FORM FOR IBF/BCSA/GUK COACHES/INSTRUCTORS REGISTRATION

March 28th 2016 Fee 100  This allows you to Coach IBF/BCSA/GUK Members

Plus

Members of other organisations on an occasional basis

Personal training is not included in this cover

Expires March 27th 2017

All questions to be completed fully in block capitals. All Coaches/Instructors must be registered with the DBS, have a recognised First Aid Certificate and hold a valid Coaching Qualification or Instructors Certificate of Competence

 Limit of Indemnity 1million

Please Note : Insurance will not commence until a correctly completed  and signed proposal form and your cheque is received by our insurance broker LRO Insurance. All cover is subject to the terms, conditions and exceptions of the master policy held by our broker and is available for inspection upon request. Please read the following declaration, sign at the bottom and return this form, together with your cheque.

Declaration: I declare that to the best of my knowledge and belief there are no known incidents or circumstances that might give rise to a claim.  

 

 Signed    ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. Date ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... .

You can pay over the internet via Internet Banking or

Paypal (sombogb@blueyonder.co.uk) if using paypal please insure you pay their admin fee or add 5%

or Cheque

Please send form via Email when possible IBFBCSA@googlemail.com

Surname

Christian (First) Name

Address

Town

CountyPO Code

Date of Birth

Club

 
 
 
 
 
 
 
             
Qualification or Certificate First Aid Certificate Years of Coaching Martial Arts Grade if any e.mail Tel No other relevant information