Name:*

Address:*

Town:*

Postcode:*

Email:*

Telephone:*

Value of marquee, tables, chairs, lighting etc: £:*

Value of Portable Structures: £:*

Value of Generators: £:*

Is Public Liability Required ?*

Public Liability Sum Insured:

From:*

(yy//mm/dd)

To:*

(yy/mm/dd)

Proposed site:*

Type of event:*