Proposer

To ensure validity of the policy you must answer the following questions truthfully, to the best of your knowledge and belief. You must disclose any facts which are material to the risk being proposed. Such material facts would assist the underwriter to assess the risk and determine whether or not to offer cover. If you are in any doubt about disclosing information you should contact us.

Please be aware your answers form the basis of any subsequent policy and the policy schedule is actually produced from your answers, please therefore enter answers as carefully as possible, doing your best to avoid typing errors. Thank you.

Your Details

Is this policy to be in the name of a Company?

YesNo

What is the company name?

What are the names and dates of birth for all directors?

Please use one line for each person and separate their name and date of birth with a comma. Date of birth should be in the format DD/MM/YYYY.
i.e. Mrs. Anne Example, 13/01/1975

Title

Please select your title. If your title is not available, please select "Other" and fill in the resulting text box.

Please Specify Title

First Name

Last Name

What is your date of birth?

Are you and your company (if applicable) domiciled in the UK?

YesNo

Unless agreed to the contrary, UK law will apply.

Contact Details

Please type your house/company building name/number and postcode

Building name

Building number

Street

Town

County

Postcode

Telephone

Mobile

Email Consent

YesNo

This is an ON-LINE live product only. Do you consent to use email for all matters relating to this policy.

Where did you hear about us?

Fireworks Liability Insurance Application for one-off display

Your Details

Fireworks Liability Insurance
Application for one-off display