Outdoor Instructor Insurance Form - John Ansell and Partners Ltd

Your details

First Name: *

Last Name: *

Business Name:

Address:

Post Code:

Telephone No: *

Email: *

Website:

Number of Years In Operation:

Current Insurer:

Premium:

£

Period Insurance Required From/Renewal Date:

Employer’s liability insurance

Number Of Employees:

Wage Roll

Clerical Wages:

£

Instructors Wages:

£

Catering & Maintenance:

£

All Others:

£

Payments to Labour Only Sub-Contractors:

£

Public products liability insurance

Annual Turnover (Please indicate turnover split)

UK Activities

Total Turnover

Payments to Bona Fide Subcontractors

Classroom Activities/Management Training:

Classroom Activities/Management Training Total Turnover:

£

Classroom Activities/Management Training Payments to Bona Fide Subcontractors:

£

Paintball:

Paintball Total Turnover:

£

Paintball Payments to Bona Fide Subcontractors:

£

Climbing & Other Activities at Height:

Climbing & Other Activities at Height Total Turnover:

£

Climbing & Other Activities at Height Payments to Bona Fide Subcontractors:

£

Land Based Motorised Activities:

Land Based Motorised Activities Total Turnover:

£

Land Based Motorised Activities Payments to Bona Fide Subcontractors:

£

Water Sports - Motorised:

Water Sports - Motorised Total Turnover:

£

Water Sports - Motorised Payments to Bona Fide Subcontractors:

£

Water Sports - Non Motorised:

Water Sports - Non Motorised Total Turnover:

£

Water Sports - Non Motorised Payments to Bona Fide Subcontractors:

£

All other Activities:

All other Activities Total Turnover:

£

All other Activities Payments to Bona Fide Subcontractors:

£

Please list other activities undertaken:

Overseas Activities

Total Turnover

Payments to Bona Fide Subcontractors

Estimated overseas turnover:

Estimated overseas turnover Total Turnover:

£

Estimated overseas turnover Payments to Bona Fide Subcontractors:

£

Countries visited:

Activities undertaken:

Do the Travel regulations 1992 apply to your business?:

Is cover for your premises or equipment required?:

How did you find out about us?:

If other is selected above please specify:

Other information – Please list your qualifications and include details of any claims made against you:

Activity Insurance Form

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