, limits will be restricted to £5,000,000 (Employers’ Liability) and £2,000,000 (Public and Products Liability)

Personal Accident : Tick if cover required

Persons Insured – Club Members whilst
1. playing cricket as a member of the club team or any representative team under the recognized rules of cricket and under the control of an umpire.
2. taking part in cricket practice including net practice under club arrangements.
3. performing official duties as an umpire or scorer in any match played by the club.
4. traveling as a member of a team (other than by motorcycle) under club arrangements to and from away matches.
5. involved in routine maintenance of the grounds and buildings.
Aged 65 or under

Note: Cover is also provided for the breakage or damage to Dentures and Spectacles whilst playing or
officiating in any one match up to a limit of £500 in any one claim, subject to the first £25 being excluded.
Note: Under 16’s – Death, loss of limb(s) or eye(s) or Permanent Total Disability is restricted to £2,500
Note: For persons not gainfully employed the benefits are limited to 50% of the normal benefit payable
Note: Up to 20 units are available in respect of Temporary Disablement.

Commercial Legal Expenses : Tick if cover required

(This Section is underwritten by DAS Legal Expenses Insurance Company Limited)

The Das Commercial Legal Protection policy offers comprehensive cover in all the main areas where legal disputes may arise including the following:

Employment Disputes and Compensation Awards
Statutory Licence Protection
Contract disputes
Property Protection
Bodily Injury
Tax Protection
Attendance Expenses
24 hour helpline services and much more

Limit Provided: £100,000

Other Requirements : Tick if cover required

Please use the submit button below the rest of the proposal form

Minimum Security Condition
1. Final exit doors are to be secured as follows
(a) Timber doors – by mortice deadlocks having five or more levers or conforming to BS3621 with matching boxed striking plate
(b) Aluminium doors – by cylinder mortice lock operating a swinging lock bolt
(c) PVCu doors – by key operated multi-point locking devices having three or more locking points
(d) the first closing leaf of double leaf doors must be fitted internally with bolts top and bottom
(e) When the Premises are closed for business ALL locks fitted to final exit doors must be put into effect.
2. All other external doors and internal doors leading to common areas or other premises are to be secured:
(a) By the means set out in (1) or
(b) by key operated security bolts fitted top and bottom
3. All opening windows or rooflights accessible from the ground or via roofs, pipework or other structures are secured by key operated locking devices or screwed permanently shut.
4. Any security measures stipulated or agreed by Insurers in writing.

If you have a Complaint
We hope that you will be very happy with the service that we provide. However, if for any reason you are unhappy with it, we would like to hear from you. In the first instance, please write to your Insurance Adviser or us at Meadons Insurance Brokers Limited, 11 Cheshire Street, Market Drayton, Shropshire, TF9 1PD or telephone us on 01630 658455.

Meadons Insurance Brokers Limited and Norwich Union are covered by the Financial Ombudsman Service for complaints from private individuals, certain small businesses, charities and trusts. If you have complained to us and we have been unable to resolve your complaint, you may be entitled to refer it to this independent body. Following the complaints procedure does not affect your right to take legal action. Further details of our complaints procedure can be found in your policy booklet.

Telephone Call Recording

Choice of Law
The appropriate law as set out below will apply unless you and the insurer agree otherwise:

1. The law applying in that part of the UK, Channel Islands or Isle of Man in which you normally live or (if applicable) the first named policyholder normally lives; or
2. In the case of a business, the law applying in that part of the UK, Channel Islands or Isle of Man where it has its principal place of business; or
3. Should neither of the above be applicable, the law of England and Wales will apply.

Data Protection – Information Uses
For the purposes of the Data Protection Act 1998, the Data Controller in relation to any personal data you supply is Aviva Insurance Limited.

Insurance Administration
Information you supply may be used for the purposes of insurance administration by the insurer, its associated companies and agents, by reinsurers and your intermediary. It may be disclosed to regulatory bodies for the purposes of monitoring and/or enforcing the insurer’s compliance with any regulatory rules/codes. Your information may also be used for offering renewal, research and statistical purposes and crime prevention. It may be transferred to any country, including countries outside the European Economic Area for any of these purposes and for systems administration. In assessing any claims made, the insurer or its agents may undertake checks against publicly available information (such as electoral roll, county court judgments, bankruptcy orders or repossessions). Information may also be shared with other insurers either directly or via those acting for the insurer (such as loss adjusters or investigators).

