Group personal accident insurance. Sport. Adult and youth football teams Summary of benefits Basic and Superior policy summary

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1 Sport Lower premiums and enhanced cover for the 2013/14 season Group personal accident insurance Adult and youth football teams Summary of benefits and policy summary Valid from 1 July 2013 Appointed by The FA

2 Protection for your most valuable assets As The FAs appointed broker to deliver the National Game Insurance Scheme, we have worked in conjunction with The FA and County Football Associations to create personal accident products for adult and youth football teams. Why have personal accident insurance? If you become injured whilst participating in a club activity, you can incur significant financial losses as a result. Personal accident insurance can help offset some of these unexpected expenses. This insurance can pay out a set amount if someone is injured in an accident and the payout can be a lump sum or a weekly amount. About Bluefin Sport We are a national provider of insurance and risk management solutions to the world of sport and our approach has helped to make us one of the UK s leading sport insurance brokers. We are currently the number one provider of football insurance in the UK with clients ranging from grassroots through to the professional levels of the game. Working alongside Bluefin Sport, The FA hopes to significantly improve the insurance available to the national game Kelly Simmons, Director of National Game and Women s Football Our partnership with The FA Testament to our success in football was our appointment by The FA as the approved insurance broker to deliver the National Game Insurance Scheme (NGIS). Alongside other products, the provision of personal accident insurance forms a major part of the NGIS. Together with The FA, we want to encourage this additional protection for all those involved in the game. It ensures all participants have protection in the event of an injury and because this is a non negligence cover it can help reduce litigation in the game. For example, unlike a liability policy you do not have to find someone to be at fault for an injury to receive compensation. When does cover apply? Although you can purchase insurance at any time, your cover will not start until the 1 July 2013 (or later if you apply after 1 July). All policies whenever bought will expire on 30 June of each given year and will renew annually. This is to fall in line with County FA affiliation processes. NOTE: If you purchase your policy after 1 October 2013 your premium will be calculated on a pro rata basis to reflect the time on cover to the 30 June. This will be calculated automatically online and return premiums are issued if applying by post). The policies operate whilst at any ground or premises worldwide (please see exclusions) where there is an agreed fixture or training and includes travelling directly to and from such activities. In addition the policy cover has been extended to include all club social events (please see exclusions). The life cover is included and operative whilst training and playing football matches only. Who is covered? The policy automatically includes: players. trainers. committee members. club officials. managers. If you require cover for a veterans team contact us at nationalgame@bluefingroup.co.uk or

3 Appointed by The FA Cover designed to suit your requirements We offer a or package for both adult and youth teams. This means you can pick and choose the levels of benefits you need and what you can afford. or? cover is our minimum benefit level entry policy to provide a cost effective solution for those operating on a low end budget. It does not include any weekly benefits. The cover provides: Cover for serious and long term injuries. Options to upgrade to Extra to include a broken bones benefit (adult team option only). cover options are for those looking to increase benefit levels and tailor the cover to suit their needs. The cover provides: All the cover benefits plus a vast range of additional benefits covering both long term and short term injuries. Choice of a weekly benefit amount for adult teams. Ability to include a range of optional extra benefits. What are the main exclusions? lnfluence of alcohol, solvents, drugs or medication unless prescribed. Being a professional footballer. Member of the armed forces. Engaging in a criminal act, riot or civil commotion. Motorcycling other than mopeds or scooters up to 50cc. Club social events that include fireworks, bonfires, driving events, bouncy castles, water sports or any activity above 3 metres off the ground. Travel to Afghanistan, Iraq, Ivory Coast, Somalia, Nigeria, Pakistan, Venezuela, Columbia, Mexico, Yemen or Chechnya. Please see the policy for full details of exclusions. Supporting grassroots football By joining the many thousands of clubs already insured via the NGIS you are helping to provide grassroots football with lower costs. By purchasing these products and supporting the NGIS you are helping to secure a sustainable future for the national game. Why choose us? We re The FAs appointed broker and provide the official National Game Insurance Scheme products. 