TRADE PROPOSAL FORM FOR INDIGO LIABILITY COVER - Dive Assist - community resource for Divers and the Dive Trade

Please complete all sections of this form. Dashes are not acceptable answers & the form will be returned to you for completion, which may delay your application. Important Restrictions and Limitations of Cover are indicated in Red Ink. Please make sure and understood these notes fully.

Full (Main) Company Name to be insured: *

Any Subsidiary or Trading styles/names that need to be insured: *

Names of all Directors, Partners & Officers: *

Registered Number if the company is a Limited Company (Ltd): *

Business Address: *

Postcode (if applicable) :

Country: *

Main Contact Name: *

Position: *

Telephone Number: *

Email *

Website Address: *

Postal Address (if different from above):

Date business established at the above premises: *

Elsewhere:

Business status: Sole Trader / Partnership / Limited Company / Other: *

Please specify

What types of locations are used for instruction/training, and to what maximum depth? *

Please provide a breakdown of the total turnover of your business as follows:

Diver Training £ *

Repairs & Servicing of Diving Equipment £ *

Retail Sales £ *

Any Other Turnover:

Please provide the:

Total Number of:

Annual Wages (£)

Dive Instructors

No of Dive Instructors *

Wages of Dive instructors *

Assistant Instructors/Dive Guides

No of Assistanct Instructors *

Wages Assistanct Instructors *

Non-Diving staff

No of Non-Diving staff *

Wages of Non-Diving staff *

Volunteers

No fo Volunteers *

N/A

Qualifications & diving practices of Instructors / Assistant Instructors / Dive Guides must comply with National/Local regulations & any other Statutory Regulations, in addition to their certifying Association’s recommendations for safe Diving Practice

INDIGO LIABILITY INSURANCE

Coverage Required:

Limit:

Insured Section A - Public Liability

Insured Section A - Public Liability *

£3 million GBP
£5 million GBP

Insured Section B - Products Liability

Insured Section B - Products Liability

£3 million GBP
£5 million GBP

Insured Section C – Pollution Liability

Insured Section C – Pollution Liability *

£3 million GBP
£5 million GBP

RISK PROFILE

If you answer ‘YES’ to any of the following questions, please provide further details in the APPLICATION NOTES below, clearly indicating which question the information relates to.

1. Do you ever operate from premises owned by other companies?

1. Do you ever operate from premises owned by other companies? *

2. Do you provide overnight Accommodation?

2. Do you provide overnight Accommodation? *

3. Do you provide Catering facilities?

3. Do you provide Catering facilities? *

4. Do you provide any Instruction Courses abroad?

4. Do you provide any Instruction Courses abroad? *

5. Does the Company utilise any other form of breathing apparatus other than standard manufacturers’ open-circuit scuba diving equipment?

5. Does the Company utilise any other form of breathing apparatus other than standard manufacturers’ open-circuit scuba diving equipment? *

6. Does the Company utilise any form of mixed gas?

6. Does the Company utilise any form of mixed gas? *

7. Does the Company engage in Cave Diving or underwater pot holing?

7. Does the Company engage in Cave Diving or underwater pot holing? *

8. Does the Company run any of the following courses:

i) First Aid Courses

i) First Aid Courses *

ii) Oxygen Administrations Courses

ii) Oxygen Administrations Courses *

iii) Boat handling/licencing Courses

iii) Boat handling/licencing Courses *

iv) Nitrox/Trimix Courses

iv) Nitrox/Trimix Courses *

v) Rebreather Courses

v) Rebreather Courses *

vi) Diving apparatus other than SCUBA

vi) Diving apparatus other than SCUBA *

vii) Any Other Non-Diving Specialty Courses

vii) Any Other Non-Diving Specialty Courses *

9. Does the Company participate in any form of Commercial Diving?

Please note that this policy does not provide any cover for any Commercial Diving Activities.

9. Does the Company participate in any form of Commercial Diving? *

10. Does the Company use small boats for open water dive training?

Please note that we may insure the liability of operating vessels up to 15 metres in length in relation to the business activities, but please contact us if you own or operated vessels in excess of this length.

10. Does the Company use small boats for open water dive training? *

11. Does the Company offer servicing of diving equipment?

You must be approved to service diving equipment, and you must comply with any Local/National Statutory regulations for this type of business.

11. Does the Company offer servicing of diving equipment? *

12. Does the Company hire out its own water that it owns or operates for recreational diving?

(i.e. Lake/Quarry/Pool) If ‘YES’, you will need to provide further information before we are able to provide cover in respect of your liability for operating a dive site, even if you do not hire out your water.

