Event insurance contact form


Your name
Business Type
E-mail address
Address line 1
Address line 2
City
State/County
Post code
Telephone No.
Type of contract	If an event - estimated visitors
Current insurer	Renewal date
	For bouncy castles we need to know: If used on licenced premises, if they have slides, if dry hire allowed and if adult/ child
Comments contract, details of equipment etc
Have you any specific demands and needs?	I have no specific demands and needs
Declaration I have completed the form to the best of my knowledge and belief. I have made a full disclosure of all material facts. I have read and understood the Important information below. I understand that there is no cover in force until confirmed by B. Portwood & Co Ltd, a satisfactory proposal form completed and accepted and payment of the premium made - either in full or an instalment plan set up acceptable to B. Portwood & Co Ltd.

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