60% of County Football Associations and The FA recommend us. Ability to buy online or apply by post. Supporting The FAs new Whole Game System (WGS). No pre-existing condition exclusions in respect of accidental bodily injury (with exception of dislocations). No limit to number of players/club officials in a team. Wide policy wording definitions. Permanent total disablement from usual occupation. (This means the benefit is paid out if you are unable to continue your current (usual) job due to disablement. Many policies only pay this benefit if you are unable to undertake any job again). Long benefit periods. and range of options to tailor the policy cover. Legal and counselling advice helplines included at no additional cost providing support when you need it most. BACS claims payment (optional). Monthly instalments available for premiums of 80 and over. Online only over 5 months at 6% (APR Typical 21.7%). A&E departments in England have seen a 14% rise in sports injury cases in a year. Just over 388,500 cases were treated in the 12 months to February 2012 Source: NHS

4 The policy benefits Helping to spread the costs We understand that the current economic climate provides many financial challenges for grassroots clubs and their members. Adult team covers 50% premium discount for adult small sided teams If you purchase your cover online, we can provide a competitive monthly instalment facility enabling you to spread the cost of your insurance over 5 months at 6% charge (APR Typical 21.7%) for premiums of 80 and over. For example: 30 = 82 per team. 5 x payment of a month per team, which includes the 6% charge of 4.92). Visit bluefinsport.co.uk/ngis to get a quote today. Efficient claims service Clubs will experience additional claims payment efficiency with the insurers optional BACS payment facility ensuring injured persons receive benefit payments direct to their bank account. Your demands and needs This product is designed to meet the demands and needs of football clubs that wish to protect their members against consequences of accidents whilst playing in, training for or travelling to a club fixture resulting in accidental; injury, death or disability. The level of cover you choose will dictate whether cover includes a weekly benefit for temporary disability in addition to the one-off lump sums for permanent disability. The levels of cover are explained more fully on the following pages. This statement does not constitute advice or a personal recommendation for our personal accident insurance products. Should you require advice please contact us. The next step Details of the premiums and covers can be found in this document. For instant quotations and cover visit our website where you will also find useful information relating to the NGIS. Please contact our dedicated team if you require any advice or assistance nationalgame@bluefingroup.co.uk bluefinsport.co.uk/ngis 26per team Accidental death 30,000 Life cover 7,000 Permanent total disablement 1 (including permanent partial disablement) Loss of sight in one or both eyes Loss of one or more limbs Up to 50,000 30,000 30,000 Option to include: 1 Many personal accident policies will only pay under this benefit if you are 100% disabled but our policy will pay a percentage relative to your level of disability - this is known as permanent partial disablement. Policy notes: (TTD = Temporary Total Disablement) Which policy should I get? Extra Additional 20per team benefit 50 (legs, collar arms &/or cheek) The maximum age limit for players is 55 and club officials 75 years of age. If you have any players and officials above this age please refer to Bluefin sport as cover may be arranged for them. Life Cover will commence at attainment of 6 years of age and will cease at attainment of 50 years of age. 2 Cover excludes the first 14 days of incapacity. If insured persons are not in paid employment but is a student then a maximum benefit of 25 per week is payable with a 6 week benefit period. The TTD benefit only applies to an insured person who are in paid employment of 16 hours per week or more. The TTD benefit does not apply to those individuals without paid employment or who are employed less than 16 hours per week or whose sole employment is football There is no cover for professional footballers. Aggregate limit 2,000,000. (This is the maximum amount that the insurer, ACE, will pay per event in total under this and any other policies issued by ACE) Sadly we experienced a claim for the accidental death benefit in the 2012/13 season which highlights why it remains so vital to have at least the level of cover in place for your team(s). Thankfully incidents of this nature aren t a common occurance but the short term injuries, such as a broken arm or leg can be. This can lead to time off work if you are an adult in employment or additional costs if you need to take time out to care for an injured youth player. To ensure you provide wider protection for your players and officials you should consider purchasing the range of benefits. You still receive all the benefits but you can include many more meaningful benefits for the more common incidents. The premiums shown are inclusive of Insurance Premium Tax of 6%. Exclusions and limitations apply. For full terms and conditions please contact Bluefin Sport. Copyright 2013 Bluefin Insurance Services Limited. All Rights Reserved.

