Bury St Edmunds Quaker Meeting House Contacts and Declarations

Contact Details and Declarations
Name of Organisation / Individual
Contact Address

First line of address

Second line of address

Town / CityPost Code

Post Code
Name of person booking

First NameLast Name
Contact details

Phone numberEmail address
Position within Organisation
Name of person running event (if different)

First NameLast Name
Contact details

Phone numberEmail address
Name of person to send invoice to (if different)

First NameLast Name
Contact details

Phone numberEmail address
Declarations
We confirm that this is the status of the booking:
Insurance:
We commit ourselves to the hiring agreement
Signature
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Hirer's Public Liability Insurance Declaration

We confirm that we have Public Liability Insurance, which is underwritten by:
Public Liability Insurance Company
Policy Number
Renewal Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Indemnity Limit
Employer's Liability Insurance Company
Policy Number
Renewal Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Our insurers have been advised of our activities on your premises and we confirm to you that our insurance does cover property in our custody or control and our legal liability for any damage to your building.
Signature
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Contact Details and Declarations