Please complete this form including all mandatory fields.
Proposal form will be submitted upon successful payment where your proposal will be processed.
Please contact Registration for queries.
It is essential you provide us with ALL MATERIAL FACTS. Failure to disclose all material facts may invalidate your insurance or may result in the insurance not operating fully.
If 'Yes' please note cover is limited to:Products limited to Food & Drink and/or Associated Sports Equipment and/or Accessories sold or supplied
Please provide details of any previous claims made.
To the best of my knowledge and belief the information provided in connection with this declaration, whether in my own hand or not, is true and I have not withheld any material facts. I understand that non-disclosure or misinterpretation of a material fact may entitle insurers to void the insurance. (N.B. a Material fact is one likely to influence acceptance or assessment of the risk by Insurers. If you are in doubt as to whether a fact is material or not, please discloses it). I understand that signing this declaration does not bind me to complete, or Insurers to accept, this insurance.
Fun4Sure & LRO Insurance are trading names of Frita Insurance Services Ltd. 150 Minories London EC3N 1LSTel: 0207 347 5160; Fax: 0207 347 5161; email firstname.lastname@example.org; Website: www.lroinsurance.co.uk;Authorised & Regulated by the Financial Services Ltd. (FSA Register No. 311136) Registered in England & Wales No. 02761363
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