5 By purchasing these products you are helping to provide grassroots football with lower costs. With your support of NGIS you are helping to secure a sustainable future for the national game. Instalments - pay over 5 months for premiums of 80 or more. Available for online purchases only. Choose a weekly benefit: Option to include: Includes all benefits: Accidental death 30,000 Life cover 7,000 Permanent total disablement 1 (including permanent partial disablement) Loss of sight in one or both eyes Loss of one or more limbs Plus the following: Choice of weekly TTD benefit 2 level Benefit period 104 weeks (legs, collar arms &/or cheek ) Primary dislocation of kneecap, elbow, shoulder or hip INCLUDED AS STANDARD FOR 2013/14 30, 50, 75, 100 or Loss of speech 30,000 Loss of hearing both ears Loss of hearing one ear NEW for 2013/14 30,000 6,250 Loss of internal organ 30,000 Emergency dental (pain relief) Emergency medical expenses Rehabilitation and retraining Home/car adaptation expenses Extra travel expenses Benefit period 4 weeks Coma benefit Benefit period 365 days Hospitalisation Benefit period - 30 days Legal advice and counselling helplines Home help (TTD extension) Up to 50,000 30,000 30,000 Up to Up to 2,500 Up to 10,000 Up to 25 per week 25 per day 25 per day 24/7 Includes being a f/t housewife or househusband as an occupation 30 82per team to include: TTD weekly benefit 2 30 per wk per team to include: TTD weekly benefit 2 50 per wk per team to include: TTD weekly benefit 2 75 per wk per team to include: TTD weekly benefit per wk per team to include: TTD weekly benefit per wk TTD = Temporary Total Disablement Save money - buy online (No policy fees) Extra Additional 35per team Increase broken bones benefit from 100 to 250 Include dental expenses following an accident up to 250 Physiotherapy. 50% of costs up to max 25per week/6 sessions average per person This product is sold per team not per person. The amounts below are purely to illustrate the average cost per person for a year based on an average sized 11 a side team of 15 members: Plus per person 3.07 per person 5.47 per person 9.33 per person per person per person per person Please note: Our policies do not have a restriction on numbers within a team so even greater savings per person can be achieved if you have more than 15 members in each team. Do you have players over 55? No problem. Call us on Or visit bluefinsport.co.uk/ngis Please note: 5 administration fee will need to be added to the total premium for all postal applications

6 The policy benefits Youth team covers 1. Choose or cover Please note that steps 2 and 3 only apply if cover selected 2. Decide if you wish to Silver Gold 14 per U13 s team & above 10 per U12 s team & below Accidental death 10,000 Life cover 7,000 Permanent total disablement 1 (including permanent partial disablement) Loss of sight in one or both eyes Up to 25,000 25,000 Loss of one or more limbs 25,000 Loss of speech 25,000 1 any personal accident policies will only pay under this benefit if you are 100% disabled but our policy will pay a percentage relative to your level of disability - this is known as permanent partial disablement. It does happen! A ball hit a young boy direct in the face causing a detatched retina. The policy paid out 50,000 under the loss of sight benefit and the club paid just 26 for the insurance. 23 per U13 s team & above or 16 per U12 s team & below Accidental death 10,000 Life cover 7,000 Permanent total disablement 1 (including permanent partial disablement) Loss of sight in one or both eyes Loss of hearing (one ear) 6,250 Loss of internal organ 6,250 Emergency medical expenses 100 Emergency dental (pain relief) (legs, collar, arms &/or cheek) (fingers and toes) Rehabilitation and retraining Home/car adaptation expenses Weekly benefit 2 for club officials (Temporary Total Disablement -TTD) Benefit period 52 weeks 14 day deferment period 3 Hospitalisation Benefit period -30 days Coma benefit Benefit period days Legal advice and counselling helplines Up to 30,000 25,000 Loss of one or more limbs 25,000 Loss of speech 25,000 Loss of hearing (both ears) 25, Up to 2,500 Up to 10, per week 15 per day 25 per day 24/7 31 per U13 s team & above or 23 per U12 s team & below Accidental death 10,000 Life cover 7,000 Permanent total Up to 50,000 disablement 1 (including permanent partial disablement) Loss of sight in one 50,000 or both eyes Loss of one or more 50,000 limbs Loss of speech 50,000 Loss of hearing (both ears) 50,000 Loss of hearing (one ear) 12,500 Loss of internal organ 12,500 Emergency medical expenses 200 Emergency dental (pain relief) (legs, collar, arms &/or cheek) (fingers and toes) Rehabilitation and retraining Home/car adaptation expenses Weekly benefit 2 for club officials (Temporary Total Disablement -TTD) Benefit period 52 weeks 14 day deferment period 3 Hospitalisation Benefit period -30 days Coma benefit Benefit period days Legal advice and counselling helplines up to 2,500 Up to 10, per week 15 per day 25 per day 24/7 The premiums shown are inclusive of Insurance Premium Tax of 6%. Exclusions and limitations apply. For full terms and conditions please contact Bluefin Sport. Copyright 2013 Bluefin Insurance Services Limited. All Rights Reserved.

