"Supporting markets and market traders throughout Ireland with expert advice, assistance and exclusive and competitive
MAST Ltd, Phone 01-2300788 Fax: 01-2300788 Mobile: 087 697 1751 Email: email@example.com
Clarinda Mews, 23 Clarinda Park West, Dun Laoghaire, Co.Dublin, Ireland
MAST Membership Application Form
Proposed member details
Date of birth
Please tick the boxes that apply to you...
Are you a Market/Event Trader?
Are you a Home Baker/Sugarcrafter?
Are you a Street Entertainer?
Do you hold classes/workshops?
Other - please specify..
Are you a Market/Fair/Event Organiser?
Are you a Artist/Crafter?
Are you a Face Painter/ Childrens' Entertainer?
Details of trading: Produce, Goods, Services
Please advise number of stalls run by you at any one time.
Note: Two or more stalls at the same time will incur an extra charge.
Have you or any employee ever been convicted or charged with a criminal offence?
If 'yes', please provide details below.
Public Liability Only
Products Liability (Food Only)
Products Liability for Products Other than Food*
Goods in Transit
* Please provide product details below.
Products Liability for non-food is quoted separately.
** Employers Liability is quoted separately.
Annual Multi Cover (multiple markets/locations)
Annual Solo Cover (single location only)
Short Term (1, 2 or 3 days - single location)
Short Term (1 month - single location)
Short Term (1, 2 or 3 days - multiple locations)
Have you had any insurance claims in the last 3 years?
Have you completed a HACCP course? (food vendors only)
Do you have HSE Certification? (food vendors only)
* Details of Insurance available on request.
DATA PROTECTION: The information you provide about yourself and about third parties will remain confidential and may be used for the provision and administration of insurance products and related services. This information will be processed and held on the computer systems of MAST, Frank Glennon Ltd, or Liberty Insurance dac and manual record systems. A person may request in writing, a copy of details about himself/herself held by MAST, Frank Glennon Ltd or Liberty Insurance dac by sending a written request to the Data Protection Compliance Officer, Liberty Insurance dac, The Liberty Centre, Blanchardstown Retail Park, Blanchardstown, Dublin 15, D15 YT2H together with payment of the applicable fee (currently €5). There is also a right to correct any inaccuracies identified in the personal data.
DECLARATION: I/We declare that the statements and particulars given in this Membership Application are, to the best of my/our knowledge and belief, true and complete and that this Membership Application will form the basis of my/our contract for Membership Insurance Benefits with Liberty Insurance dac. I/we confirm that I/we am/are giving my/our permission for the information provided in this form to be used for the purposes set out in the Data Protection section above.
Phone: 01-2300788 or 0876971751