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Village Hall Enquiry Form
Please complete the enquiry form below and click submit or alternatively click back and download a PDF copy which you can fax or post to us at your convenience. If you have any queries please call us for assistance on 023 8026 9009
Name of Organisation
Address of Village Hall
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Contact Name
Contact Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Email address
Telephone Number
Is the organisation a registered charity?
Yes
No
If so what is the charity number?
Year established
Do you have a Hallmark Award?
Not applicable
Level 1
Level 2
Level 3
Construction and Activities:
Walls
Brick or Stone
Other (Please provide further details)
Roof
Tile or Slate
Other (Please provide further details)
Please describe the construction of the premises
Approximate percentage of roof which is flat
Construction of flat roof
Concrete
Felt on Timber
Other (Please provide further details)
Approximate year Hall built
Is the premises a listed building?
No
Grade 1 Listed
Grade 2* Listed
Grade 2 Listed
Please provide further information in the box below
Does the premises have a key box/key safe?
Yes
No
Does the premises have any solar equipment?
Yes
No
Please clarify what equipment at the end of the form
Has the premises previously suffered from any Subsidence, Heave, or Landslip?
*
Yes
No
Please also state "Yes" if you're aware of any underpinning to the foundation.
Are your premises within 500 metres of a watercourse?
Yes
No
Is there any history of flooding at the premises?
Please provide details of any playing field or outdoor play equipment for which you are responsible
Sums to be insured
Buildings
Outdoor play equipment
General contents
Computers & electronic equipment
Property belonging to hirers
Bar stock
Items used away from the premises
(e.g. laptop, computers, trophies, marquees)
Solar Panels or Storage Batteries
Please provide details
Money cover is automatically included at a sum insured of £2,500
Public & Property Owner’s Liability is automatically included at a £5m limit. Cover also includes Public Liability for non profit-making hirers of your premises
Employers’ Liability is included for employees and volunteers at a £10m limit
Committee Details
Number of committee members/trustees
If you are aware of any bankruptcies, CCJs or criminal convictions (other than motoring) in respect of any trustee or committee member then please provide details.
Maximum number of additional volunteers
No of employees
Duties of employees
Annual wageroll
Total annual income
Of the total annual income, what approximate percentage is from alcohol sales?
What is your Employer Registration Number? (If you have one)
Do you require Personal Accident cover for committee members?
Yes
No
Trustees Indemnity cover is normally included at a limit of £100,000. Please indicate if you require a higher amount
£250,000
£500,000
£1,000,000
Do the assets of the organisation exceed £2.5m?
Yes
No
Activities arranged by committee
Activities arranged by hirers
Committee Activities undertaken away from Hall & maximum attendance at these events
Previous Insurers
Present Insurer
Approximate Premium
Renewal Date:
DD
/
MM
/
YYYY
Where did you hear about Norris and Fisher?
Have you had any claims or incidents within the last 5 years?
*
Yes
No
If yes please provide full details:
Please include a date of loss, claim settlement amount, and the type of claim (Flood/Public Liability/Fire etc)
Please declare if any Principals/Committee Members/Trustees have had any of the following:
*
Previous insurance declined, cancelled or terms applied
Declared bankrupt or had any unsatisfied County Court Judgments
Convicted with or charged with or received caution for any criminal offence other than motoring that is not spent
None of the above
If you answer yes to any of the first three options, please provide further information in the box below
Further details where appropriate including anything that is unusual or could be relevant to insurers:
Preferred method of contact
Please select
Phone
Email
Post
*
I have read and agree to the terms and conditions.
Our terms and conditions can be read on our website at www.norrisandfisher.com/terms
Norris and Fisher (Insurance Brokers) Ltd complies with the requirements of the Data Protection Act (DPA) 1998 and General Data Protection Regulations (GDPR) 2018. This Act places legal obligations upon Norris and Fisher (Insurance Brokers) Ltd in respect of the way we collect, review, distribute and store personal data.
In order to assess your application and help us reach a decision, we need to process relevant personal details. By ticking this box you are giving your consent for Norris and Fisher (Insurance Brokers) Ltd to do this.