7 To ensure you are buying the official NGIS products make sure you look out for this logo... Instalments - pay over 5 months for premiums of 80 or more. Available for online purchases only. increase benefit levels 3. Choose any optional extras (not available if cover only selected.) Platinum Youth Weekly 16-18yr olds Student Tutorial 36 per U13 s team & above or 27 per U12 s team & below Accidental death 10,000 Life cover 7,000 Permanent total Up to 75,000 disablement 1 (including permanent partial disablement) Loss of sight in one 75,000 or both eyes Loss of one or more 75,000 limbs Loss of speech 75,000 Loss of hearing (both ears) 75,000 Loss of hearing (one ear) 18,750 Loss of internal organ 18,750 Emergency medical expenses 250 Emergency dental (pain relief) (legs, collar, arms &/or cheek) (fingers and toes) Rehabilitation and retraining Home/car adaptation expenses Weekly benefit 2 for club officials (Temporary Total Disablement -TTD) Benefit period 52 weeks 14 day deferment period 3 Hospitalisation Benefit period -30 days Coma benefit Benefit period days Legal advice and counselling helplines up to 2,500 Up to 10, per week 15 per day 25 per day 24/7 Additional 16 per team of 16 to 18 yr olds Weekly benefit (temporary total disablement) 35 per week for 16 to 18 year olds employed for at least 16 hours or more. (Benefit period 52 weeks. 14 day deferment period 3 ). Parent / Legal Guardian Inconvenience Benefit Additional 4 per U13 s & above team or 3 per U12 s team & below Up to 100 in the event of unforeseen travel costs in the event of an accident. Policy notes: Expenses relating to home tuition or necessary additional expenses to attend school following an injury. Up to 35 per week after 7 days, 26 week period. Physiotherapy 50% of costs up to max 25 per week/6 sessions. The maximum age limit for players is 18 and club officials 75 years of age. If you have any players and officials above this age please refer to Bluefin Sport as cover may be arranged for them. Life cover will commence at attainment of 6 years of age and will ceases at attainment of 50 years of age. 2 If insured persons are not in paid employment but is a student then a maximum benefit of 25 per week is payable with a 6 week benefit period. The TTD benefit only applies to club officials who are in paid employment of 16 hours per week or more. 3 Deferment period refers to the period at the beginning of a period of temporary total disablement during which benefits are not payable. The TTD benefit does not apply to those individuals without paid employment or who are employed less than 16 hours per week or whose sole employment is football. There is no cover for professional footballers. Additional 10 per U13 s & above team or 8 per U12 s team & below Additional 6 per U13 s & above team or 5 per U12 s team & below Aggregate limit 2,000,000. (This is the maximum amount that the insurer, ACE, will pay per event in total under this and any other policies issued by ACE). Save money - buy online (No policy fees) Or visit bluefinsport.co.uk/ngis Please note: 5 administration fee will need to be added to the total premium for all postal applications

8 At a glance glossary... Accident & accidental Means a single, sudden, unusual, and unexpected event, which occurs at an identifiable time and place during the period of insurance and which causes bodily injury. Accidental death Death caused by accidental bodily injury. Aggregate limit The maximum amount that the insurer will pay per event in total under this and any other policies issued by the insurer to the insured. The name of our range of products designed to provide the minimum basic levels of insurance. Benefit period Means the maximum (but not necessarily consecutive) period for which benefits are payable in respect of any insured person for any one accident. The benefit period commences at the end of the deferment period, if any. Bodily injury Injury which is caused solely by accidental means and which independently of illness or any other cause occurs within 12 months from the date of the accident. Broken bones (adult policies) A lump sum benefit is paid if an accident occurs causing bodily injury and the insured person fractures one or more of the bones listed below: i) Leg (femur, tibia, fibula), ankle (tarsals) or kneecap (patella) ii) Arm (humerus, radius, ulna) or wrist (carpals) iii) Cheek bone (malar) iv) Collar bone (clavicle) Broken bones top up (optional superior extra adult policies) The insurer will pay the insured person an additional amount on