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. 

The Dive Centre liability Insurance is provided by Dive Master Insurance Consultant Ltd.

Dive Master Insurance are diving insurance specialists, their team will assist your Dive Centre.

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

Please provide the:

Total Number of:

Annual Wages (€)

Dive Instructors

Assistant Instructors/Dive Guides

Non-Diving staff



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


Coverage Required:



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.

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

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

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.

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

(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.

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

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

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.

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.


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.