Leisure Proposal Form Shooting Activities

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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 *

Confirm Email **

Postcode*

Address*

Trading As?*

Company Registration Number*

Charity Registration Number*

Company Registration Number*

Name of Partners*

Partners Address*

Partners Telephone Number *

Partner's Full Name*

Partner's Address*

Partner's Telephone Number*

Trading Name*

Business Premises Postcode*

Business Address*

Are any of your sites now or previously an MOD (Ministry of Defence) site? *

Yes

Do you have a Woodland or Urban Site? *

Yes

Business Website Address*

What year was the business established?*

Is this a new business or start-up?*

Yes

Do you have health & safety experience operating this equipment?*

Yes

Do you intend to obtain the services of third party health & safety expertise?*

Yes

Do you have previous experience in operating this activity?*

Yes

Do you have previous experience running a business?*

Yes

Please attach a copy of a completed risk assessment*

Drag & Drop Files Here Browse Files

Please select the activities you undertake?*

Airsoft

Paintball

Laser Tag

Archery Tag

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Public & Employers' Liability

When do you require your cover to start?*

Last year's premium?*

Current Insurer*

Please choose level of public liability required: *

Do you require employers' liability insurance? *

Yes

Do you have any volunteers or unpaid workers? *

Yes

Do you use subcontractors? *

Yes

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)? *

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

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Public & Employers' Liability Cont.

ESTIMATED Annual Turnover Split between activities:

Quads/Karting £ *

Segway’s £ *

Paintball £ *

Laser Tag £ *

Airsoft £ *

Team Building £ *

Clay Shooting £ *

Other Activities £*

Café etc £ *

Skate park £ *

Total £*

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

Are all activities supervised?*

Yes

Minimum age of participants for activities provided?*

Are Pre-game Safety briefings given all times*

Yes

Do ALL Participants wear protective clothing, Eye Gear, Overalls etc?*

Yes

Do you use pyrotechnics?*

Yes

Are the pyrotechnics manufactured in the UK?*

Yes

Do you have towers on site?*

Yes

Height of towers in metres*

Do you have first aid facilities on site? *

Yes

Do you have/use an incident log book for minor injuries? *

Yes

Are activities fully supervised by a qualified marshals / instructors? *

Yes

What materials are used for the barriers?*

Please give full details as to 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

Do you have a café/catering Trailer on site?*

Yes

Do you serve food?*

Yes

If you serve food, what type?

Hot food*

Yes

Hot drinks*

Yes

Cold food*

Yes

Cold drinks*

Yes

Do you have a deep fat fryer? *

Yes

If yes, is this *

Freestanding

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

Please list the total value of the below items;

Gaming Equipment Value? *

Stock cover value?*

Computers/Electronics Equipment Value? *

Buildings and Security

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

Please describe construction*

Do you have an alarm?*

Yes

If yes, what type of alarm is fitted? *

Do you have CCTV*

Yes

Has there been any cause of flood at the premises or in the Neighbourhood? *

Yes

Please provide details*

Are the buildings occupied solely by yourselves? *

Yes

Text Area*

Are these premises secured by a Minimum of 5 level mortice Deadlock on all externally assessable doors and key operated window locks on all accessable windows?*

Yes

If 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 one likely to influence 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

Please provide details*

Are you aware of any shortcomings that could lead to claims?*

Yes

Please provide details*

Are you aware of any loss through employee dishonesty? *

Yes

Please provide details *

Ever been declared bankrupt or been a director of a company that has been declared bankrupt or insolvent? *

Yes

Please provide details *

Ever been convicted of or charged with (but not yet tried) or been given an official police caution in respect of any criminal offence other than a motoring offence?*

Yes

Please provide details *

Ever been declined or refused insurance cover, had insurance cancelled or had special terms imposed?*

Yes

Please provide details *

Been prosecuted in the last 5 years under Health and Safety Legislation? *

Yes

Please provide details *

Does the business have any ongoing employee disputes?*

Yes

Please provide details *

Your Full Name*

Your Position*

Submit

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Leisure Proposal Form Shooting Activities

Contact and Business Details

Public & Employers' Liability

Public & Employers' Liability Cont.

ESTIMATED Annual Turnover Split between activities:

All Risks Cover

Please list the total value of the below items;

Buildings and Security

Declaration

Call Us

01702 225400