top of the Broken Bones benefit specified above. Broken bones (youth policies) A lump sum benefit is paid if an accident occurs causing bodily injury and the insured person fractures one or more of the bones listed below: i) Leg (femur, tibia, fibula), ankle (tarsals) or kneecap (patella) ii) Arm (humerus, radius, ulna) or wrist (carpals) iii) Cheek bone (malar) iv) Collar bone (clavicle) v) Finger or toe Coma benefit Where bodily injury results in coma, insurers will pay the insured person the amount shown in the schedule for each day the insured person remains in a coma up to 365 days. Club officials Includes managers, trainers, referees, committee members and assistant referees. Deferment period A period at the beginning of a period of temporary total disablement during which benefits are not payable Dental injury If an accident occurs during the period of insurance and effective time and causes bodily injury to an insured person and directly results in the loss of permanent natural teeth, insurers will pay up to the amount in the policy for all teeth lost or partially lost. Claims for partial loss of tooth or teeth shall be calculated by assessing the percentage of tooth lost in relation to the maximum benefit payable. This cover does not apply to deciduous (milk) teeth, dental implants, crowns, veneers, dentures, bridges or intra orally wear and tear of teeth. Effective time Whilst at any ground or premises worldwide where there is an agreed fixture or organised training including travelling directly to and from such activities. Cover has been extended to include club social events but excluding hazardous events such as, fireworks, bonfires, driving events, bouncy castles, water sports or anything at a height above 3 metres from ground level e.g. bungee jumping. The life cover is operative whilst training and playing football matches only. Emergency dental (pain relief expenses) External oral impact which results in damage to the insured person s teeth which necessitates immediate emergency pain relief. This does not cover any other procedure other than the relief of pain. Emergency medical expenses If an insured person incurs any additional reasonable emergency medical expenses for immediate and urgent treatment, the insurer will reimburse the insured person up to the amount shown in the policy. Excess An amount you pay towards a claim or that is deducted from the settlement. Extra travel expenses (adult policies) Additional reasonable travel expenses incurred up to an amount provided per week for a maximum period of time as shown in the policy. Home / car Adaptation and home relocation expenses Where bodily injury results in quadriplegia or paraplegia, and the benefit for permanent total disablement becomes payable, insurers will also indemnify the policyholder for expenses incurred, up to the amount shown in the policy, for adapting the insured person s home or car or for relocating to another home to cater for the practical changes involved in living with the disablement. Home help (adult policies) Temporary total disablement cover includes insured persons whose occupations are as full time house wives or house husbands. Home tuition (youth policies) Up to the amount shown in the policy for expenses which relate to providing a home tutor or necessary additional expenses required to attend school where the insured person is a student. Hospitalisation Payable for injuries independent of illness or any other cause, results in their hospital confinement, within twelve calendar months from the date of the accident, insurers will pay the insured person for each complete twenty-four hour period of such hospital confinement up to a maximum benefit as shown in the policy. Inconvenience benefit (youth policies) In the event of unforeseen travel expenses for parents/legal guardians due to an accident the insurers can pay up to the amount shown in the policy. Insurance Premium Tax (IPT) A levy that is a percentage of your premium (currently 6%) applied by the government. This excludes life insurance where there is 0% insurance premium tax applicable. The tax payable is shown as a separate charge on your documentation (Isle of Man and the Channel Islands are exempt from this tax). These insurance policies are exempt from VAT (Valued Added Tax). Legal advice helpline During the period of insurance the insured person may obtain personal legal advice over the telephone. The advice may include but is not limited to: a) Advice where injury has been caused by the negligence of a third party.

