Club Cricket Cover Form - Mead Sport Insurance: Sport, travel and liability insurance cover for sports people, federations, associations, clubs and events

please call us for a quote on FREEPHONE 0800 0850 261

Please complete this form and click Submit

Name of Club
Contact Telephone Number
Contact Name and Position
Email Address:
Contact's Address
Club's Post Code
Current Insurers
Renewal Date
Current Premium
SUMS INSURED/LIMITS REQUIRED Please show split in sums insured below
PROPERTY MATERIAL DAMAGE
Please show here the % DAY ONE uplift if required
Clubhouse £
Clubhouse Contents, Fixtures/Fittings £
Irrigation System £
Freezer/Refrigerated Stock £
Other Stock excluding Bar/Cellar Stock £
Bar/Cellar Stock £
Computers including Software £
1: Damage to Squares/Pitches £
2: Damage to Synthetic Pitches £
Private Dwellings if any £
1: Plant, Machinery £
2: Sightscreens £
3: Coverss/Nets £
Cups, Trophies, Pictures Total £
Cups, Trophies, Pictures Max any Item £
Money in Safe Limit £
Metered Water £
Personal Effects - Club Members £
Personal Effects - Club Officers/Employees £
Glass Sum Insured to include Windows, Sanitary ware, Signs etc £
BUSINESS INTERRUPTION ***
Gross Annual Profit £
Indemnity Period - Number of Months Required
Book Debts £
EMPLOYERS and PUBLIC/PRODUCTS LIABILITY
Annual Wage Roll Administration etc £
External £
Employers Liability to a Limit of £10 million required?	YES NO
Public Liability to a limit of [please tick]	£2,000,000 or £5,000,000
Whether or not you require Business Interruption * cover please provide Total Annual Turnover £**
split between Subscriptions £
and all other income including Match Fees £
Motor Third Party Liability [Road Traffic Act Cover]
Is cover required for licensed motorised items such as tractors, mowers etc?	Yes No
If YES how many items are to be covered
General Information Please give details of construction of all Buildings to be insured
Clubhouse
Groundsman's Outbuildings
Any Private Dwellings
Security System Details
	Audible Only Central Station Digicom Redcare CCTV DualCom Paknet Shutters other
Alarm Company Name
NACOSS Approved?	YES NO
Are the Outbuildings connected to the central alarm system?	YES NO
Does anyone live permanently in the Clubhouse?	YES NO
Does anyone live permanently elsewhere on the Ground?	YES NO
Do all external doors have 5 lever Mortice deadlocks?	YES NO
Do all exterior Windows have key operated locks?	YES NO
Do all exterior Windows have shutters?	YES NO
Does the Clubhouse have any flat roofs?	YES NO
If YES what %
GENERAL SECURITY INFORMATION AND HISTORY Please advise if you have had any experience in respect of the following and if so give details
Vandalism	YES NO
If YES, give details
Flooding	YES NO
If YES, give details
Subsidence	YES NO
If YES, give details
CLAIMS HISTORY
Please give details of any claims or incidents that could have led to a claim during the LAST FIVE YEARS. Please include details of any outstanding claims or recent incidents that could lead to a claim
CLUB DETAILS Number of elevens
Saturday
Sunday
Midweek
Ladies
Colts
Veterans
Please insert the name of the league you participate in
Please insert the number of sides you participate with
How many Adult playing members do you have?
How many Colts playing members do you have?
How many others, non playing members do you have?
Do you share your ground?	YES NO
If YES, give details
Other Uses. Our Premises are used by NON Members for activities such as weddings, Parties etc	YES NO
If YES, please give details
Additional Insurance Requirements. Please state below if there are any other Benefits not mentioned above that you would like included in your insurance cover
Do you have any stands or floodlights that require insurance?	Yes No
If YES please advise the relevant Sums Insured
Do you require any Gym Equipment insured?	Yes No
If YES please advise the relevant Sum Insured
Do you require Increased Cost of Working insured?	Yes No
If YES please advise the relevant Sum Insured
When providing details of your Annual Wage Roll please split the figure as follows:
Clerical/Administration £
Bar Staff/Steward/Waiters etc £
External Staff £
Show below the ages of all Buildings to be insured
Have you had any experience, during the past five years, of Fllods or Subsidence?	Yes No
If YES please give details
Do you require Terrorism cover?	Yes No
Do You require Engineering Inspector?	Yes No
If YES please give detail of items to be coverered [If YES this will require a separate Proposal Form being acceptable to the Underwriters]
Do you require Directors and Officers/Club Officials Indemnity cover?	YES NO
(this cover will require a separate proposal Form being acceptable to Underwriters) Limit Required	£100,000 £500,000 £1,000,000
Do you require Fidelity Guarantee cover - available up to £50,000	YES NO
If YES please indicate how many members of Staff are to be covered
The information provided will be dealt with strictly under the Terms of The Data Protection Act 1998. We thank you for providing us with the opportunity of offering terms for your insurance requirements.
Once we have received the completed Form we will acknowledge immediately and will provide terms within 5 working days. We are only at the quotation stage and completion of this Form does not mean that any cover is in place or that terms for insurance have been agreed by either party.

Specialist Insurance Brokers

MEAD Sport and Leisure Limited
FREEPHONE: 0800 0850 261 - PO Box 1035, Smallburgh, Stalham, Norwich, NR12 9ZL - Fax: 01692 535452
E: ask@sportsinsurancemead.com - W: www.sportsinsurancemead.com

Mead Sport and Leisure Limited has been authorised by The Financial Services Authority FSA to carry out regulated activities as an appointed representative of
Golfguard Limited FSA Firm Reference Number 310410