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The "Jack High" Scheme
Questionnaire |
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| Club Name |
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| Club Address |
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| Postcode |
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| Club Phone Number |
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| Contact Name / Office Held |
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| Contact Address |
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| Postcode |
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| Daytime Phone Number |
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About Your Club: |
| Business Activities: |
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| Are you near (100 metres) a river/water
course/similar hazard? (Yes or No) |
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Construction of Main
Clubhouse |
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| Walls:
Floor: Roof:
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Construction of other
Buildings |
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| 1. Walls:
Floor: Roof:
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| 2. Walls:
Floor: Roof:
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| 3. Walls:
Floor: Roof:
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| Number of Greens:
Membership/Social:
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| Do you have the following: |
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| a: Appropriate Fire Extinguishers |
(Yes or No) |
| b. Current Electrical Inspection Certificate |
(Yes or No) |
| c. Record of annual inspection of felt or timber
roof areas |
(Yes or No) |
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d. No Smoking Signs displayed |
(Yes or No) |
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About Your Security - Can you provide the following
details |
| Name of Alarm Company: |
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| Is there a Maintenance Agreement in force: |
(Yes or No)
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| Is the Alarm Signal: |
Redcare/Directline/Digital Comm/Bell Only
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| If the club is not alarmed can you confirm that
you meet the minimum security requirements? |
(Yes or No) |
| Do you use a Safe for retention of money
overnight? |
(Yes or No) |
| Details of Safe: |
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Make: Model:
Retention Limit:
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| Maximum amount of Money in Transit to Bank |
£ |
| Maximum amount of Money in Safe Outside Business
Hours |
£ |
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| About Your Sums Insured: |
Sums insured must reflect replacement cost
like for like as new to avoid under-insurance |
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| All Building(inc Walls/Fences/Sprinkler System) |
£ |
| Greens - Outdoor |
£ |
| Courts |
£ |
| Other playing surfaces eg. Indoor Carpet |
£ |
| Stock (Wines, Spirits & Tobacco) |
£ |
|
Stock (Other - Beers, Soft Drinks, Badges etc) |
£ |
| Trophies |
£ |
| Maximum any one trophy |
£ |
| Floodlights |
£ |
| Contents (All buildings) |
£ |
| Annual Income (All Sources) |
£ |
| Wages Bill |
£ |
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| About Additional Cover: Do you
require: |
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| *Directors & Officers (Committee)
Liability-Financial loss through breach of duty etc (includes libel and
slander) |
(Yes or No) |
| *Legal Expenses (including Contract Dispute) |
(Yes or No) |
| Theft by Official (Fidelity Guarantee) |
(Yes or No) |
| Personal Accident (Committee & Voluntary member
help) |
(Yes or No) |
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| (*See separate enclosure) |
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Loss History over last 5 years
detailing: |
| About Your Loss History: (In
last 5 years): Date/Amount/Circumstances |
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| Your Renewal Date |
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| Your Present Insurer |
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| Your Current Premium |
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