9 b) Advice on employment issues including redundancy, bullying, harassment, unfair discrimination and retirement. Life cover A specific sum payable to the insured person s beneficiaries after the insured person s death (whilst playing and training only), the benefit is payable provided the insured person s death was not an accidental death. Life cover will commence at attainment of 6 years of age and will cease at attainment of 50 years of age. Loss of hearing Total and irrecoverable deafness confirmed by audiometer and sound threshold tests. Loss of internal organ Total and permanent: a) loss by removal: or b) effective loss of use of one lung or one kidney, the spleen or the liver. Loss of limb In respect of: a) an arm amputation or complete and permanent loss of use at or above the wrist; b) a leg amputation or complete and permanent loss of use at or above the ankle (talo-tibial joint). Loss of sight To be deemed to have occurred: a) in both eyes when the insured person s name has been added to the register of blind persons maintained by the government on the authority of a qualified ophthalmic specialist; or b) in one eye when the degree of sight remaining after correction is 3/60 or less on the Snellen Scale (which means the insured Person is only able to see at 3 feet that which they should normally be able to see at 60 feet) and ACE is satisfied that the condition is permanent and without expectation of recovery. Loss of speech Total and permanent loss of speech. Material Fact You must ensure that all of the information provided to the insurer in the application form, by correspondence, over the telephone, on claim forms and other documents is true, complete and accurate. You should note that providing incomplete, false or misleading information could affect the validity of the ACE insurance policy and may mean that all or part of a claim may not be paid. Permanent disabling injury Means loss of sight, loss of hearing, loss of speech or loss of limb. Permanent partial disablement A percentage of the permanent total disablement benefit will be paid relative to the level of disability: 1. Permanent total disablement 100% 2. Total loss of use of: a. back or spine (excluding cervical) without cord involvement 40% b. neck or cervical spine without cord involvement 30% c. shoulder, elbow or wrist 25% d. hip, knee or ankle 20% 3. Loss of or total loss of use of: a. foot below the level of the ankle(talo tibular joint) 50% b. thumb 20% c. one forefinger or big toe 15% d. any other finger 10% e. any other toe 4% Permanent total disablement Disablement other than any permanent disabling injury which has lasted for at least 12 months and which in the insurers opinion is beyond hope of recovery and will in all probability continue for the remainder of the insured person s life will prevent the insured person from engaging in or giving attention to: a) their usual occupation if in gainful employment; b) business profession or occupation of any and every kind if the insured person: i) is not in gainful employment ii) is employed solely as a footballer iii) has football as their main employment; c) business schooling profession or occupation of any and every kind if the insured person is under 16 years of age or under 18 years of age and in full time education for the remainder of their life. Physiotherapy cover If an accident occurs during the period of insurance and effective time that causes bodily injury to an insured person and directly results in a valid: 1. Temporary total disablement claim or 2. Broken bones claim Insurers will pay the insured person 50% of the costs for each session of necessary physiotherapy incurred within 12 months of bodily injury, up to a maximum of 25 per visit, for total of 6 sessions provided that the insured person has a written referral from their General Practitioner for physiotherapy arising from such bodily injury. Primary dislocation benefit Primary dislocation means the first time an insured person has suffered a dislocation of the following joints; i) Kneecap ii) Elbow iii) Hip The insurer will pay the Insured Person up to the amount shown. Rehabilitation and retraining Where bodily injury results in the permanent total disablement benefit becoming payable for an insured person, insurers will indemnify the insured person up to 2,500 for reasonable costs incurred to rehabilitate and/or retrain the insured person for an alternative occupation, subject to insurers prior written approval being obtained. Student An insured person who is in full time education and enrolled or attends classes at a school, college, or university. The name of our product range that provides upgrade options from our cover range. Temporary total disablement (TTD) Temporary disablement which entirely prevents the insured person from engaging in their usual occupation. Usual occupation The tasks, duties and other functions, which the insured person normally performs in connection with their paid employment for which they are engaged in 16 hours or more per week. permanent temporary disablement (PTD) is paid when an injury prevents you from continuing your usual occupation. Worldwide The policy operates worldwide excluding travel to Afghanistan, Iraq, Ivory Coast, Somalia, Nigeria, Pakistan, Venezuela, Columbia, Mexico, Yemen or Chechnya. The full policy wording can be found on our website bluefinsport.co.uk/ngis

