Nightclub Insurance

CONTACT INFORMATION

1. Name of person completing this form

2. Contact email address

3. Contact Telephone Number

PROPOSERS' GENERAL INFORMATION

4. Full name of proposer(s) (including trading name)

   PAYE References

   (please do not answer this question if the proposer is ERN exempt, has no employees or does not require Employers Liability Insurance)

   • Company/Subsidiary Name
   • PAYE reference
5. Full postal (correspondance) address
6. Full Business Description

   Please answer 'Yes' in the boxes below to accurately describe your business:

   Nightclub
   YesNo
   Stripclub
   YesNo
   Casino
   YesNo
   Bar
   YesNo
   Public House
   YesNo

   Please use the box below to state any other aspect of your business. you will not be covered for activities that are not disclosed.

   Other
7. Number of years in business

GENERAL QUESTIONS

8. Please read the following statements and confirm if they are true in respect of this proposal:

   you have never:

   i) Had an insurance proposal declined

   ii) Had special conditions imposed

   iii) Had a claim rejected

   iv) Had an insurer refuse to renew a policy or cancel a policy

   You have not had any criminal convictions (other than minor motoring offences) nor do you have any prosecution pending.

   You have not been the subject of a County Court Judgement (or Scottish equivalent) nor been declared bankrupt or insolvent nor placed under administration.

   You have had no formal objections or refusals of an application for any licence and there are no circumstances which may prejudice the continued holding of a licence.

   • Can you confirm that all of the above statements are correct:
   • YesNo

9. If any of the statements above are not true in relation to this proposal, or if there is any additional information that should be disclosed, please use the box below to provide full details. Please leave the box blank otherwise.

10. • Do you have any other business interests?

    • YesNo

    • If 'Yes', please provide full details in the box below.

11. Please use the table below to provide details of your projected profit/loss for the next 3 years.

    (A projected loss must be declared as a negative amount by using the minus (-) sign.)

    Financial Year	Projected Profit/Loss (£)
    1
    2
    3

12. **The following questions must only be answered in respect of new ventures or businesses in the first year of trading**

    Please use the box below to provide details regarding how the Business has been financed i.e Detail any loans received or investment made by you in relation to the Business.

PROPERTY

13. SUM INSURED / LIMITS: Please specify the Sum Insured/Limits you require

    PREMISES INFORMATION

    Risk Address

    • Premises 1
    • Premises 2
    • Premises 3
    • Premises 4

    MATERIAL DAMAGE

    SUM INSURED / LIMITS: Please specify the Sum Insured/Limits you require

    PREMISES INFORMATION

    Buildings & Landlords Fixtures & Fittings

    Stock

    Wines Spirits & Tobacco

    Trade Contents Fixtures and Fittings

    Rent Payable

    Select an Indemnity period 12 months 24 months 36 months

    BUSINESS INTERRUPTION

    Gross Profit

    Select an Indemnity period 12 months 24 months 36 months

    Additional Increased Cost Of Working

    Select an Indemnity period 12 months 24 months 36 months

    Rent Receivable

    Select an Indemnity period 12 months 24 months 36 months

    MONEY

    Money In Safe

    Money In Transit

    GOODS IN TRANSIT

    ALL RISKS TO BUSINESS EQUIPMENT (UK and Europe)

    Laptops & Mobile Phones

    Other Equipment

    BOOK DEBTS

    STOCK DETERIORATION

    LOSS OF LICENSE

    Select an Option 0 £100,000 £250,000

    FIDELITY GUARANTEE

    Select an Option Not required £25,000

    COMPUTER EQUIPMENT BREAKDOWN

    Breakdown

    Breakdown ACOW

    HOUSEHOLD CONTENTS AND PERSONAL EFFECTS

14. CONSTRUCTION

    Please read the following statements and state if they are true in respect of this proposal:
    1. All Premises are constructed of brick and/or stone walls with slate, tile, felt or concrete roof;
    2. No Premises has a flat roofed area exceeding 25% of its total;
    3. No Premises is an individual flat or tenement building.
    4. No Premises is a listed building.
    • Can you confirm that all of the above statements are correct:
    • YesNo

    If 'No' please provide details in the box below

15. OCCUPANCY

    • Are any of the Premises shared with another occupant?
    • YesNo

    If 'Yes' please provide details in the box below

    • Is the Business operated seasonally i.e closed for more than 30 consecutive days in the year?

