Lloyd Manley Associates - Sport Enquiries Form

Please complete the following Sport Enquiry form

Name of club:
Contact name:
Contact telephone number:
E-mail:
Sport played:
Amateur or semi-pro:
Number of Adult male teams:
Number of Adult female teams:
Number of Junior teams:
For Junior teams, please state age groups and if mixed sexes:
Weekly benefit required (min £10, max £150):	£
Is Public Liability indemnity required?	Yes No
If yes, limit of indemnity required:
Does the club own the sports field / ground being used?	Yes No
What is the approximate average attendance at each teams games:
Is there a stand at the ground?	Yes No
If Yes, please give details of who owns the stand, construction of the stand and capacity of the stand:
Has there been any incident, whether insured or not, that could have given rise to a claim over the past 5 years with regards Personal Accident or Liability?	Yes No
If YES please give details:
What date is cover required from:

Authorised and Regulated by the Financial Services Authority for General Insurance Business No. 302600