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Please provide the full name of the individual for whom this policy is proposed.
Please provide the full business or residential address of the individual for whom this policy is proposed.
Please provide the county address for the proposer of this policy.
Please provide the name of the individual that you wish to be contacted in connection with this policy.
Please provide the phone number of the individual that you wish to be contacted in connection with this policy. It should be in international format.
Please provide the e-mail address of the individual that you wish to be contacted in connection with this policy.
Do you need to specify a different risk address:
Choose a timeframe for the policy:
Single is for a particular once off event. Annual relates to organisations that would have an annually renewable policy.AnnualSingle
Choose the event type concerned:
Please select an event type. [ Show List ]
Choose the category of Party:
Please select the type of party this policy will cover. [ Show List ]
Describe your party:
Please provide a very short description of your party.
Please provide the name of the event, for which you want cover.
Does this Event Type Adequately describe your Event:
Please Answer 'No' if there are other activities proposed that are not described by this Event Type.YesNo
Choose the type of Instruction you provide:
Please select the type of Instruction you provide. [ Show List ]
Describe your class:
Please provide a very short description of class.
Choose the category of Club:
Please select the type of club this policy will cover. [ Show List ]
Describe your club:
Please provide a very short description of your club.
How many events do you hold per annum:
Provide outline of annual Event(s):
Outline of each event:
- Number of attendees
- Event Location
- Safety and Risk Reduction measures in place
Event Start Date:
Event End Date:
Policy Start Date:
Policy Cover can be extended beyond the actual event period to allow for set-up and takedown - at no extra charge.
Policy End Date:
Max number of attendees / participants? :
Provide the estimate for the entire attendance for the duration of your event, not per day attendance.
How many years have you been trading/established/qualified:
If you have been trading/established for less than 1 year we will require evidence of your experience in the trade.
Number of people involved in event organising committee:
Please provide current or previous insurer if applicable, if not then please enter "N/A"
What policy start date do you require:
I have read the Dangerous Activities list and I confirm that No dangerous activities will be undertaken:
Please confirm that you are claims free within the last 5 years:
If this is your first insurance, please say yes, because you are claims free.YesNo
Please advise of the nature of your claim(s):
Please provide details on the nature of all claims made in the past 5 years.
Public Liability indemnity limit:
Public Liability covers you, your business or event if you are sued by a third party who has suffered loss as a result of your negligence and where you have a legal liability or duty of care to that third party.€2,600,000 €6,500,000
Please provide your yearly turnover:
Do you Require Employer's Liability:
Employer' Liability Insurance protects you against your legal liability for injury, illness, disease or death of any employee or volunteer under a contract of service with your business.YesNo
No. of Employees/Volunteers:
Please advise us of the number of employees you will employ for the event.
Do any employees engage in manual work:
Manual work is where employee or volunteer is physically assisting with set up / or take down of the event, moving property or equipment, stewarding or anything other than purely clerical or administrative work.YesNo
No. of employees engaged in manual work:
Please advise us of the number of employees that will be engaging in manual work.
Manual Labour Wages:
Cost of Property Maintenance / Repairs:
Other wages being paid:
Information on Other wages:
Please provide details of employees not covered under other categories.
Do you Require Cancellation Cover:
If your event is cancelled due to something beyond your control, we will pay you for your loss of net profit or your irrecoverable expenses, up to the limit you choose. Conditions apply.YesNo
Select the level of Cancellation Cover you require:
€7,500 €15,000 Other
Enter the amount of Cancellation Cover you require:
Is non-appearance cover for individual acts required:
Will your event be held outdoors:
€7,500 €15,000 Other
Do you Require Property Cover:
Property Cover reimburses you for any loss of or damage to your property (or property you are responsible for) either at or whilst travelling to and from your event. Cover also includes loss of or damage to the venue's buildings, fixtures, fittings and machinery.YesNo
Please advise the sum insured you require:
What is the maximum number of participants allowed:
All participants will be over 18 years old:
Is the event being held on public thoroughfares or public lands:
Will food be served:
Do you comply with HACCP standards:
HACCP has seven steps which are set out in the Regulation (EC) No 852/2004 on the hygiene of foodstuffs. At minmum all food business must follow the Basic hygiene pre-requisites and implement a food safety management system appropriate to their business. See www.fsai.ieYesNo
Do all third parties have their own insurance:
Third Party Insurance Details:
Please provide details of the insurance status of all third parties and sub-contractors.
Has the permission of the local authority been sought & granted:
How many Floats will be in the parade:
Is this parade being held in a city or urban centre:
Outline the Principal Activities:
Please describe as best is possible the activities planned to take place at your event.
Will Alcohol be served at the event:
Proposer is a member of A.O.I.F.E:
Is the Policy Proposer a member of the Association of Irish Festival Events?YesNoUnknown
Please provide your Age:
You must be aged 18 or over to obtain cover.
Do you have a formal qualification for this activity:
Do you require Participants to Sign a disclaimer or 'suitability to participate' form:
Maximum Participants in any one class:
Do you have a Child Protection Policy in place:
Are your lights installed by a qualified electrician:
Has the installer adequate Public Liability Insurance & have you recieved copy of same:
Is your property in a good state of Repair:
Is the property Adequately secured when not in use:
How many Member organisations do you have:
Do you require cover for committee organised events:
Organised Event Details:
Please provide details of each event, including venue, no. of attendees etc..
