MANN BROADBENT (AMATEUR SPORTS INSURANCE) PERSONAL ACCIDENT & COMBINED LIABILITY INSURANCE SCHEME

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1 PAGE 1 OF 3 Schedule Certificate Number Insured Name Insured Address WMBPL PONTHIR FOOTBALL CLUB Sport Insured Insured Persons Endorsement(s) Applicable Part Time Registered Players Included Football Any registered members, playing members, trainers and coaches of the Assured One No Period of Insurance Policy Effective Date Policy Expiry Date Date of Issue 30th September 2011 Policy Premium Reason for Issue Personal Accident Premium Public Liability Premium Employers Liability Premium Insurance Premium Tax Sub Total Policy Administration Fee Legal Expenses (Underwritten by ARAG plc) Total Premium New Business (@ 5.00%) Broker Agent Details Broker Name Broker Address Mann Broadbent Limited 2 Foundry Street Worcester WR1 2BJ Number of Teams No. of Teams Age Limit CAT A: ADULT CAT B: OFFICIALS CAT C: JUNIOR to 60 years 16 to 75 years 5 to 16 years

2 PAGE 2 OF 3 Section 1 Personal Accident - Schedule of Benefits ITEM 1 Death BENEFITS PAYABLE IN RESPECT OF ACCIDENT 2 Permanent Total Loss of Sight of One Eye 3 Permanent Total Loss of Sight of Both Eyes 4 Loss of One or More Limb(s) 5 Permanent Total Loss of Speech 6 Permanent Total Loss of Hearing (a) In One Ear (b) In Both Ears 7 Permanent Total Disablement (other than loss of sight of one or both eyes or loss of limb(s), or loss of Speech and Hearing in one or both ears) SUM INSURED (each Insured Person) CAT A: ADULT 2,500 8 Temporary Total Disablement during such disablement but but not not beyond beyond 104 number Weeks weeks from the from date the on which date the on Insured which the Person Insured first became Person first disabled became and excluding disabled and the first excluding 14 Days the of first disablement number days each of claim disablement each claim per week Maximum Sum Insured Any One Occurrence CAT B: OFFICIALS CAT C: JUNIOR 2,500 1,250 Section 2 Combined Liability Sub Section A Employers Liability Sub Section B Public and Products Liability Sub Section C Legal Defence Costs applicable to Unpaid Volunteers only Excess applicable to Sub Sections B & C 100,000

3 PAGE 3 OF 3 ADDITIONAL BENEFITS APPLICABLE TO ALL CATEGORIES Dental Expenses In the event of of accidental bodily bodily injury injury of an of Insured an Insured Person Person sustained sustained whilst playing whilst or playing officiating or officiating for the Assured for the Assured Club at home Club at or home away or fixtures, away fixtures, Underwriters Underwriters will pay up will to pay a maximum up to a maximum of 250, should of 250, as should a result as of a such result accidental of such accidental bodily injury, bodily the Insured injury, the Person Insured requires Person Dental requires Treatment. Dental Treatment. It is a condition of this section that any Dental Treatment required must be carried out by a legally qualified Dental Practitioner. Underwriters shall not be liable for: a) The first 25 of each and every claim b) Loss of or damage to crowns, dentures, bridges, veneers or any other dental appliances or the like Hospital Daily Benefit The Underwriters will pay pay a a benefit benefit of of per per day day for each for each completed completed 24 hour 24 period, hour period, up to up a maximum to a maximum of 14 days of 14 in days all, should in all, the should Insured the Insured Person require Person hospital require in-patient hospital treatment in-patient following treatment an following accidental an bodily accidental injury sustained bodily whilst injury playing sustained or officiating whilst playing for the or Assured officiating Club for at the home Assured or away Club fixtures. at home or away fixtures. Underwriters shall not be liable for the first 72 hours of in-patient treatment. Operative Time This Insurance shall only cover the Insured Person(s) whilst: Categories A & C 1. as an active participant in Organised Training Sessions, excluding the preparation of pitches and equipment 2. in travelling directly or from away Matches provided that the Company will not be liable for more than twenty registered players and one trainer/coach 3. in Matches for and on behalf of the Insured on the day stated 4. in any social activity organised by the Club on premises belonging to or hired by them Category B 1. in attending or travelling directly to or from any committee meeting function or engagement which forms part of the Insured Person s official duties 2. in travelling directly to or from away Matches 3. in the preparation of pitches 4. in attending Matches 5. as an active participant in organised training/coaching sessions 6. in any social activity organised by the Club on premises belonging to or hired by them