10 About our insurance services 1. The Financial Services Authority (FSA) The FSA is the independent watchdog that regulates financial services. It requires us to give you this document. Use this information to decide if our services are right for you. 2. Whose products do we offer? a We offer products from a range of insurers. We only offer products from a limited range of insurers We only offer a product from ACE European Group Limited to satisfy the Personal Accident insurance requirements of the applicable clubs that are affiliated to their County Football Association. 3. What will you have to pay us for our services? a a A 5 fee for postal applications only No fee for arranging the ACE European Group Limited Personal Accident insurance policy on line. You are entitled, at any time, to request information regarding any commission which we may have received as a result of placing your insurance business 4. Who regulates us? Bluefin Insurance Services Limited, 5 Old Broad Street, London, EC2N 1AD is authorised and regulated by The Financial Services Authority. Our FSA Reference Number is Bluefin Insurance Services Limited permitted business is advising, arranging and administering (including handling claims) general insurance contracts. You can check this on the FSA s Register by visiting the FSA s website or by contacting the FSA on Ownership Bluefin Insurance Services Limited is an insurance intermediary ultimately controlled by AXA UK Plc through our parent, Bluefin Insurance Group Limited. 6. What to do if you have a complaint? If you wish to register a complaint, please contact us: in writing: Complaints Officer Bluefin Insurance Services Limited CI Tower St George s Square New Malden Surrey KT3 4TP by phone: by fax: by insurance.complaints@bluefingroup.co.uk If you cannot settle your complaint with us, you may be entitled to refer it to the Financial Ombudsman Service. 7. Client and Insurer Money When we receive premium payment from you or premium refund from your insurer, ACE European Group Limited, ( ACE ) we hold these on behalf of ACE as determined by the Terms of Business Agreement we have in place with them. This protects you against the risk of our insolvency as the money is deemed to have been immediately received by ACE. However, ACE will not have fulfilled their obligation to pay a premium refund to you until we pay those monies to you. Equally, once we have received a premium payment from you, we shall be unable to refund that premium to you without the consent of ACE. Insurer Money and/or Client Money (that is money held on your behalf or as deemed to be Client Money by the FSA Client Money Rules) will be held in a Non-Statutory Trust Account and in accordance with such rules. A copy of these rules is available at the FSA website Under the terms of a Non-Statutory Trust, general creditors are not able to make claims on such money. We are entitled to use Client Money held on behalf of one customer to pay another customer s premium before the premium is received from that other customer and to pay premium refunds before we receive payment from the insurer. However, we are not entitled to use Client Money to take our commission payments before we receive the relevant premium payment from the customer. We may hold both Insurer and Client Money in the same bank account but when this happens insurers will have previously agreed that any claim by you on monies that are Client Money will come before their claim. Unless we receive your written instruction to the contrary, we shall treat receipt of payment from you and refund of premium which fall due to you, as being within your informed consent to the payment of those monies into a Non-statutory Trust Account. Interest earned on Client and Insurer Money held by us is retained by us. 8. Are we covered by the Financial Services Compensation Scheme (FSCS)? We are covered by the FSCS. You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Further information about compensation scheme arrangements is available from the FSCS. 9. The capacity in which we are acting As an insurance intermediary we usually act as your agent and are therefore subject to the law of agency which imposes various duties on us. In the case of this personal accident insurance we act for and owe duties of care to insurers and the following table is provided to advise you when and how this arises so you will be aware of any possible conflicts of interest. Sourcing a suitable policy (i.e. when we get quotes for you) Placing the insurance (i.e. when we arrange for your cover to start) In the event of a claim We act as your agent We act as agent of the insurer We act as your agent We act as agent of the insurer We will act as your agent We will act as agent of the insurer Delegated Authority - The terms for this policy have been provided using an authority delegated to Bluefin by the insurer. a a a nationalgame@bluefingroup.co.uk bluefinsport.co.uk/ngis Bluefin Sport is a trading name of Bluefin Insurance Services Limited which is authorised and regulated by the Financial Services Authority. Registered Office: 5 Old Broad Street, London, EC2N 1AD. Registered in England No: Sport

11 Group personal accident Application 1) Club details (Please complete sections 1 to 7, ensuring you sign the declaration on the back) Tear out Tear out Club name Contact address Phone Affiliated County FA 2) Number of teams Number of adult 11 a side teams Number of adult 5/7 a side teams 3) Adult team cover Please select level of cover required Please multiply your number of adult teams by the premium selected Would you like any optional extras? Please multiply your number of adult teams by the premium selected 4) Youth team cover Please select level of cover required Please multiply your number of youth teams by the premium selected Would you like any optional extras? Please multiply your number of youth teams by the premium selected 5) Inception date Please confirm the date you wish the cover to start Contact name Postcode * (Please refer to summary of the benefits) / /20 Please note, your cover must operate from 1st July, or later to 30th June each year ) Total premium Please add the total premium due for all your teams (add boxes A to J) Administration fee (No fee online) (Please tick) o o o o o o per 11 a side team per 5/7 a side team (Please refer to summary of the benefits) Parent/ legal guardian benefit Student Tutorial Extra Extra (Please tick) o o per 11 a side team per 5/7 a side team Silver Gold Platinum (Please tick) o o o o per U13 s team & above per U12 s team & below Physio (Please tick) o o o per U13 s team & above per U12 s team & below Affiliated League *By providing your address you consent to receiving policy documentation, renewal invitations and correspondence electronically only. Number of youth U13 s teams & above Number of youth U12 s teams and below NB: Extra additional option is only available if cover purchased and Extra is only available if cover is purchased G H NB: The benefit below only applies to teams consisting of 16 to 18 yr olds so please specify the number of teams you require cover for and multiply by 16. Youth Weekly yr olds (Please tick) per 16-18yr old teams Number of teams J o 16 Add A to J A Please turn over B C D E F I Please note that cover cannot commence until payment has been received and the proposal form accepted by Bluefin Sport

