Name of Organisation:

Office Bearer:

Office Bearer Email Address:

Please retype the Office Bearer Email Address here, to reduce the risk of errors:

Office Bearer Tel. No.:

Address of Organisation:

Post code:

How long has your organisation been established?

Full description of activities:

Please supply a copy of your latest Report and Accounts together with any other literature about your organisation. You can copy from electronic versions and paste within the text box, or fax or post us a copy of the report, accounts and other literature separately.

copies of all relevant documents are being faxed/posted separately

copies of some documents are being faxed/posted separately

no documents are being faxed/posted separately

Period of Insurance :

From:

To:

Property

1. Replacement cost as new of all furniture fixtures and fittings

2. Replacement cost as new of all Electronic Equipment

a) at your premises

b) away from your premises
(i.e. laptop computers, mobile phones etc.)

3. Business Files

4. Stock

5. Buildings/Tenants Improvements
(reinstatement cost including debris removal cost and professional fees)

Liability

1. Description of Employees & Volunteers, supplied or hired or borrowed by the proposer

Number of volunteers

Number of employees

Annual Payment to employees

Clerical & Managerial and non-manual

All other

Please list, for 'All other', all of the job types for volunteers and employees and indicate:

• number of volunteers
• number of employees
• annual payment to employees

for each of these job types.

2. Do you provide advice or information?

Yes
No

3. What form does the advice or information take?

4. Is advice or information provided for a fee?

Yes
No

Business Interruption

Do not complete if proposing solely for a shop as cover is automatically included - see Schedule

1.

Indicate indemnity period required

12 months
18 months
24 months

2.

State estimated Gross Revenue

3.

Sum Insured if cover is to be limited to Additional Expenditure only

General Questions

1.

Are your premises in a good state of repair?

Yes
No

2.

Do any of the buildings that you occupy have walls that are not made of brick, stone or concrete, or roofs not made of slate, tile, concrete, metal or asbestos?

Yes
No

3.

Has your organisation previously held insurance?

Yes
No

4.

Has any previous insurer declined a proposal, refused to renew a policy or imposed special terms or conditions?

Yes
No

5.

Has any Director or Trustee been convicted of, or is any prosecution pending for, arson or any offence involving dishonesty of any kind, e.g. fraud, robbery, theft or handling of stolen goods?

Yes
No

6.

Has any Director, Trustee or Office Bearer ever been declared bankrupt or insolvent?

Yes
No

7.

Has your organisation incurred any loss, destruction or damage, or made any claims, or had any claim made against it in the last 5 years?

Yes
No

If you have answered yes to questions 2-7 please provide details:

Do you require quotations for any of the following cover?

Theft by Employee

Yes
No

Personal Accident

Yes
No

Legal Expenses

Yes
No

Trustee Insurance

Yes
No

Counselling Services

Yes
No

Loss of No Claim Discount for Volunteers

Yes
No

If so please complete the appropriate additional proposal form(s).

Please read the following carefully before you confirm the statements in the Declaration by submitting the form. The answers you have given to these questions will usually provide us with sufficient information to enable us to consider this proposal. However, because no list of questions can be exhaustive please consider carefully whether there is any other material information known to you which could influence our acceptance and assessment of the risk. Material information would include any special features of the risk which makes losses more likely to happen or more serious if they do.

Please disclose here any such material information even if you have doubts as to whether it is material or not:

Failure to disclose all material information may result in you being quoted the wrong terms, a claim being rejected or reduced, or the policy being invalid. You should also keep your own record (including copies of letters) of all information supplied to us in arranging this insurance.

Please check the wording of this Proposal and the data you have entered carefully before proceeding by clicking on the 'continue to next stage: final check' button, below. Clicking on the button will not submit your details yet, but will cause another page to load.

The new page that loads will give you a chance to check your data again, and if you need it you will get another opportunity to make changes before finally sending the data.

If you notice an error shortly after sending the data (when you see the page that invites you to print the submitted data out for your records) you can resubmit a corrected version. After submitting, you can try using your browser's Back button to return to the form. If you are lucky, the data might still be displayed, which would save you typing it all in again.

If you resubmit in this way, please also indicate this here:

Are you resubmitting this form after making a change to a recent submission?

YES NO

If you only notice an error later and it's too late to go back and resubmit, or you find that the data has disappeared from the form when you return to it, please make a copy of your printed record and fax it to us along with an indication of the change(s) you wish to make.

Alternatively, please call us on (0131) 225 6005 and explain the change(s) you would like us to make for you.

Please note that in such circumstances we may have to send you a form to fill in on paper and sign in order to confirm changes.

Declaration

I/We declare that to the best of my/our knowledge and belief the answers given are true and all material information as explained has been disclosed. I/We agree that if any answers have been completed by any other person, such person shall for that purpose be regarded as my/our agent and acting on my/our behalf and not the agent of Royal & Sun Alliance Insurance plc. I/We declare that this Proposal Form is for insurance in the normal terms and conditions of the insurer's policy and shall be incorporated in and for part of the insurance contract.

Name of Director/Trustee/Office Bearer:

Date:
(dd/mm/yyyy)

The insurance will not commence until the Insurers have indicated their acceptance of the Proposal. The Insurers reserve the right to decline any Proposal. PLEASE INFORM US IMMEDIATELY OF ANY CHANGES IN CIRCUMSTANCES, OR ANY ALTERATIONS YOU WISH TO MAKE IN THE INFORMATION YOU HAVE PROVIDED IN THIS FORM. Royal & SunAlliance Insurance plc Registered in England and Wales No. 93792. Registered Office: St Mark’s Court, Chart Way, Horsham, West Sussex RH12 1XL. Members of the Association of British Insurers.