Caddysure
Golf Clubs
Social Clubs
Sports Clubs
Personal Accident
About Us Insurance Services Request a Quotation Online Documents Latest News Meet the Team Contact Us
 
Personal accident Quotation Request Form  

We are happy to provide quotations and cover for amateur sports clubs personal accident insurance. Please complete the insurance quotation form below giving as much information as possible. Alternatively you can telephone us on 01708 777750 to discuss your requirements.

Agent / Insurance Adviser Name
CCV Agency No
Contact Name
Contact Tel No
Contact Fax No
Email Address
Name of Sports Club proposing for insurance
Name of Club Official
Address
Postcode
Year founded
Total Club Membership (amateurs only)
( If any of the Insured Person’s are Junior Members, please confirm split between Junior and Senior Membership.)
Sports to be insured
Number of teams
(Individual Sports rated per 20 members or part thereof)
Total number of
playing members
Seniors
Juniors
Average number of
games per team each
week during season
BENEFITS REQUIRED
ACCIDENT BODILY INJURY BENEFITS
Please enter the benefits required (Maximum lump sum £100,000)
Death
(Death benefit for Junior Members restricted to £5,000 sum insured)		 Sum Insured £
Loss of one or more limbs or one or both eyes
Loss of speech/hearing
(25% of sum insured for loss of hearing in one ear)
Permanent Total Disablement from gainful employment
of any and every kind
ACCIDENT BODILY INJURY BENEFITS
Please enter the benefits required (Maximum income benefit £300 per week).
Temporary Total Disablement from usual occupation
Standard Deferment Period 14 days. Payment Period 104 weeks. 		Sum Insured £
DEFERMENT PERIOD
Standard Deferment Period 14 days. Payment Period 104 weeks.
Please select the deferment period to apply.
Other
Please provide details of all accidents to members arising out of any Club sport or activity occurring during
the past 3 years.
Date
Cause (state the sport or activity or if in the course of travel)
Nature of injuries
Period of Total disablement

Are all Club members, to the best of the Proposer’s knowledge and belief, in good health and free from any material, physical or mental defect or infirmity? If No, please provide details.

Additional information
Use this space to provide information in support of the quotation request
Do you hold this case?
Existing Insurer?
Current Renewal Date?
Target Premium?
To help prevent spam and other types of unwanted email please enter
the letters in the box below when submitted this form to us

Cover is subject to a satisfactorily completed proposal form.
One of our advisers will be in touch with you about this quotation request very shortly.
Contact us for further information or an appointment
 
 
Designed by The Bureau
 
 
Authorised and regulated by the Financial Services Authority