Is your trailer trading from the same location more than 50% of the time:
How many meetings per year do you have:
Does this adequately describe your trade:
Please give us an accurate description of your trade:
What is the approximate population of your town:
Activities will be held on Open Water:
Current number of Club Members:
Health & Safety Statement:
A Health & Safety Statement is required under Section 20 of the Safety, Health and Welfare at Work Act 2005 requires that an organisation produce a written programme to safeguard, the safety and health of employees or third parties. The safety statement outlines the company policy and commitment to safety and health. It should state how the employer will ensure their safety and health, in use of people, materials & equipment and influence how work is done and show how hazards have been identified and the risks assessed and eliminated or controlled.YesNo
Is this mandatory?
A Risk Assessment is a list that an organisation or employer creates and writes down each hazard and what to do about each one. Ultimately, assessing risk means that anything in the workplace or public place that could cause harm to the public or to your employees. It also sets out the magnitude of risk (high, low, med) and identifies whether the risk is acceptable or whether further precautions need to be taken to prevent harm. See www.hsa.ie YesNo
What is the average number of attendees per night:
Does your group conduct any hazardous activity or stunts:
How many houses / residences in your association:
Erection of structures is carried out by bonefide subcontrators with their own insurance:
Structures such as stages or grandstandsYesNoNA
Will there be First Aiders in attendance:
If not applicable, to the best of your knowledge, please select no.YesNo
Are you running your event in conjunction with Local Authority requirements:
Details of Partner:
If different to Proposer Name
Premises Address: (if different)
If different to Proposer Address
Machinery Plant & Contents:
Deterioration of Stock:
Loss or damage to goods in cold storage due to sudden & unforeseen damage or failure of plant
Wines & Spirits:
Cigars, Cigarettes & Tobacco:
Rent Payable per annum:
Rent due to insureds’ Landlord
Including gaming and amusements
Goods in Transit:
Cover for specific items of high value
Give details of Items:
Premises is in good state of repair:
Construction of premises:
Construction from brick, stone or concrete and roofed with slate, tile or concrete are considered standard100% Standard Construction Up to 25% Non-Standard Construction Up to 50% Non-Standard Construction Greater than 50% Non-Standard Construction or Timber
Construction of Outbuildings:
100% Standard Construction Up to 25% Non-Standard Construction Up to 50% Non-Standard Construction Greater than 50% Non-Standard Construction or Timber
Year of Construction:
Number of Stories:
Premises is a listed building:
Listed building grading/status:
Premises has flat roof:
Details of roof construction:
Give detail on the proportion of roof that is flat, its age and construction type
Premises has a dance floor:
Including any area used for dancingYesNo
Any history of flooding in the area:
Please provide details of flooding:
Outline the year and the extent of the flooding including distance from the nearest water course
Proposer occupies whole of premises:
Provide details of other tenants and parts you and they occupy:
Premises is permanently occupied:
If the premises is to be left unoccupied or closed for any period of the year please outline here by selecting 'No'YesNo
Provide details of un-occupancy:
Occupation of other tenants and portion of building occupied
Wiring last checked by electrical contractor:
Electrical Contractor must be qualified and RECI registeredWithin last 5 years Within last 10 years Within last 15 years Within last 20 years 20+ years ago
Break Glass Boxes:
Alarm Bell Only:
Alarm Linked to Station:
5 Lever Mortice Locks:
CCTV to Scale:
NSAI Approved Alarm:
Shutters or Bars:
Multi-point Locking System:
Other Additional Security:
Provide information on additional security
Do you Require Business Interruption:
Estimated Gross Revenue:
The money paid or payable to you for services provided in the course of business at the premises.
Estimated Gross Profit:
The amount by which the turnover plus closing stock exceeds the opening stock and uninsured working expenses
Specify Indemnity Period:
12 Months 18 Months 24 Months 36 Months
Rent Receivable per annum:
Increased Cost of working:
Additional Expenditure reasonably incurred for purpose of avoiding reduction in turnover. Refer to policy wording.
Loss of Licence:
Depreciation in value of interest of insured in premises, or additional costs reasonably incurred due to loss of licence. Refer to policy wording.
Book of Debts:
Covers costs of monies due following loss of damage to accounting books / records.
Do you Require Money Cover:
In Premises during Business Hours:
Deposited in Bank Night Safe:
In locked safe overnight:
Manufacturers limit for storage in the safe. If unknown please leave blank
Estimated Annual Cash Carryings:
Not in the premises and in the custody of a Special Security Carrier
In home of Insured:
In a locked safe of adequate rating
Are there any other facts not covered by this Proposal Form which you consider may be material to this proposal for insurance:
Dublin Address: No 4 Ashtown Business Centre, Navan Road, Dublin 15
Phone: 01 8385604
Main Address: Insurance House, Main St., Carrick on Shannon, Co. Leitrim.
Phone: 0818 91 91 01 Fax: 071 9620411Email: firstname.lastname@example.org
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Joseph G Brady Insurance Ltd Trading As Event Insure is regulated by the Central Bank of Ireland.