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Contact name
Company name
Telephone number
Email address
Business address
Town
Postcode
Trade description
—Please choose an option—GymSupervised GymPartly Supervised GymUnsupervised GymPersonal training studioOther (please detail)
If 'Other', please detail explicitly
What is the insured’s trading type?
—Please choose an option—Ltd CompanyPartnershipSole Trader (T/a)Other
If 'Other', please detail
Website
When did you start trading?
Policy due date
Who are you currently insured with?
What is your current insurance premium?
Have you had any claims in the last 5 years?
—Please choose an option—YesNo
If 'Yes', details (dates, incidents, amounts)
Facilities available (tick all that apply)
Sports or fitness related instruction/ classesGymnasium - Free Weights, Exercise Machines, Treadmills other Cardio Machines and the alikeBoxing / Martial ArtsSwimming poolsSauna or steam room or the alikeMassage, hair, beauty, cosmetic treatments or other therapiesSpray tanningSunbeds/solariumsSale of sports nutrition supplements
Other facilities
Do you allow anyone under the age of 16 years to use the facilities?
—Please choose an option—YESNO
If 'Yes', please provide further details including minimum age and what equipment & activities they use
Do you provide coaching & tuition such as personal training & classes?
—Please choose an option—YES - by owners/directors and/ or directly employed trainers / instructors onlyYES - by 3rd party self-employed sub-contractors onlyYES - by owners/directors and/ or directly employed trainers / instructors AND 3rd party self-employed sub-contractorsNO
SUMS INSURED – If NEW VENTURE, PROVIDE ESTIMATES
Buildings
Subsidence cover required?
Tenants Improvements
Computers/electronic business equipment
Contents, fixtures & fittings
Stock
Wines, spirits & beers
Frozen/refrigerated stock
Glass
Signs & canopies
Money (business hours)
Money (in safe outside business hours)
Type of safe
—Please choose an option—No Safe on PremisesSafe Installed per Manufacturer Instructions
Goods in transit
Business interruption period
—Please choose an option—0 Months12 Months18 Months24 Months36 Months
Public liability limit
—Please choose an option—£1,000,000£2,000,000£5,000,000£10,000,000
Your annual turnover
Annual staff wageroll (clerical/administrative/directors only)
Annual staff wageroll (directly PAYE employed trainers/instructors)
Do the premises have an intruder alarm?
—Please choose an option—NOYES - Bells / Audible OnlyYES - Digital Communicator Keyholder AlertYES - Central Station Monitored Exc Police ResponseYES - Central Station Monitored Inc Police Response
Is frying equipment used?
Notes (optional)
DECLARATION
You or any director or partner in any business, any partner in any partnership, any director of any company, or the company; either in any personal capacity, in the name of the business proposed or in respect of any other business in which any of you have ever had an interest have:
- Never had a proposal for insurance declined, cancelled or refused; - Never had insurance cancelled mid-term, a renewal refused, increased or special terms or conditions imposed by an insurer; - Never been given an official police caution, convicted of, charged (but not yet tried) or have any prosecution pending for any offence (excluding any motoring convictions and any offences which are spent under the Rehabilitation of Offenders Act 1974); - Never been the subject of or issued with a County Court Judgement (CCJ), money judgement or court decree and/or ever been cited in any unsatisfied court judgements (or the Scottish equivalent) or any other judgements or decrees in relation to debt; - Never been declared bankrupt or insolvent, the subject of an individual voluntary arrangement (IVA) or company voluntary arrangement (CVA) with creditors, voluntary liquidation, a winding up or administration order, or administrative receivership proceedings, bankruptcy or insolvency proceedings; - Never been disqualified from being a company director; - Never been censured by any regulatory or trade body or any action been taken against the company by the office of fair trading, consumer groups or the alike; - Never been served under any Health & Safety, Welfare, Environmental, Consumer Protection or Food Safety legislation or any other legislation, with any warnings, enforcement measures, prohibition notice, improvement orders, proceedings or criminal proceedings by any Health and Safety Executive, Environmental Health Office, Environment Agency, local or government authority or any other enforcement agency or authority; - Never been convicted of, charged (but not yet tried) with, officially cautioned or have any prosecution pending for a breach of any Health & Safety, Welfare, Environmental, Consumer Protection, Food Safety legislation or any other legislation; - Never been the subject of a recovery action by Customs and Excise or the Inland Revenue.
Please confirm if you agree with the declaration
—Please choose an option—Yes - I agree with the declarationNo - I do NOT agree with the declaration
If you do NOT agree, please advise here why
How did you hear about us?
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