Proposal Form for Diving Schools / Centres / Stores / Clubs

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 you have read and understood these notes fully.

1. Full name including any trading name*

2. Names of Directors or Partners

3. Registered Number if the company is a Limited Company

4. Business Address

Include Postal address

Contact Name

Position

Tel No

Mobile No

Fax No

Email Address

Website Address

Business Description

Dive Store
Dive School
Dive Store & Dive School
Other

Include Details

6. Date business established

DD

MM

YYYY

Status

Insert Details

8. Description of Business/Type of activities undertaken

(include related companies &/or trading styles you want insured)

9. Which certifying Associations does the School/Centre train to?

SSI
PADI
TDi/SDi
NAUI
APNEA
RAID
Other

Insert Details

10. Instructions / training locations

Swimming Pool
Ocean
River
Lake
Dam
Cave

Please specify 'to what depth' for each of the checkboxes you tick above

11. Please provide a breakdown of the total turnover of your business as follows:

Diver Training ($)

Retail Sales ($)

Repairs & Servicing of Diving Equipment ($)

Other – Describe and Specify value ($)

12. Please provide the Total Number and Annual Wages of

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.

Risk Profile

If you answer yes to any of the following questions, please provide further details on a separate sheets clearly indicating which question the information relates to.

1. Do you ever operate from premises owned by other companies?

Yes
No

2. Do you provide overnight accommodation?

Yes
No

3. Do you provide catering facilities?

Yes
No

4. Do you provide any Instruction Courses abroad

Yes
No

5. Does your School/Centre utilise any other form of breathing apparatus other than standard manufacturers’ open-circuit scuba diving equipment?

Yes
No

6. Does your School/Centre utilise any form of mixed gas?

Yes
No

7. Does your School/Centre engage in Cave Diving or underwater pot holing?

Yes
No

8. Does your School/Centre run any

First Aid courses

Yes
No

Oxygen Administrations courses

Yes
No

Boat handling courses etc.

Yes
No

Nitrox/Trimix

Yes
No

Rebreather

Yes
No

Diving apparatus other than SCUBA

Yes
No

Other Speciality Courses

Yes
No

Please List

9. Does your School/Centre participate in any form of Commercial Diving?

Yes
No

This policy does not provide any cover for any Commercial Diving Activities

10. Does the School/Centre use small boats for open water dive training?

Yes
No

11. Do you offer servicing on Diving Equipment?

Yes
No

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

12. Do you have / hire out your own water for recreational diving ie lake/quarry etc?

Yes
No

If YES, you will need to complete an additional form 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

13. Does the School/Centre own or operate a compressor?

Yes
No

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

14. Is the Compressor separately insured for liability?

Yes
No

General Details

If you answer yes to any of the questions below, please provide further details on a separate sheets clearly indicating which question the information relates to.

1. Have you or any director or partner in the business now proposed or for any previous business ever been insured for the risks now proposed?

Yes
No

2. Have you or any director or partner or person to be insured had any

a) previous insurance or proposal declined, cancelled or refused?

Yes
No

b) renewal refused?

Yes
No

c) special terms or conditions imposed?

Yes
No

3. Have you previously suffered any loss or damage or ever been involved in any claim/accident/incident involving any of the following:

A Diver*

Yes
No

A Non-Diver*

Yes
No

Sale or hire of goods*

Yes
No

Supply of air/mixed gas*

Yes
No

A member of staff*

Yes
No

Forwarding goods or services offered*

Yes
No

Supply of food and drink*

Yes
No

Other risk associated with this business*

Yes
No

4. Have you or any director or partner or person to be insured:

a) been convicted of or charged (but not yet tried) with any criminal offence?*

Yes
No

b) either personally or in any business capacity been declared bankrupt, insolvent or gone into liquidation?*

Yes
No

5. Do you currently hold any other Insurance for any aspect of your business?*

Yes
No

If the answer is “yes” please list.

Material Facts

Failure to declare a material fact (any fact likely to influence the Company’s acceptance or assessment of this proposal) will render the insurance voidable. If you are in any doubt about whether facts would be considered material you should disclose them.

1. Are there any material facts you should disclose?

Yes
No

Declaration*

I agree

Please check this box to declare that to the best of my/our knowledge or belief that the particulars and statements given in this proposal and any other information provided in connection with this proposal are true and complete and this proposal, declaration and information shall be the basis of the contract between myself/ourselves and The Underwriters. I/We accept the Company’s standard form of policy and endorsements for this insurance. If applicable, I/we further agree that if I/We do not pay any installment on the due date then I/we must pay the total premium which is outstanding within 7 days of The Underwriters asking for it. If I/we do not pay the policy will be cancelled.

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