12 7) Declaration (Please read, sign and date) IMPORTANT: Please read the information below. Your application will not be accepted unless the declaration is signed. Definitions Some words in this application form are in bold and have particular meaning. Wherever they appear their particular meaning is given below: We/Us/Our/Ourselves: ACE Europe Life Ltd and ACE European Group Ltd. You/Your: Club Official, Club Secretary, Committee Member. Insured Person: Person(s) specified in the Schedule as being insured person(s). Material Facts Disclosure You must ensure that all of the information provided to the insurer in the Application Form, by correspondence, over the telephone, on claim forms and other documents is true, complete and accurate. You should note that providing incomplete, false or misleading information could affect the validity of the ACE insurance policy and may mean that all or part of a claim may not be paid. Data Protection Statement PLEASE READ this notice as it explains the purposes for which We will use the personal and sensitive personal data (information) which We hold. We accept fully Our responsibility to protect the privacy of customers and the confidentiality and security of information entrusted to Us. Where You have provided information about another person in connection with the purchase and/or performance of this insurance Policy You confirm that they have appointed You to act for them, that they have consented to the processing of their personal data, including sensitive personal data and they have consented to any possible future transfer of their information abroad. You also agree to receive on their behalf any data protection notices from Us. We will use the information You have provided for; customer service handling claims in connection with this accident insurance policy. We may disclose information to Our service providers and agents for these purposes. The information You have provided may also be used for the purpose of fraud prevention including passing details to other insurers and regulatory bodies. In the event that an Insured Person makes an injury related claim, We may need to obtain further Sensitive Personal information such as medical history in order to assess the claim. The claim form will explain in more detail how this Sensitive Personal data is handled. If an Insured Person asks We will provide details of the information We hold in accordance with the applicable law. Any information which is found to be incorrect will be corrected promptly. We may monitor and/or record Your communication with Us either Ourselves or by reputable organisations selected by Us, to ensure consistent servicing levels and account operation. We will keep information about Insured Person(s) only for so long as it is appropriate. Contact Details for Us The Customer Service Manager, 200 Broomielaw, Glasgow G1 4RU Telephone: (Within UK only) A&Hcustserv.complaints@acegroup.com Statement of Fact Neither You or any manager, Club Official(s) or committee member(s) of the club now applying for this insurance have:- been convicted of or charged (but not yet tried) with a criminal offence other than (road traffic) motor offences received an official caution for a criminal offence within the last three years other than a (road traffic) motoring offence. In respect of the club which is the subject of this insurance contract, or any other business which You, Your managers, Club Officials or committee members have been involved with, no insurer has ever:- declined, cancelled or refused any proposal of insurance; cancelled or declined to renew any insurance; imposed special terms or conditions. If You are unable to confirm these statements, You must contact Bluefin immediately. These are all considered to be Material Facts. I declare that I have the authority of the club players and Club Officials to supply any personal details. I declare to the best of my knowledge: i In respect of the persons to be insured no insurer has declined to provide accident insurance or cancelled or refused to renew such insurance; ii The above statements and particulars, whether written by me or by others on my behalf, are true and complete; iii I have not withheld any Material Fact. I agree that this application and declaration shall be the basis of the contract between ACE European Group Ltd and ourselves, and I agree to accept the company s standard form of policy for this class of insurance. Tear out Signature Position within club Date Payment method and where to send For postal applications we can only accept payment in the form of a cheque made payable to Bluefin Insurance Services Please return this form and payment to Bluefin Sport, Castlemead, Lower Castle Street, Bristol BS1 3AG nationalgame@bluefingroup.co.uk bluefinsport.co.uk/ngis Bluefin Sport is a trading name of Bluefin Insurance Services Limited which is authorised and regulated by the Financial Services Authority. Registered Office: 5 Old Broad Street, London, EC2N 1AD. Registered in England No: Sport Tear out Copyright 2013 Bluefin Insurance Services Limited. All Rights Reserved.