In the case of personal data, with limited exceptions, and on payment of the appropriate fee, you have the right to access and if necessary rectify information held about you.

Credit Searches and Accounting
In assessing your application, the insurer may search files made available to it by credit reference agencies who may keep a record of that search. The insurer may also pass to credit reference agencies information it holds about you and your payment record. Credit reference agencies share information with other organisations, enabling applications for financial products to be assessed or to assist the tracing of debtors to prevent fraud.

The insurer may ask credit reference agencies to provide a credit scoring computation. Credit scoring uses a number of factors to work out risks involved in any application. A score is given to each factor and a total score obtained. Where automatic credit scoring computations are used by the insurer, acceptance or rejection of your application will not only depend on the results of the credit scoring process.

Sensitive Data
In order to assess the terms of the insurance contract or administer claims which may arise, the insurer may need to collect data which the Data Protection Act defines as sensitive (such as medical history or criminal convictions). By proceeding with this application you will signify your consent to such information being processed by the insurer or its agents.

Marketing
Aviva group and its agents may use your information to keep you informed by post, telephone, e-mail or other means about products and services which may be of interest to you. Your information may also be disclosed and used for these purposes after your policy has lapsed. If you do not wish your information to be used for these purposes please write to Norwich Union, FREEPOST, Mailing Exclusion Team, PO Box 6412, Derby DE1 1SB.

Fraud Prevention and Detection
In order to prevent and detec fraud we may at any time:
Share information about you with other organisations and public bodies including the Police;
Undertake credit searches and additional fraud searches;
Check and/or file your details with fraud prevention agencies and databases, and if you give us false or inaccurate information and we suspect fraud, we will record this.

We can supply on request further detailsof the databases we access or contribute to

We and other organisations may also search these agencies and databases to:
Help make decisions about the provision and administration of insurance, credit and related services for you and members of your household;
Trace debtors or beneficiaries, recover debt, prevent fraud and to manage your accounts or insurance policies;
Check your identity to prevent money laundering, unless you furnish us with other satisfactory porof of identity.

Claims History
Under the conditions of your policy you must tell us about any Insurance related incidents (such as fire, water damage, theft or and accident) whether or not they give rise to a claim. When you tell us about an incident we will pass information relating to it to a database.
We may search these databases when you apply for insurance, in the vent of any incident or claim, or at time of renewal to validate your claims history or that of any person or property likely to involved in the policy or claim.

You should show these notices to anyone who has interest in the insurance under the policy.

State any other material facts here. Failure to do so could invalidate the policy. A material fact is one which is likely to influence an insurer in the assessment and acceptance of the proposal. If you are in any doubt as to whether a fact is material it should be disclosed to the insurer.




Important – Disclosure

All material facts must be disclosed. Failure to do so could invalidate the policy. A material fact is one which is likely to influence an insurer in the acceptance and assessment of this application. If you are in any doubt as to whether a fact is material then it should be disclosed to the insurer. If any changes in circumstances arise during the period of insurance cover please provide your insurer with details.

A specimen copy of the policy wording is available on request. We recommend you keep a record (including copies of letters) of all information provided to the insurer for your future reference. A copy of the completed application form will be supplied on request within a period of three months after its completion.

Declaration:

I/We understand the contents of this completed application and I/we declare that the information given is, to the best of my/our knowledge and belief correct and complete.
I/We agree that the statements in this application shall form the basis of the contract between the insurer and myself/ourselves and if the risk is accepted I/we undertake to
pay the premium when called upon to do so. I/We understand that my/our information may also be disclosed to the General Insurance Standards Council and other regulatory
bodies for the purposes of monitoring and/or enforcing the insurer’s compliance with any regulatory rules/codes.

Proposer's Name

Proposer's Position

Date

Note – cover will not be in force until the Proposal has been accepted by the Company except to the extent of any official Cover Note which it may issue.

Aviva Insurance Limited, Registered in Scotland, No 2116.
Registered Office: Pitheavlis, Perth PH2 0NH. A member of the Aviva group.
Authorised and regulated by the Financial Services Authority