Event Insurance Approval Form
Guide
Please provide FULL details. If your have more than one event, please supply separate questionnaires. Please contact us by telephone on 07840 809083 if you have further questions.
Alternatively you can 
download a copy here and email or post it back to us once completed.
Right click over link above, then left click 'Save Target As' to download to your computer. Should you have trouble downloading this form please contact us at services@cyclosport.org
Note: All information provided is in full confidence and comes under the Data Protection Act 1998.
On submitting this form, you will receive:
An email confirming the details you have entered.
An email confirming that cover has been accepted.
Online guide and downloadable forms (risk assessment, police traffic management notifcation form, incident report form, and a claim form).
Organiser's Details
Please provide your full details (you the organiser). Please note, these will be used to contact you at any stage. Please provide valid email addresses. Fields marked with a * are mandatory.
Full Name
*
Email Address
*
Other Email Address
Address1
*
Address2
Town
*
County
*
Postcode
*
Telephone
*
Mobile
*
What is the Best Way To Contact You
e.g. By home phone after 6pm or by email
Event Details
You must provide ALL fields in this section.
Insured Event Name
e.g. The Cycle Challenge
Website Address
e.g. www.cyclosport.org
Event Date
Day
Month
Year
Event Address
Please provide as much detail for your event as possible. Note: Address below is the full address of the event HQ.
Address1
Address2
Town
County
Postcode
About Your Event
Please provide as much detail for your event as possible. Please provide full and accurate details.
Event Venues (will they be closed locations or open/public sites)
e.g. open public site
Anticipated participation/attendence
e.g. 1,000 riders
Limit of Imdemnity Required
Minimum of £5 million required by local authorties
Estimated Turnover
e.g. £30,000
Description of activities and risk assessment parameters
e.g. Non-competitive cycling event – cyclosportive. Note: these are not races.
Police Traffic Management and Possibly Local Authority
Experience/qualifications of organiser
e.g. 40 years experience of organising cycling events.
Will you be providing any refreshment facilities?
e.g. Yes, three feeding stations and HQ facilities
Employees
Employees are paid members of your event organisation. Where volunteers or marshalls receive benefits of any kind, this may be deemed employment.
How many?
e.g. 10 employees
If so, what will the expected wage roll be?
e.g. £500
How many?
e.g. 5 marshals and 5 volunteers
Will there be stewarding/crowd control/barriers/filtering etc at the event:
e.g. Yes a large team of volunteers will control the event
Safety
A legal declaration for riders to accept on entry to your event will be sent to you on acceptance of insurance.
Full safety procedure guidelines and documentation will also be made available to you on acceptance of insurance.
Will you have an application form/medical screening form for completion by entrants?
e.g. Entry form only + legal declaration for entrants
Will you be providing medical/first aid facilities?
e.g. Yes, a team of fully Qualified Paramedics or Qualified First Aider(s)
Current Premium
Current Premium (£)
e.g. including any registration fee (if you have previously run the event)
Declaration
If you have organised such events in the past, could you advise whether you or others involved in the venture have had any claims or know of any circumstances that could give rise to a claim in the future in the last five years:
e.g. No claims in the fours years we have organised the event
Your Password
Please provide a password so that you can maintain and update your event insurance (in a secure manner) once initially received.
Password
e.g. abc123
Please read this declaration carefully before signing and dating.
I/We apply for cover with respect to the sections of insurance I/we have indicated.
I/We have answered the appropriate questions and declare that:
• To the best of my/our knowledge and belief the information given is true in every respect
• If anything in this proposal was written by another person he/she acted as my/our agent for this purpose
• I/We will provide at the end of each period of insurance information as required by the Company concerning those covers which are on an adjustable basis and will pay such additional premium as may be required.
• I/We will notify the Company of any changes in material facts immediately I/we shall become aware of them.
I/We agree that:
• This proposal shall be the basis of the contract between me/us and the Company.
• I/We will accept the Company’s policy applicable to the insurance.
• I/We will pay the premium to the Company when called upon to do so.
Signature
Signature Date
Day
Month
Year
Cyclosport/Broker Admin Only