01792 001350

Third Sector, Community & Not-For-Profit – Insurance Quote Request

Please complete as much as possible. We’ll use this to obtain tailored insurance terms for your charity, community group or not-for-profit organisation.

Your details

Organisation name *

Registered name (if different)

Main contact name *

Position / role

Correspondence address *

Postcode *

Telephone number *

Email address *

Website

Preferred contact method

Organisation details

Type of organisation *

If other, please describe

Charity / company / CIC registration number (if applicable)

Approx year first established

Legal status

Are you affiliated to any national body / umbrella organisation?

If affiliated, please provide details

Estimated annual income / turnover £ *

Approximate split of income – grants / contracts (%)

Approximate split of income – donations / fundraising (%)

Approximate split of income – trading / charity shops / fees (%)

Number of paid employees (full-time equivalent)

Number of volunteers (approx)

Number of service users / beneficiaries (approx)

Activities & services

Main activities / services provided *

Which groups do you work with? (tick all that apply)

General public Children / young people (under 18) Vulnerable adults People with disabilities / additional needs Older people People experiencing homelessness Refugees / asylum seekers Other specific groups

Details of any “other” or higher-risk activities

Do you run events open to the wider public?

If yes, please describe typical events and approximate numbers attending

Do staff / volunteers visit service users in their homes or off-site locations?

If home / off-site visits take place, please provide details

Premises & security

Main premises address (if different from correspondence)

Postcode (premises)

Type of premises

Approximate year building constructed

Construction of main building

Construction type / details

Flat roof? (any part of the building)

Approx % of the roof that is flat

Opening hours / typical usage times

Security protections

Intruder alarm?

Any history of flooding, subsidence or structural movement?

If yes, please provide details

Wages & volunteers

Estimated annual wages – management / senior staff £

Estimated annual wages – support / project workers £

Estimated annual wages – admin / office staff £

Estimated annual wages – caretakers / cleaners / maintenance £

Estimated annual wages – any other staff £

Approx number of volunteers (if not given above)

Property damage – sums insured

Buildings sum insured £ (if you own the building) Full rebuilding cost including debris removal and professional fees.

Tenants’ improvements £

Contents – furniture, fixtures & equipment £

IT / computer / office equipment £

Specialist equipment (projectors, PA, musical instruments, etc.) £

Stock / food / supplies (including food bank stock) £

Business interruption / loss of income

Business interruption / loss of revenue cover required?

Indemnity period

Estimated annual gross income / revenue £

Sum insured required for business interruption £

Liability cover

Employers Liability required? Usually required if you have employees or volunteers.

Number of people to be covered under Employers Liability (staff + volunteers)

Public Liability limit required

If other PL limit required, please specify

Trustees’ / Directors’ & Officers’ Liability required?

Any professional / advice-based services (e.g. counselling, advice, advocacy)?

If yes, please describe the nature of advice / support given

Safeguarding & health & safety

Do you have written safeguarding / child protection policies?

Are staff / volunteers working with children or vulnerable adults DBS / PVG checked?

Do you carry out written risk assessments for activities and events?

Claims & history

Any claims or incidents (paid or outstanding) in the last 5 years? *

If yes, please provide details Please include dates, type of claim, amount paid / outstanding and circumstances.

Have you or any trustee / director / committee member ever had insurance cancelled, declined, refused, or had special terms imposed, or any unspent criminal convictions? *

If yes, please provide full details

Current insurance (if applicable)

Current insurer

Policy renewal date

Approximate annual premium £

Anything else we should know?

Additional information Any other details which may help us obtain the most competitive terms for you.

Fields marked with * are required.

By submitting this form you are providing consent for Miller & Partner Ltd to contact you in relation to this quotation and any related insurance products.

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Office: Vivian House, Roman Bridge Close, Mumbles, Swansea, SA3 5BG

Call 01792 001350

Email: [email protected]

Miller & Partner is an Authorised Representative of Gauntlet Risk Management Ltd and are authorised and regulated by the Financial Conduct Authority (FCA) under firm reference number 1029698. You may check this on the Financial Services Register by visiting the FCA website, https://www.fca.org.uk/firms/financial-services-register or by contacting the FCA on 0800 111 6768 Privacy Policy

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Third Sector, Community & Not-For-Profit – Insurance Quote Request