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 email@example.com
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?*
Full name of group*
Main contact name*
2nd contact name*
When was your group formed?*
When did you start working with Keep Wales Tidy?*
Is your group constituted?*
How many members does your group have?*
On average, how many volunteers attend each event?*
Are you part of a parent organisation?*
If yes, please state which organisation
Please provide a brief description of your activities and nature of your work
note that certain activities will be excluded under Endorsement 215 '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.
Other (please specify)
The following two statements are compulsory to obtaining insurance from Keep
Please tick so that you understand these criteria.
Does your group fell trees?*
Do you use chainsaws?* If yes, an additional charge applies
Do all chainsaw users hold a valid qualification and correct ppe?
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?*
Do you work near rail 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
Do you need extra tool cover?*
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
Payment should be made to:
Account Name: Keep Wales Tidy R/C 1082058 Sort Code: 08-90-03 Account No:
* 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
* 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.’
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.
Position in group*
If you have any queries about completing this form, contact your Keep Wales Tidy
Project Officer or the Group Insurance Secretariat at firstname.lastname@example.org
Need help with our online reporting system? Your local project officer can take you through the process step-by-step.
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