Back to STB Insurance EKF Page Name of Instructor Applicant* First Last Name of Applicant's Registered Association/Club*Email* Phone*Postcode*Karate Dan Grade*1st2nd3rd4th5th6th7th8th9th10thCover required*£5,000,000 cover for £56.75, or £10,000,000 cover for £78.75£5,000,000£10,000,000Start Date for Insurance* Date Format: DD slash MM slash YYYY Activities are Karate only?*(cover excludes the use of live/sharp blades)YesNoPlease phone us on 01603 626904 as this will need to be agreed in advanceAny previous claims?*YesNoPlease phone us on 01603 626904 as this will need to be agreed in advanceI confirm I am over 18 years old*YesNoPlease phone us on 01603 626904 as this will need to be agreed in advanceI confirm I have a valid and vetted DBS Certificate*YesNoPlease phone us on 01603 626904 as this will need to be agreed in advanceI confirm I have a valid and current First Aid Qualification or a Qualified First Aider will be present at all times*YesNoPlease phone us on 01603 626904 as this will need to be agreed in advanceI confirm that I am a member of the EKF and that the Information provided is correct at the time of submission*YesNoPlease phone us on 01603 626904 as this will need to be agreed in advanceYour chosen Premium is: £ 0.00 I have read, understood and agree to your terms & conditions*Read our Terms & Conditions Agree Credit or Debit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.
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