Duty of Disclosure of Material Facts (Duty of Fair Presentation)
A material fact is an important fact about you or your circumstances. Fairpresentation means that you must have disclosed all material facts, matters andcircumstances which you know, which could influence an insurer's orunderwriter's decision to accept your insurance. This also applies to factsthat you ought to know. You must disclose sufficient information to make theinsurers aware that they need to make further enquiries. They can then chooseto accept or decline your insurance. If they accept, they may apply certainterms. The duty of fair presentation is a significant obligation placed uponyou under the contract of insurance. If you fail to meet this obligation, insurers can take various actions in accordance with the Insurance Act 2015.
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Full trading name (if applicable)
Address
*
Address line 1
Address line 2
City
Postcode
Telephone
*
Please enter a valid phone number.
Email
*
Confirmation Email
Confirm email
Date of birth
*
/
Day
/
Month
Year
Please select the option which best describes your business:
*
Please Select
Private individual
Sole Trader
Partnership
Limited Company
Syndicate
Is a joint policy required?
*
Yes
No
Title
*
Please Select
Dr
Miss
Mr
Mrs
Prof
Rev'd
Name
*
First name
Last name
Date of birth
*
/
Day
/
Month
Year
Is the risk address the same as the correspondence address?
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Yes
No
Please provide the full risk address
Current insurer (if applicable)
Annual renewal date (if applicable)
How many years' experience do you have in the equine industry?
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What equine qualifications do you have?
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What training, experience or qualifications do you have in order to provide Equine Assisted Therapy/Equine Facilitated Learning?
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Please give a full description of your business activities. Please provide complete details as only those activities described here will be considered for insurance:
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Are any other activities carried out?
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Yes
No
Please provide full details
How long has your business been established? Please indicate if this is a new venture.
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From what date is cover required?
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/
Day
/
Month
Year
Date
What is your position? (e.g. proprietor, director)
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What is your annual turnover for Equine Assisted Therapy/Learning?
*
What level of cover do you require?
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Please Select
£2,000,000
£5,000,000
£10,000,000
Please state the maximum number of horses at the premises at any one time:
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Please advise the number of horses for each category below:
Please state the number of horses owned by you:
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DIY Liveries
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Part liveries:
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Please state the maximum number of horses used for equine assisted therapy at any one time
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Are all horses that are used for Equine Assisted Therapy/Learning owned by you?
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Yes
No
If no, please provide further details:
Do you require Care, Custody and Control cover for any third party horse in your care?
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Yes
No
If yes, please tick the level of cover required. (Please note, a maximum limit of £100,000 applies in the insurance year)
£5,000 any one horse
£10,000 any one horse
£25,000 any one horse
£50,000 any one horse
Please state the maximum number of horses in your care owned by other people:
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Please supply the age, breed, and height of each horse/pony you will be using, as well as how long you have owned them:
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How long will each session be?
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What activities will you be doing within each session?
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Will there be a ridden element in any of the sessions?
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Yes
No
Will the sessions be taking place on your own premises?
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Yes
No
If no, please provide details:
Will you be using any mechanical equipment in conjunction with the sessions? (e.g. mechanical horse)
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Yes
No
If yes, please provide details:
Please state how frequently it is serviced and who it is serviced by:
Please state details of where the sessions will be taking place and confirm that all session are held in a secure area
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Do you have a current DBS check?
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Yes
No
What experience do the horses/ponies have doing this activity?
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What is the minimum age of session participants?
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Please state the ratio of participants to employees/handlers:
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Please state the ratio of participants to ponies:
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Do you have a written Health & Safety policy with risk assessments in place?
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Yes
No
Do you have an Accident Report Book?
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Yes
No
If yes, is it updated if an accident occurs?
Yes
No
Have full risk assessments of the horses/ponies been carried out, with written records kept?
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Yes
No
Do you have a valid licence if required to hold one by your local authority?
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Yes
No
Have any of the horses/ponies ever shown any signs of abnormal behaviour, for example but not limited to: kicking, biting, bucking, bolting etc.
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Yes
No
Will you provide personal protective equipment (PPE)?
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Yes
No
If yes, what items are provided?
Will the PPE be checked regularly with written records of the checks kept?
Yes
No
Do any of the paddocks have a public right of way running through them?
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Yes
No
Are paths adequately signposted to make members of the public aware of any grazing horses?
Yes
No
Please provide full details including the approximate distance of all paths under your control:
Are the paths fenced off preventing the public from accessing any horses?
Yes
No
What type of fencing surrounds the paddocks?
How frequently are the fences checked?
How far is the nearest paddock to the public highway?
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Do you have any employees (paid or voluntary)?
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Yes
No
Please note you are legally required to arrange Employers' Liability for paid employees and for paid self-employed persons working under your direction.
If yes, how many?
Please provide your employers reference number (ERN) (if applicable)
Do you have written staff induction/training records?
Yes
No
Please detail below the name, age and qualifications/experience of all persons engaged in the instruction or accompaniment of the equine assisted therapy.
If you have employees, will yourself as the policy holder/owner be present at all times or will the employees run the sessions?
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Yes
No
Has any insurer in respect of any of the risks to which this proposal refers, declined to insure you, cancelled or refused to renew your insurance or imposed special terms?
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Yes
No
If yes, please provide details:
Have there been any losses suffered, or events occurred which might have resulted ina claim, whether or not claimed for, during the last five years, in respect of any of the activities for which cover is required?
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Yes
No
If yes, please provide details:
Have you or any of your officers, business partners or directors, ever been convicted of any criminal offence other than a driving offence or have any non-motoring prosecutions pending? You only need tell us about any convictions that are unspent under the Rehabilitation of Offenders Act 1974.
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Yes
No
If yes, please provide details:
Have you or any of your officers, business partners or directors, ever been declared bankrupt or insolvent?
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Yes
No
If yes, please provide details:
Have you or any of your officers, business partners or directors, ever been investigated or convicted under the Fraud Act 2006, or equivalent legislation?
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Yes
No
If yes, please provide details:
How would you prefer to be contacted by Cliverton?
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Phone
Email
How did you hear about Cliverton?
*
Please Select
Google search
Facebook
Instagram
TikTok
Horse & Rider magazine
Horse and Hound magazine
National Equine Show
BETA
The Equine Index
Equine 24/7
Family or friend
Word of mouth
Other
If 'other', please state where:
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Would you like to receive news and updates from Cliverton?
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Yes
No
Fair presentation of risk
Not making a fair presentation of the risk, or not advising us of any errors in the information provided may result in a breach of the fair presentation of risk. Depending on the nature of the breach and what would have happened had the information been accurate, the insurer may choose to: 1. Declare your policy void (treating your policy as it had never existed), 2. Change the terms of your policy, 3. Refuse to deal with all or part of any claim or reduce the amount of any claim payment, 4. Cancel your policy. If any of the information within the documents provided is incorrect, you must advise us. We reserve the right to change the terms and conditions, premium or withdraw this quotation. I/we confirm that as far as I am/we aware the statements made by me/us or on my/our behalf in connection with this insurance are true and complete. I/We agree to accept a policy in the Company's usual form for this class of business.
SUBMIT
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