    • YesNo

    • If 'Yes' are the Premises occupied by you when the Business is closed?

    • YesNo

16. SECURITY

    Please complete the table below to provide details of the security protections in effect at each Premises.

    #	Intruder Alarm Maintained by an NSI or SSAIB company	Persons on Premises Overnight (12am to 7am)	Other Security (Please describe)
    Premises 1	NoneAudibleCentral StationBT Redcare	Resident Owner / ManagerOvernight Manned SecurityNone
    Premises 2	NoneAudibleCentral StationBT Redcare	Resident Owner / ManagerOvernight Manned SecurityNone
    Premises 3	NoneAudibleCentral StationBT Redcare	Resident Owner / ManagerOvernight Manned SecurityNone
    Premises 4	NoneAudibleCentral StationBT Redcare	Resident Owner / ManagerOvernight Manned SecurityNone

17. FIRE RISK MANAGEMENT

    Please read the following statements and state if they are true in respect of this proposal:

    A valid Fire Safety Certificate is in force at all Premises to be insured.

    There are no open fire places.

    All Premises are within 10 miles of a full time Fire Station.

    • Can you confirm that all of the above statements are correct:
    • YesNo

18. WET PERILS

    Is the Premises in a flood plain or area that has previously flooded or unduly exposed to storm or tempest?

    1	Premises 1	YesNo
    2	Premises 2	YesNo
    3	Premises 3	YesNo
    4	Premises 4	YesNo

19. SUBSIDENCE

    Please read the following statements and state if they are true in respect of this proposal:
    1. All Premises are free from signs of damage which may be attributable to Subsidence, Landslip or Heave;
    2. None of the Premises are monitored or have been monitored for Subsidence, Landslip or Heave or actually incurred damage from Subsidence Landslip or Heave;
    3. None of the Premises are in areas that are prone to Subsidence.
    • Can you confirm that all of the above statements are correct:
    • YesNo

20. TERRORISM

    • Do you require terrorism insurance

    • YesNo

COMBINED LIABILITY

21. LIABILITY LIMITS AND ESTIMATES

    Employers Liability Limit required

    Select an Option Not required £10,000,000

    Public Liability Limit required

    Select an Option Not required £1,000,000 £2,000,000 £5,000,000

22. WAGEROLL AND TURNOVER ESTIMATES

    Employee Type	Estimated Annual Wageroll
    Clerical (Non manual work) Employees
    Directly Employed Door/Security Staff Wageroll
    Agency Door/Security Staff Payments
    Dancers Wageroll
    Maintenance Staff Wageroll
    Other Manual Staff Wageroll

    Turnover Type	Estimated Annual Turnover
    All Turnover

23. FACILITIES

    Please state 'Yes' in the boxes below to detail all facilities that you provide and activities that are involved in the Business.

    Door Staff	YesNo
    Dance Floor (used by members of the public)	YesNo
    Dance Floor (only used for private pre-booked functions)	YesNo
    Stage	YesNo
    Live Music more than twice per week	YesNo
    Rides, Pyrotechnics, Foam Parties or Inflatables	YesNo
    Late Opening (past midnight) more than twice per week	YesNo
    Nightclub (either advertised or widely known as such)	YesNo
    Lap Dancing	YesNo
    Strip Tease	YesNo
    Casino	YesNo
    Childrens Play Area or Soft Play Equipment	YesNo
    Restaurant	YesNo
    Massage Parlours	YesNo
    Celebrity Functions	YesNo

    If there are any other facilities or activities relating to your business, you must detail them fully in the box below.

24. CUSTOMERS

    What is the maximum capacity for each of the Premises to be covered?

    • Is use of the Premises limited to members and their guests only?

