We’re excited to introduce our new online insurance form – making it even quicker and easier to get the cover you need.

Please make sure you answer all of the questions below. If you have any problems, just get in touch with the team. Email group.funding@keepwalestidy.cymru

A Microsoft Word version of the form is available on request.

Have you been constituted for less than 12 months*?

Is this a new application or a renewal?*

1. Your contact details

Main contact details
2nd Contact Details

2. Information about your group

Is your group constituted?*

Are you part of a parent organisation?*

3. Information about your activities

Which of the following environmental activities does your group undertake?

Do you hold any fundraising activities or community events?

If yes, please tick all that apply

NB: higher risk activities eg firework displays/bouncy castles will not be covered so please ensure that you or the hiring company has their own liability cover in place.

4.Risk assessment

The following two statements are compulsory to obtaining insurance from Keep Wales Tidy

Please tick so that you understand these criteria.

Does your group fell trees?*

Do you use chainsaws?* If yes, an additional charge applies

Are you involved in running adventure play facilities, BMX tracks, skate parks or any other similar activity?*

Do you have any play equipment used by children?*

Do you use the application of heat in any of your activities?*

Do you work on/in any of the following?*

Please note that work on tunnels, mine shafts, in quarries and involving construction of public roads is excluded from the policy. Tick all that apply

Do you work near rail tracks?*

N.B. Cover will only apply when at least 20 metres away from tracks.

Do you carry out work/activities involving explosives or excavation?*

Has your group had any insurance claims in the last 3 years?*

Do you require your public liability limit to be increased from £5million to £10million? (This is only necessary if specifically requested by landowner and evidence should be attached with application). If yes, an additional charge applies*

Do you need extra tool cover?*

5. Cost

Keep Wales Tidy has arranged and purchased this insurance scheme on block on behalf of groups in order to provide simple, affordable, insurance cover. The scheme is subsidised by Keep Wales Tidy, so we ask groups to pay a contribution towards the cost.

Contributions vary, depending on what cover you require, how active your group is and what period your insurance cover runs for.

How much extra tool cover do you require? (Please note; permanent structures are not covered under the policy (i.e. sheds, greenhouses, fences, etc.)

How many hours of activity does your group do each month?*

Additional donation to support the work of Keep Wales Tidy

Total: £

Payment should be made to:

Account Name: Keep Wales Tidy R/C 1082058
Sort Code: 08-90-03
Account No: 65576964

NB: Please use your group name as a reference for the payment.

* The prices listed are for 12 months cover. If you join part-way through the year, the cost will be lower. Please speak to KWT for a revised price before transferring payment.

* The number of hours the group are out on average each month

* Cover is subject to ‘experienced persons only who have received the relevant training and that the required protective clothing is worn at all times.’

6. Declaration

Keep Wales Tidy Data Protection Statement

An electronic copy of this information will be retained. The information will be used by Keep Wales Tidy for administration purposes of the scheme and will be shared with the insurance broker and insurance company. It will also be shared with the local KWT project officer so they can support you in your work. The data will be destroyed/deleted within 36 months from the end of the cover period. Contact details will only be disclosed to third parties to enable Keep Wales Tidy to process your application.

Please sign the declaration and agree to Keep Wales Tidy using your data as described above.

If you have any queries about completing this form, contact your Keep Wales Tidy Project Officer or the Group Insurance Secretariat at group.funding@keepwalestidy.cymru

Get in touch with your local project officer

Need help with our online reporting system? Your local project officer can take you through the process step-by-step.

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