EmailMeForm
Good Neighbour Group 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 Group
Contact Name
Correspondence Address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Email Address
Telephone Number
Preferred method of contact
Please select
Phone
Email
Post
How long has the group been established?
Maximum number of volunteers
Total annual income
Covers required
Public Liability*
Employer's Liability*
Trustees Indemnity
Personal Accident
Money
Legal Expenses
*Mandatory Covers
Automatic Limits:
Public Liability £5,000,000
Employer's Liability £10,000,000
Trustees Indemnity £100,000 (can be increased)
Activities automatically covered: Light DIY, Light Gardening & Befriending including transport.
Do you organise any additional activities or events e.g. coffee mornings, day trips?
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
Have you had any claims or incidents within the last 5 years?
*
Yes
No
If yes, please provide further details in the box below
Further details where appropriate
Please use this box to elaborate on anything which may be unusual about your organisation or operations
Renewal Date
DD
/
MM
/
YYYY
Where did you hear about us?
Internet Search
Recommendation
Marketing
Other
*
I have read and agree to the terms and conditions.
PLEASE INDICATE YOUR ACCEPTANCE BY CLICKING 'I HAVE READ AND AGREE TO THE TERMS & 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 signing this form, you are giving your consent for Norris and Fisher (Insurance Brokers) Ltd to do this.