Proposer’s Name (in full)(Mr/Mrs/Miss)……………………………………………………………………………
Name of Equestrian Centre………………………………………………………………………………………….
Establishment Address………………………………………………………………………………………………
………………………………………………………Tel No:……………………………Fax No:………………...
Correspondence Address (if different from above)…………………………………………………………………
………………………………………………………………………………………………………………………
……………………………………………………….Tel No:………………………..…..Fax No:…………..…...
Date Established……………………….
(a) Are you a B.H.S. Approved Riding School?
YES/NO
(b) Are you a member of A.I.R.E.?
YES/NO
If you have answered “YES” please provide a copy of a current certificate or membership application.
(c) Have you ever been declined for approval or membership by B.H.S. or A.I.R.E.? If you have
answered ‘YES’ please state reasons……………………………………………………………………….
…..……………………………………………………..………………………………………………………..
(d) Full description of activities: (only activities specified will be insured)
………………………………………………………………………………………………………………….
Are all of the activities declared supervised by qualified personnel?
If ‘YES’ give details of qualifications for each of the above
YES/NO
…………………………………………………………………………………………………………………
If “NO” give brief outline of equine experience on separate sheet.
(e) Have all of the activities for which you have been requested cover been
approved by the BHS or AIRE?
If “NO”give details of the activities concerned and the reason why approval
has not been sought
(f) Do you have a Cross Country course?
If “YES” is it used other than by riding school clients under supervision?
If “YES” please give details
YES/NO
YES/NO
YES/NO
…………………………………………………………………………………………………………….
(g) Do you operate Pony Trekking?
If “YES” please advise:
Average number of rides per week
Maximum distance of rides
Maximum duration of rides
Maximum number of rides per week
Maximum number of riders
Are fixed routes always followed?
How much travel is on public roads
Are there any overnight stops away from premises
(h) Do you hire out any of your facilities?
If “YES” please give details including
to whom ie. private individuals/Pony club/Other
If other please give details on separate sheet
YES/NO
……………………..
……………………...
………………..…
………………..…….
………………..…….
………….…………..
………….…………..
……………………...
YES/NO
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PUBLIC LIABILITY
1.
2.
Maximum number of Horses/Ponies used for riding instruction
(ie. owned on loan or liveries)
Maximum number of other Horses at premises
(ie. in training or at livery / at grass not used for riding instruction
Total
3.
4.
5.
6.
7.
8.
9.
……………………………….
……………………………….
……………………………….
Do you provide accommodation for any persons other than employees
YES/NO
e.g. Courses Students/Guests? If Yes state number of beds
……………………… ……….
Please provide full details of residential holidays ie. are they available to non-equestrian holiday
-makers?
…………………………………………………………………………………………………….…..
Do you hold Shows or Gymkhanas at the premises?
YES/NO
If “YES” please answer the following questions.
a. How many per year?
Outdoor……………………. Indoor…………….….…..
b. If you use an Indoor School please give approximate size…………………………………..……..
number of seats ……………………………….…….….
c. Give average and maximum number of competitors per Show Day…………………………..……
d. Give average and maximum number of spectators
……………...
e. Are shows open to the public?
YES/NO
f. Do you charge admission to the public?
YES/NO
Do you hold Hunter Trials?
YES/NO
If “YES” please advise how many per year
Is Voltige (Vaulting) instructed on your premises?
YES/NO
If “YES” please provide full details on a separate sheet
Do you give instruction in connection with the use of horse drawn vehicles?
YES/NO
If “YES” please request supplementary proposal form
Do you require indemnity of
(a).€1,270,000
(b).€2,540,000
(c).Other specify………………………………………..…….
( We would be pleased to give a quotation on both, if required)
Do you require indemnity for other animals? (e.g. cattle, goats, mules, donkeys, sheep etc.) YES/NO
If “YES” give details and numbers………………………………………………………………………
…………………………………………………………………………………………………………….
EMPLOYERS LIABILITY
1.
Do you require Employers Liability cover?
If “YES”:
Please state number of employees
Clerical
Manual
Students
2.
YES/NO
Full-Time
…………
…………
…………
Part-Time
…………
…………
…………
Casual
………...
………..
…..……
State number of persons engaged in the use of any dangerous machinery………………………..……
Please provide details of the machinery used……………………………………………………..…….
PRODUCTS LIABILITY
Do you require Products Liability cover?
If “YES” please provide details of products involved and the annual turn over
YES/NO
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GENERAL
1.
Have you, your family or any employee become aware during the last 5 years of any injury to or death,
disease, illness arising out your business of any employee or any member
of the public or damage to their property?
YES/NO
If “YES” give details below.
YOU MUST INCLUDE ANY CLAIMS/INCIDENTS ALREADY REPORTED TO BLOODHORSE
INSURANCES
Brief circumstances including date
(whether claim made or not)
Amount Paid
€
Amount Outstanding
€
a.
b.
2.
3.
4.
Have you , your family or any employee previously been
insured against any of the risks proposed, either in the name of the
proposer or in any other name?
If “YES” please give details, including names of previous Insurers
Has any Insurer ever declined to insure you, your family or any
employee or refused to renew or terminated any of your insurances,
including if under another trading name?
Please give name of Insurers
Have you, your family or any of your directors or partners ever been
convicted with a criminal offense or are any prosecutions pending
(other than motoring offences)?
If Yes please give details.
YES/NO
YES/NO
YES/NO
PROPOSER’S DECLARATION
TO BE COMPLETED IN ALL CASES
I/We declare that to the best of my/our knowledge and belief the above statements are true and complete and
will form part of the contract between me/us and the Underwriters and that I/We have not withheld any
material information.
Date cover to commence……………………………………………………………………….………..
Proposer’s Signature…………………………………………… Date………………………….………
N.B:
1. Material information is likely to influence acceptance or assessment of this proposal by Underwriters; if you are in doubt as to what
constitutes material information, you should consult your Broker. Under general question 1 all incidents must be shown, including those
already reported to Bloodhorse Insurance.
2. No insurance is in force until the risk has been accepted by Insurers and cover confirmed to you by your broker.
THE UNDERWRITERS RESERVE THE RIGHT TO DECLINE ANY PROPOSAL
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