Leisure Proposal Form Shooting Activities

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Quick Qualifying Questions

Just a couple of qualifying questions to save you filling out the entire form if we cannot help.

Are you based outside of the UK? (i.e. Southern Ireland)*
Yes
No
Do you need your insurance to start within the next 7 days?*
Yes
No

Sorry, we are unable to obtain an insurance quote for you at this time.

Great, click next and we can gather some information for your quote.

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Contact and Business Details

Enter your reference/code here, if you have one.
Your Title *
First Name *
Last Name *
Telephone *
Email *
Enter your postcode to select your address *
House name or number *
Trading as? *
Company/Charity Registration Number *
Partners Full Name *
Partners Addresses *
Partner's Telephone Number *
Trading Name *
Business Premises Postcode *
Premises name or number *
Are any of your sites now or previously an MOD (Ministry of Defence) site? *
Yes
No
Do you have a woodland/urban site?*
Yes
No
Business website address *
Which month and year was the business established? *
Is this a new business or start-up?*
Yes
No
Do you have health & safety experience operating this equipment?*
Yes
No
Do you intend to obtain the services of third party health & safety expertise?*
Yes
No
Do you have previous experience in operating this activity?*
Yes
No
Do you have previous experience running a business?*
Yes
No
Please select the activities you undertake?*
Airsoft
Paintball
Laser Tag
Archery Tag
Other
Please describe the activity *
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Public & Employers' Liability

When do you wish your cover to commence? Insurers will not provide a quote beyond 30 days *
Last year's premium? *
Current Insurer? *
Best quote offered so far? *
Quote provider *
Please choose level of public liability required: *
Do you require employers' liability insurance?*
Yes
No

Employers’ liability insurance is a legal requirement if you employ any of the following: full-time - part-time employees/self-employed contractors you hire/temporary staff, apprentices and volunteers/people taking part in work experience or training schemes

Do you have any volunteers or unpaid workers?*
Yes
No
Do you use subcontractors?*
Yes
No
Annual Manual Wage Roll? *
Number of manual full/part time employees? *
Number of Manual Volunteers *
Annual Clerical Wage Roll? *
Number of clerical full/part time employees? *
Number of Clerical Volunteers *
What is your employer's reference number (ERN / PAYE)? *
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Public & Employers' Liability Cont.

ESTIMATED Annual Turnover Split between activities:

Quads/Karts *
Segways *
Paintball *
Laser Tag *
Airsoft *
Team Building *
Clay Shooting *
Other Activities *
Café etc *
Skate Park *
Total
0.00

Health and Safety

Please attach a completed risk assessment *
Drag & Drop Files Here Browse Files
Ratio of marshals to players per activity *
Are you a member of any Trade Association? If Yes, Please State below. *
Do you have a license to sell alcohol?*
Yes
No
Are all activities supervised?*
Yes
No
Minimum age of participants for activities provided? *
Are Pre-game Safety briefings given all times*
Yes
No
Do ALL participants wear protective clothing, Eye Gear, Overalls etc?*
Yes
No
Do you use pyrotechnics?*
Yes
No
Are the pyrotechnics manufactured in the UK?*
Yes
No
Do you have towers on site?*
Yes
No
Height of towers in metres *
Do you have first aid facilities on site?*
Yes
No
Do you have/use an incident log book for minor injuries?*
Yes
No
Are activities fully supervised by a qualified marshals/instructors? *
Yes
No
What materials are used for the barriers? *
Please provide details of what safety arrangements are in place to prevent unauthorized access on to the site, whilst sessions are in operation: *
Do you have a written statement outlining safety procedures for the Participants, and are these shown to the participant before the game?*
Yes
No
Do you have a café/catering trailer on site?*
Yes
No
Do you serve food?*
Yes
No
What type of food do you serve?
Please select*
Hot Food
Hot Drinks
Cold Food
Cold Drinks
Do you have a deep fat fryer?*
Yes
No
If yes, is this*
Free Standing
Fixed Unit
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All Risks Cover

Do you require All Risk cover (Theft, Fire, Damage) for where you store your items?*
Yes
No
Please list the total value of the below items;
Gaming Equipment Value? *
Stock cover value? *
Computers/Electronics Equipment Value? *
Buildings and Contents
Are the buildings constructed of brick, stone, concrete, metal or other non-combustible materials and roofed with slate, tiles, concrete, metal or other non-combustible materials.*
Yes
No
Please describe construction *
Do you have an alarm?*
Yes
No
If yes, what type of alarm is fitted? *
Do you have CCTV*
Yes
No
Has there been any cause of flood at the premises or in the Neighbourhood?*
Yes
No
Please provide details *
Are the buildings occupied solely by yourselves?*
Yes
No
Please describe occupancy *
Are these premises secured by a Minimum of 5 level mortice Deadlock on all externally assessible doors and key operated window locks on all accessable windows?*
Yes
No
Please describe *
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Declaration

I/we agree the information provided in connection with this proposal, whether in my/our hand or not, is true and I/we have not withheld any material facts.

 

I/we understand that non-disclosure or misrepresentation of a material fact will entitle Insurers to void any insurance granted.

 

(A material fact is likely to influence the acceptance or assessment of this proposal by insurers. If you are in any doubt as to what constitutes a material fact you should consult us your insurance broker)

 

I/we understand that the signing of this proposal does not bind me/us to complete the insurance but agree that should a contract of insurance be concluded, this proposal and statements herein shall form the basis of such contract.

 

If any answer has been written by any other person, such person shall for that purpose be regarded as my/our agent and not the agent of the insurer.

 

I/we agree that I/we have read the completed form in full and accept responsibility for the answers.

Have you made any claims or had any claims made against you?*
Yes
No
Please provide details *
Are you aware of any shortcomings that could lead to claims?*
Yes
No
Please provide details *
Are you aware of any loss through employee dishonesty?*
Yes
No
Please provide details *
Ever been declared bankrupt or been a director of a company that has been declared bankrupt or insolvent? *
Yes
No
Please provide details *
Ever been declined or refused insurance cover, had insurance cancelled or had special terms imposed?*
Yes
No
Please provide details *
Been prosecuted in the last 5 years under Health and Safety Legislation?*
Yes
No
Please provide details *
Does the business have any ongoing employee disputes?*
Yes
No
Please provide details *
Your full name *
Your Position *
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Call Us

01702 225400

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Copyright Primo Plc 2018 | All Rights Reserved

Primo plc is registered in England and Wales, Reg No 1008700 at Cumberland House, Baxter Avenue, Southend-on-Sea, Essex SS2 6HZ
Tel: +44 (0)1702 225400

Primo Plc is authorised and regulated by the Financial Conduct Authority.