Conference and Exhibition Organisers Insurance Proposal Form

Page 1 of 5

1. General Information

Are you an Insurance Broker or Direct Client*
 Insurance Broker Direct Client
Insurance Broker Company Name
Financial Services Authority Number
Insured Company Name (or Insured Person)*
Contact Name*
Telephone*
Email*
Please state the experience the organiser has for events of this type (for example: 2 years, 10 events)*
What is the name of the event*
Please provide a description of the event*
Has the event been held before?*
 Yes No
If yes how many times?

Has the event ever suffered a loss?*
 Yes No
If Yes please provide details
Please state the name, address and type of venue?*
Is the Venue Indoors, Outdoors or in a Temporary Structure? Please tick all that are appropriate.*
 Indoors Outdoors Temporary Structure
When does your event start (date)?*
When does your event finish (date)?*
When will you begin setting up your event at the venue (date)?*
When will you complete breaking down your event and leave the venue (date)?*
Have all the licences, visas and permits been obtained and are all contractual obligations completed?*
 Yes No
If No please explain.

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2. Liability Insurance

Do you require Public Liability Insurance?*
 Yes No
Please state the required value (or values for multiple quotes)
Please state the estimated attendance per day
Please state the number of stewards that will be used to ensure the safe running of the event
Will the police or a security company be present?
 Yes No
If Yes please expand

Is the Venue a secure site?
 Yes No
Will alcohol be allowed into the Venue?
 Yes No
Will alcohol be on sale at the Venue?
 Yes No
Will there be any celebrities present?
 Yes No
Will any of the following be present at your event: Motorised/Mobile/Water Bound Activities, Arial Displays or Processions, Fireworks or Explosives, Stunts/Racing or any kind of hazardous activity?
 Yes No
If Yes please provide details

Will there be any temporary structures including but not limited to Marques and Tiered Seating) at your Event?
 Yes No
Will you ensure that the erectors of any structures are made responsible for Public Liability insurance and that such insurance has a sum insured at least equal to that requested herein and will you check to ensure that such insurance is current for the event?
 Yes No Not Applicable
Will the any structure be inspected by a Local Authority Surveyor?
 Yes No Not Applicable
Will suitably qualified staff be in attendance to provide First Aid?
 Yes No
Do you require Employers Liability?
 Yes No
If yes please state the activities being undertaken by employees (including casual staff and volunteers)
Please confirm the number of employees including volunteers

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3. Cancellation Insurance

Do you require Cancellation Insurance?
 Yes No

On which basis do you wish to insure? You may request a quotation for both options?

1. Costs, expenses & commitments
2. Loss of revenue (ie. total income including profits)
Is the venue due to undergo any construction or refurbishment work?
 Yes No
Is the event held in conjunction with or dependent upon another event?
 Yes No
Please state the critical factors which the successful holding of the event relies.
Do you require Non Appearance Insurance?
 Yes No
Please provide the Name, Date of Birth, Occupation and Involvement for each person (seperate each with a comma, use a new line for each person)
Please provide details of any previous non-appearance of the above individuals
Are any of the persons to be insured suffering from any physical, psychological or medical conditions, undergoing any form or medical treatment or following any prescribed regime?
 Yes No
If Yes please provide additional information
What allowance has been made for travel delay? Where are the insured persons arriving from and how will they be travelling to the event?

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4. Property "All Risks" Insurance

Do you require Property "All Risks" Insurance?*
 Yes No
Please confirm the items to be insured and their value
If you require insurance to include cash please provide a cash limit
Please confirm where and how cash will be stored, during the event and overnight and how it will be managed during your event.

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5. Final Confirmation

Would you like information on Annual Organisers Insurance to cover multiple events that you run?
 Yes No
I declare that I have never been

1. Bankrupt
2. Disqualified from being a Company Director
3. Involved as an owner, director, or partner with any company that went into receivership, administration, or liquidation
4. Convicted (or charged but not tried) of any criminal offence involving dishonesty of any kind
5. Organising or attending an event where you have suffered a loss

 Yes No
If you have selected no please give details

Declaration

Important Notice

Please note that failure to disclose all material facts (that is those facts an insurer would likely to influence the acceptance or assessment of this proposal) may invalidate the Insurance. If you are in any doubt whether a fact is material you should disclose it. You are advised to keep a record (including copies of letters) of all information supplied to the Insurer for the purpose of entering into the contract of insurance. A copy of the completed proposal form is available on request for a period of 3 months after it’s completion.

Declaration

I / We declare that the particulars and statements given in this Proposal and the information provided are to the best of my/our knowledge and belief complete and true, and I am / We are willing to accept the Certificate of Insurance issued by Worldwide Hole ’N One Ltd on behalf of certain Lloyd’s Underwriters including its terms, conditions, and exclusions.

By ticking this box you agree to the above statements*
 
Name*
Position*
 
 

WorldWide Special Risks is Authorised and Regulated by the Financial Conduct Authority in the United Kingdom.