To obtain a quotation please fill out the form below and click on the 'Submit' button. The information you provide will form the basis for a proposal form and cover issue Where needed help can be obtained dynamically by hovering your mouse over the help icon: Header Assistance  Or you may contact Courtprice Limited on 0121 447 7555. Contact Information: Let us know who is handling the enquiry. First Name   Surname   Position in Club   Email address   Telephone   Mobile   Fax     Information about your business: Club Business Name   Primary trading address: Postcode     Turnover     Number of years trading     Business description:     Note: Public liability cover includes 'bar games' such as Darts, Skittles & Pool. The standard cover will not extend to games or activities such as Angling, Bowls, Tennis & Cricket or contact Sports e.g. Football & Rugby. These all require separate cover for Personal Accident and Public Liability. Similarly events such as Fairs, Fetes & Fireworks require special consideration. Cover is available so please give details of any sports activity or events in the box below:- Construction / Security Are 100% of the premises and outbuildings constructed from brick, stone, or concrete, and roofed with slates, tiles, concrete, metal or asbestos?   Yes No If No then please detail construction type: Does the premises have an operational fire detection system with remote signalling, sprinklers, or a fire suppression system?   Yes No Does the premises have a burglar alarm?   Yes No What type of signalling?   Please select N/A Redcare Central Station Bells Only Is your Property protected by any of the following: local authority cctv, shutters bars or grilles on all accessible windows, manned security overnight or does a member of staff live on the premises?   Yes No Money Cover The standard policy limit for Money on the Premises During Business Hours and cash in Locked Safe Overnight is These limits can be increased subject to a suitable “Thief Resistant” Safe being installed. Please indicate what higher limit you would require Please give details below of the make, model, size & age of the safe(s) you have: Buildings Full Value of Property to be Insured including architects and surveyors fees, and removal of debris Contents Value of Tenants Improvements and All Other Contents Target Stock - Cigarettes, Tobacco, Wines & Spirits Stock (Ex target Stock) Claims and Excess Details How many claims have you had in the last 3 years (for all locations)? What is the total value of all claims submitted in the past three years (for all locations)? Please supply claims details: What level of excess is required?   Please select £500 £1000 £1500 £2000 General Extensions If either Subsidence or Terrorism cover is selected it will apply to all acceptable locations. There is a standard £1500 subsidence excess. Do you require Subsidence cover?   Yes No Do you require Terrorism cover?   Yes No Management Protector What limits do you require for: Employee Dishonesty Please select £5,000 £25,000 £50,000 Loss of Licence / Registration. Cover is automatically provided for: Club Legal Expenses Cover is automatically provided for: Group Personal Accident Option 1 - covers a maximum of 1000 members, 1 full time Steward, 6 part time employees & 12 Committee Members Option 2 - covers a maximum of 2000 members, 2 full time Stewards, 12 part time employees & 24 Committee Members Option 3 - covers a maximum of 3000 members, 3 full time Stewards, 18 part time employees & 36 Committee Members Please select the option you require   Please select Option 1 Option 2 Option 3 Previous insurance and bankruptcy details Has the proposer ever been refused cover, or has an Insurer declined or terminated cover, or insisted on a special condition at any location?   Yes No If YES please advise details Has the proposer, a senior figure in the organisation (Director or Partner), or spouse, been declared bankrupt, or entered into any arrangement with creditors; been prosecuted under any Health & Safety regulations, the Consumer Protection Act, or any other statutory regulations; or have any CCJs, criminal convictions, or prosecutions outstanding?   Yes No If YES please advise details Third Party Interests Please advise details of any third party, such as a bank or mortgage lender, whose interest needs to be noted on the policy. Additional Information Please provide any additional Information that you feel will support this presentation or to expand on earlier answers. Date Cover Required From Cover Expiry Date (Normal policy term is 12 months) Target Premium Click on the submit button to send this form elecronically to Courtprice Limited. In doing so, you voluntarily choose to provide personal details to us via this website. Personal information will be treated as confidential by us and held in accordance with the Data Protection Act 1998. You agree that such personal information may be used to provide you with details of services and products in writing, by email or by telephone. If you prefer to fax the form to us, click the printer icon below: and fax to us on 0121 447 7556 Courtprice Limited is Authorised and regulated by the Financial Services Authority.