    • YesNo

25. RISK MANAGEMENT

    • Have there been any incidents involving illegal drug trafficking/use at any of the Premises to be covered or at any other Premises with which you have been involved?

    • YesNo

    • Have there been any incidents in the last 3 years that have required a police visit and/or warning at any of the Premises to be covered or at any other Premises with which you have been involved?

    • YesNo

    • Are door/security staff vetted and SIA (Security Industry Association) licensed?

    • YesNo

    • Are all public entrances, exits and dance floors areas covered by CCTV?

    • YesNo

26. LEGISLATION

    Do you comply with the following legislation:

    Management of Health and Safety at Work Regulations 1999

    Workplace (Health, Safety and Welfare) Regulations 1999

    Personal Protective Equipment at Work Regulations 1992

    Manual Handling Operations 1992

    Health and Safety (First Aid) Regulations 1981

    The Health and Safety Information for Employees Regulation 1989

    Noise at Work Regulations 1989

    YesNo
    
    

    If 'No' please provide details in the box below

LEGAL EXPENSES INSURANCE

27. This is a 'Before The Event' policy and specifically excludes events that have already taken place.

    • Do you require Legal Expenses cover?

    • YesNo

DIRECTORS AND OFFICERS LIABILITY INSURANCE

28. Directors and Officers Liability insurance is only available to Limited companies.

    • Please state your Company Registration Number

    • Please state your Company's total consolidated turnover as shown in your latest annual report and accounts.
29. Please read the following statements and state if they are true in respect of this proposal:
    1. The Company has been established for more than 12 months
    2. The Company's activities do not involve the provision of financial products or services
    3. The Company's latest annual report and accounts shows positive net income (after tax)
    4. The Company's latest annual report and accounts shows positive shareholder funds/net worth
    5. The Company does not have any assets or subsidiaries in the USA or Canada
    6. The Company's shares are not publicly traded on any stock exchange
    7. No claims have been made against any past or present Director or Officer of the Company or its Subsidiaries?
    8. You are not aware, after enquiry, of any circumstance which may give rise to a claim.
    • Can you confirm that all of the above statements are correct:
    • YesNo

30. • Limit required

    • Select an option No cover required £100,000 £250,000 £500,000 £750,000 £1,000,000

CLAIMS

31. LOSS EXPERIENCE

    • Have you, or any company of which any of you have been a director, or any partnership of which any of you been a partner sustained any loss or damage or had a claim made against you during the last 5 years?

    • YesNo

    Date	Type of Loss	Detail	Amount Paid (£)	Amount Outstanding (£)
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption
    	Select Employers Liability Public/Products Liability Directors and Officers Liability Legal Expenses Property/Business Interruption

32. DECLARATION

    Important Notes - Please Read Carefully

    All material facts must be disclosed. If there are material facts not disclosed in making this declaration, you must disclose them in the box below or separately to BIS-nationwide. Failure to disclose material facts could result in the policy being invalidated. Material facts are those facts which might influence the acceptance or assessment of the proposal.

    Data Protection

    For Data Protection Act purposes the Proposer's personal data will be held and processed for insurance administration. For this purpose the information may also be passed to selected third parties including other insurers, credit reference agencies and reinsurers. By entering into this contract of insurance, the insurance advisor who arranged this contract of insurance on behalf of the Proposer has confirmed their authority to disclose the Proposer's personal data and to consent on the Proposer's behalf to the processing of that data by the Underwriters.

    The Proposer has a right to access (subject to limited exceptions) and if necessary rectify the information that we hold.

    Insurers pass information to the Claims and Underwriting Exchange register and the Motor Insurance Anti-Fraud and Theft Register. These registers have been established to help check the information provided and also to reduce fraudulent claims. These registers may be searched when dealing with any request for insurance. Under the conditions of the policy, all incidents must be declared whether or not they may result in a claim. The information may be passed to the registers.

    Declaration

    • By checking this box I/We confirm that the statements made by me/us or on my/our behalf are to the best of my knowledge and belief true and complete.