4 AMATEUR SPORTS CLUB PERSONAL ACCIDENT ENDORSEMENT PAGE 1 OF 1 V04 This endorsement attaches to and forms part of Certificate No. WMBPL Endorsement Number The Insured Person(s) 1 Any registered playing members, trainers and coaches of the Assured The Assured Endorsement PONTHIR FOOTBALL CLUB It is hereby understood and agreed that:- With effect from inception, date the following the following benefit benefit is provided is provided as as an an extension to to the above Certificate in respect of Category C ONLY:- BENEFIT PAYABLE IN RESPECT OF ACCIDENT Fracture to one or more bones of the arm as a result of an accident. Arm bones are the humerus, the radius, the ulna and the carpus. Fracture to one or more bones of the leg as a result of an accident. Leg bones are the femur, the tibia, the fibula and the tarsus. Fracture to collar bone, cheek bone, pelvic bone or hip bone. Fracture to one or more bones of the finger or toe SUM INSURED Fracture shall mean the breach in the structure of bones produced by accidental bodily injury, and shall not include hairline fractures, and which necessitates hospital treatment and application of a plaster/solid cast or splint or other medical treatment to aid the recovery of the fracture. Additional Premium: 0.00 Insurance Premium Tax: 0.00 Total Additional Premium: 0.00 SUBJECT OTHERWISE TO THE TERMS AND CONDITIONS OF THE CERTIFICATE Richard MacNaughton Senior Underwriter Date of Issue:

5 CERTIFICATE OF EMPLOYERS LIABILITY INSURANCE (a) (Where required by regulation 5 of the Employers Liability (Compulsory Insurance) Regulations 1998 (the Regulations), one or more copies of this certificate must be displayed at each place of business at which the policy holder employs persons covered by the policy) Policy No WMBPL Name of policyholder PONTHIR Example FOOTBALL name and CLUB trading title 2. This Certificate of Employers Liability Insurance is in respect of unpaid volunteers only 3. Date of commencement of insurance policy 4. Date of expiry of insurance policy hh mm DD MM (in words) YYYY 30th September 2011 Midnight DD MM (in words) YYYY We hereby certify that subject to paragraph 2:- 1. the policy to which this certificate relates satisfies the requirements of the relevant law Applicable in Great Britain, Northern Ireland, the Isle of Man, the Island of Jersey, the Island of Guernsey and the Isle of Alderney (b); and 2. (a) the minimum amount of cover provided by this policy is no less than 10 million (c) Signed on behalf of those Lloyd s Underwriters subscribing to the above policy (Authorised Insurer) Notes (a) Where the employer is a company to which regulation 3(2) of the Regulations applies, the Certificate shall state in a prominent place, either that the policy covers the holding company and all its subsidiaries, or that the policy covers the holding company and all its subsidiaries except any specifically excluded by name, or that the policy covers the holding company and only the named subsidiaries. (b) Specify applicable law as provided for in regulation 4(6) of the Regulations (c) See regulation 3(1) of the Regulations and delete whichever of paragraphs 2(a) or 2(b) does not apply. Where 2(b) is applicable, specify the amount of cover provided by the relevant policy THE EMPLOYERS LIABILITY (COMPLUSORY INSURANCE) REGULATIONS 1998 REQUIRED YOU TO KEEP THIS CERTIFICATE OR A COPY FOR 40 YEARS. A copy of the certificate must be displayed at all places where you employ persons covered by the policy. Sagicor Underwriting Limited Registered in England Number Registered Office: 1 Great Tower Street, London, EC3R 5AA Authorised and regulated by the Financial Services Authority Issuing intermediary s reference: WF084259T