Greengrocers Application Form

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IOMST is Irelands largest and most established market, event, entertainers /performers, classes membership organisation. In conjunction with Insurers, AIG and Brokers, Richardson Insurance Solution DAC, membership of IOMST provides access to our public/ product & employers liability scheme which provides the widest level of cover available.

Simply call us on 01-8360945 Email info@iomst.ie Or fill in our application form below.

All insurance is placed by Richardson Insurance Solution DAC and underwritten by AIG Europe S.A

Whether you trade from your shop, markets, events, sell online or deliver, IOMST can help you.

Please select type of membership

Please complete all fields.:

Proposed Member Details

Name in Full:

Trading Name:

Company Name:

Address:

Phone/Mobile:

Date of Birth:

Email:

Where did you hear about us:

If not mentioned above, please provide were you heard about us.

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Trading Details

1. Please provide full details of business, goods sold/ services and/or activities:

2. Do you hold, or have you previously held, Public Liability?

If yes, please provide the name and address of the insurer and the renewal date of the policy.

Name: Expiry Date:

3. Which of the following best describes your business.

If other, please advise.

4. Cover required for. If other, please advise. Please give details.

5. Will you be cooking or heating food, drinks or services involving heat.
If yes, Please give details of equipment used.

6. Do you provide any additional services.
1.
2.
3.
4.
Details.

7. If you know the date you would like cover to be effected from, please advise.
Please note cover cannot be back dated.

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Declaration

8. Please confirm the cover required.

Public Liability

Products Liability – food and drink products only

Non-food Product Liability – non-food Products (available only with Public Liability)

Products Liability is available for other products. Please provide full details so this can be considered.

Employers Liability (not included in cost of Public Liability)

If yes, please state the maximum amount of employees/helpers at any one time. (cover is recommended).

9. Have you ever been convicted/ charged with a criminal offence (excluding motor)?

If yes, please provide details.

10. Has any insurer ever declined a proposal, cancelled or refused renewal or required special terms on any of the insurances for which you are now proposing?

If yes, please provide details.

11. Have you suffered any claim or loss (whether insured or not) in connection with Employers, Public or Products Liability over the last 3 years?

If yes, please provide details.

Our limit of indemnity for Employers Liability is € 13,000,000.
Our limit of indemnity for Public or Products Liability is € 13,000,000.
Products Liability €13,000,000 automatically applies to food and drink.
Other products can be included where agreed by insurers.

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I/we declare that the statements and particulars given in this proposal are, to the best of my/our knowledge and belief, true and complete and that this proposal will form the basis of my/our membership of IOMST.*Please Agree to Proceed

I/we confirm that I/we am/are giving my/our permission for the information we provided in this form to be used for the purposes set out in the Data Protection section https://www.iomst.ie/iomst-privacy-policy .

Please note that the details you are being asked to supply may be used to provide you with information about other products and services from third parties. The fact that you choose not to receive such information will not affect any aspect of the facilities that are provided to you now or in the future.

Please note:
Your quotation will be sent via email to the email address supplied above, generally within an hour of receipt of your details (during business hours). Please ensure you check your email junk/spam folder in addition to your inbox for your quotation details. If you have not received any correspondence, please get in touch and we will resend.

Make sure you tick the, i/we buttons above to submit