Soft Play Centre Insurance Enquiry Form - David J Miller Insurance Brokers

Please complete the form below to get a soft play insurance quote. It shouldn't take you longer than 5 minutes.
Have you got the time to save on your insurance premium?
Alternatively we can collect details over the phone with you.
Please leave this field empty.
Contact Name:

Company Name:

Telephone Number:

Email Address:

Business Address:

Town:

Postcode (required):

Location of Premises:

Type of Trade:

If Other, Please detail:

Trading Status:

If Other, Please detail:

Website:

Number of Years Trading In Total:

Policy Due Date:

Current Insurance Held With:

Current Insurance Premium:

Have you had any claims in the last 5 years?:

If Yes Please Specifically Detail Dates, Incidents And Amounts Here:

Are You a Member of The Association of Indoor Play (AIP)?:

Facilities Available (tick boxes after each activity)
Soft Play Equipment / Soft Play FrameSports ArenaPlay 'Town' / Role Play For ChildrenCraft ActivitiesBall PoolsFace PaintingHair, beauty or cosmetic treatmentsBouncy Castle or other Inflatable Play EquipmentTrampolines (Standalone)Trampoline within Play FramePaddling/Swimming PoolsLicensed BarPedal Kart TrackNon-Motorised Ride On Toys (e.g Little Tikes)Self Propelled Ride on Karts or SimilarVending/Gaming/Amusement MachinesMechanically or electrically powered ridesFoam dart or nerf warsLaser TagClimbing WallTraverse WallOutdoor Play AreaPetting FarmZip Wire / Aerial Runway / Rope CourseRoller skating or bladingBowling LanesNurserySupervised CrecheSupervised Drop and PlayAfter School ClubYouth ClubSports ActivitiesPrivate Hire for Children's PartiesPrivate Hire for Adult PartiesPremises used by 3rd parties such as room hire for baby & toddler groups, networking groups, dance / baby ballet classes and other activitiesOther

Maximum Age Of Children Permitted On The Play Frame?:

Maximum Number of Children Permitted On The Premises at Any One Time?:

Is Frying Equipment Used?:

Sums Insured - If a new venture, please provide your best estimates

Buildings:

Do You Require Subsidence Cover?:

Tenants Improvements:

Computers, Cash Registers and Other Electronic Business Equipment:

All Activity and Play Equipment:

All Other Contents Fixtures and Fittings:

All Other Stock:

Wines and Spirits:

Beers:

Frozen Or Refrigerated Stock:

Sum Insured For Glass:

Sum Insured For Signs And Canopies:

Money Cover In Transit and On The Premises During Business Hours:

Money Cover After Business Hours In a Locked Safe:

Type Of Safe On The Premises?:

Sum Insured For Goods In Transit:

Maximum Business Interruption Cover Required:

Maximum Business Interruption Indemnity Period Required?:

Loss Of Rental Income:

Outstanding Debit Balances Book Debts:

Loss Of License:

Public Liability Indemnity Limit?:

Your Annual Turnover:

Number Of Employees:

Your Annual Staff Wageroll:

Your Employers Reference Number ERN:

Do The Premises Have An Intruder Alarm?:

Does Your Alarm Have Police Response?:

Do The Premises Have CCTV?:

Do The Premises Have A Fire Alarm?:

What Year Were The Premises Built?:

Notes, if any

Declaration
You or any director or partner in any business, any partner in any partnership, any director of any company, or the company;
either in any personal capacity, in the name of the business proposed or in respect of any other business in which any of you have ever had an interest have:

- Never had a proposal for insurance declined, cancelled or refused?
- Never had insurance cancelled mid-term, a renewal refused, increased or special terms or conditions imposed by an insurer?
- Never been given an official police caution, convicted of, charged (but not yet tried) or have any prosecution pending for any offence (excluding any motoring convictions and any offences which are spent under the Rehabilitation of Offenders Act 1974)?
- Never been the subject of or issued with a County Court Judgement (CCJ), money judgement or court decree and/or ever been cited in any unsatisfied court judgements (or the Scottish equivalent) or any other judgements or decrees in relation to debt?
- Never been declared bankrupt or insolvent, the subject of an individual voluntary arrangement (IVA) or company voluntary arrangement (CVA) with creditors, voluntary liquidation, a winding up or administration order, or administrative receivership proceedings, bankruptcy or insolvency proceedings?
- Never been disqualified from being a company director?
- Never been censured by any regulatory or trade body or any action been taken against the company by the office of fair trading, consumer groups or the alike?
- Never been served under any Health & Safety, Welfare, Environmental, Consumer Protection or Food Safety legislation or any other legislation, with any warnings, enforcement measures, prohibition notice, improvement orders, proceedings or criminal proceedings by any Health and Safety Executive, Environmental Health Office, Environment Agency, local or government authority or any other enforcement agency or authority?
- Never been convicted of, charged (but not yet tried) with, officially cautioned or have any prosecution pending for a breach of any Health & Safety, Welfare, Environmental, Consumer Protection, Food Safety legislation or any other legislation?
- Never been the subject of a recovery action by Customs and Excise or the Inland Revenue?

Please Confirm If You Agree With The Declaration(*)?:

IF You Do Not Agree With The Declaration Please Advise Why Here:

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