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