12. Does the Company hire out its own water that it owns or operates for recreational diving?

13. Does the Company own or operate a compressor?

You must conform to all applicable National/Local regulations. The Compressor must be regularly serviced and all filter changes and services must be logged.

13. Does the Company own or operate a compressor? *

14. Is the Compressor separately insured for liability?

14. Is the Compressor separately insured for liability? *

15. Is the Company registered with a National or Local Regulatory Authority?

15. Is the Company registered with a National or Local Regulatory Authority? *

16. If ‘NO’ have you applied for registration with them?

16. If ‘NO’ have you applied for registration with them? *

General Details Applicable to Indigo Liability Cover

Please carefully read the following statements and confirm that you can answer yes to the following questions.

In the event you cannot answer yes please give full details

1. You confirm that you and any individual involved in the business of the Proposer/Insured in a capacity listed in (a) to (e) below, being:

a. a director;

b. business partner;

c. a family member;

d. an individual providing working capital or loan guarantees to this business; and

e. anyone else who plays a significant role in making decisions about how the Proposer/Insured is to be managed or organised;

whether in relation to the business of the Proposer/Insured or any previous business or any other business in which you or they have been involved in any of the capacities listed in (a) to (e) above or in a personal capacity:

i. have never been declared bankrupt; Yes

ii. have never been disqualified from being a company director; Yes

iii. have never been, or been a director or officer of a company which has been, declared insolvent or had a receiver or liquidator appointed or entered into arrangements with creditors Yes

iv. have never been convicted or have any prosecution pending or been given an official police caution in respect of any criminal offence other than motoring offences and any offences which are, or been involved in a company subject to such a conviction, prosecution or caution; Yes

v. have never been charged with or convicted of, or been involved in a company charged with or convicted of, a breach of the Health and Safety at Work Act or other legislation relating to employee safety and safe working practices, or been served with, or been involved with a company served with, an improvement order or a prohibition notice under such legislation. Yes

2. You have and maintain in force all valid and necessary permits and licences to trade required for your business to operate lawfully. Yes

3. Your business complies with Health and Safety statutory requirements and regulations applicable to your business Yes

4. You and your business have not had any claims or incidents which may give rise to a claim relevant or relating to this proposed insurance:

a. within the previous 5 years; or Yes

b. you have already fully declared to us any previous claims or incidents as part of your duty of fair presentation. Yes

Please provide additional information

Indigo Liability Cover

1. Qualifications & diving practices of Instructors / Assistant Instructors / Dive Guides will comply with National / Local regulations & any other Statutory Regulations, in addition to their RSTC, CMAS or EUF certifying Association’s recommendations for safe Diving Practice Yes

2. All staff servicing diving equipment will be approved and qualified to service such equipment and follow local/national statutory regulations Yes

3. All diving will be conducted using standard manufacturers diving equipment Yes

4. If you operate a compressor

a. the Compressor will be regularly serviced and all filter changes and services must be logged. Yes

b. A written scheme will be maintained if required under local/national statutory regulations. Yes

Other material information/alterations to the Statements of Fact.

Please provide any other material information which may be relevant. If in doubt, please disclose the information. If any responses are not marked “Yes”, please explain your answer by providing all material information. See note below and add further sheets where necessary.

Other material information/alterations to the Statements of Fact.

What is Material Information?

You must search for all material information and disclose it to us without misrepresentation. Material information is anything which might reasonably influence our decision to offer you insurance or the terms (including the premium) on which any offer is made. It includes facts, circumstances, allegations and events. Material information includes special or unusual facts concerning you or your business, any particular concerns you may have which have led you to seek or increase your insurance cover and any other facts relevant to the risk taken by us. You should assume that all information specifically sought by us is material, whether in this Statements of Fact or otherwise.

Please check carefully all the information and advise your insurance adviser or our Binding Underwriter (see your policy) if any corrections or additions are required as soon as reasonably practicable.

When you are satisfied it is accurate and complete, please sign and date the form and return it to us within 30 days of inception of this policy.

Declarations

Declaration 1 *

I/we confirm that the information in this Statement of Fact is correct and complete and that all material information required for a fair presentation of the risk has been disclosed.

Declaration 2 *

I/we confirm that I am/we are authorised to sign this declaration on behalf of the Proposer/Insured and do so according to the knowledge of the Proposer/Insured, the Proposer/Insured having made all reasonable enquiries necessary to make a fair presentation of the risk.

Title/Position of signatory *

Full name *

This form should be signed by a Director of the Proposer/Insured company or by a partner of the Proposer/Insured partnership. A broker or agent should only sign this form if duly authorised by the Proposer/Insured to make the Declarations on behalf of the Proposer/Insured.

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General Details Applicable to Indigo Liability Cover

Indigo Liability Cover