About You
Contact Name
Telephone Number
Email
Company Name
Postcode
Charity Name/Number
Line 1
Line 2
Town
Registered Charity Number
Where is funding obtained?
Number of staff?
Number of volunteers?
Cover Details
Date Charity Established
If this is a new company, what is experience and qualifications in the care, health and social work industry are held by yourself or other managers?
When is your policy due for renewal?
Who is your existing insurer?
Charity Description
Anticipated Income for the coming year - £
Work with Children?
Yes No
Do you require the following covers:
Buildings?
Yes No
All Risks Cover?
Yes No
Business Interruption?
Yes No
Trustees Indemnity?
Yes No
Employers Liability?
Yes No
Public & product Liability?
Yes No
Professional Indemnity?
Yes No
Personal Accident?
Yes No