Will you be claiming any Input Tax Credits on the GST applicable to this policy? Yes No If Yes, what percentage? % Suburb State Postcode

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Will you be claiming any Input Tax Credits on the GST applicable to this policy? Yes No If Yes, what percentage? % Suburb State Postcode"

Transcription

1 Accountants Professional Indemnity Insurance. Proposal Form Please complete and return this proposal form to Aon Risk Services Australia Ltd, GPO Box 1230, Melbourne VIC 3001 If you have any questions, please do not hesitate to contact the team tollfree on Contact person Mr Mrs Ms Miss First name Family name Name of all entities to be covered by this policy (referred to in this proposal form as you and your ) ABN Will you be claiming any Input Tax Credits on the GST applicable to this policy? Yes No If Yes, what percentage? % Postal Address Suburb State Postcode Phone Mob Fax Web Preferred method of contact: Phone Mobile Accountants PI Insurance Proposal Form Page 1 of 9

2 1. Please provide the following details: Name of Partners/Principals/ Directors Professional body(ies)/ Association membership Qualifications and date obtained Age Period practicing as Partner/Principal/Director: This practice Previous practice 2. Are you a Director or Officer of any other business? Yes No If Yes, please complete details below: Position Name of Business Industry of Business 3. Please list total number of staff: Full time: Part time: Principals/partners Qualified accountants Other technical staff Admin/clerical staff Other staff 4. Do you perform work in the U.S or Canada, or work for clients located in U.S or Canada? Yes No If Yes, please complete the form and submit as normal and a member of our accountants team will be in contact to discuss your work outside Australia. 5. Do you engage consultants, sub-contractors or agents? Yes No If Yes: (a) Do you insist they carry their own professional indemnity insurance? Yes No (b) Do you enter into any hold-harmless agreements or otherwise waive any legal rights or entitlements which you may have against such consultants, sub-contractors or agents? Yes No (c) Please advise what percentage of your fees/turnover is outsourced to sub-contractors. % 6. Do you hold (or plan to apply for in the next 12-months) a limited Australian Financial Services License (AFSL) for SMSF services? Yes No Accountants PI Insurance Proposal Form Page 2 of 9

3 7. Fee income breakdown 7 (i) Indicate approximate percentage of your fee income derived from the following fields of work (round numbers) Accounts preparation/bookkeeping % Taxation/GST BAS % Auditing if you indicated a % please complete question 10 % Management Consultancy if you indicated a % please complete question 12 % Corporate Advisory Services - if you indicated a % please complete question 12 % Insolvency, Receiverships or Liquidations % Business Valuations - if you indicated a % please complete question 12 % Mergers & Acquisitions - if you indicated a % please complete question 12 % Prospectus Liability reporting and/or preparation % Referrals to other professionals % Financial planning, investment advice % Other - if you indicated a % please complete question 12 % Total % 7 (ii) Are any of the above mentioned activities performed for public companies? If so, please provide specific details below: 8. Gross income/fees 8 (i) All other questions Date of your end of financial year Estimated, for current financial year Estimated, for next financial year 8 (ii) Maximum fee any one client and field of work Fee Field of Work 9. Please state percentage of your income/fees derived from each state and overseas. ACT NSW VIC SA WA QLD NT TAS Overseas TOTAL % % % % % % % % % % Accountants PI Insurance Proposal Form Page 3 of 9

4 Please complete the specific sections below as per your answer to question 7 of the proposal form. 10. Please provide the percentage of your audit activities falling into the following categories (round numbers): Public listed companies % Public unlisted companies % Private companies % Not for profit organisations % Financial Institutions % Trust funds % Superannuation funds % Other, please specify % TOTAL % 11. Please provide details of your five largest audit clients: Client Name Nature of Business Annual Fee 12. If you indicated a percentage of activities performed in Management Consultancy, Corporate Advisory Services, Business Valuations, Merger & Acquisitions and Other activities please complete the table below: Please provide specific details of these activities: 13. Past activities Have you undertaken in the past, any activities not already described in question 12? Yes No If Yes, please describe those activities. Accountants PI Insurance Proposal Form Page 4 of 9

5 Some of these past activities may not be covered automatically. Do you wish us to investigate availability of cover for these past activities? Yes No 14. Indicate Limit of Indemnity required Minimum limit available 500,000 (TAS only). Option 1 Option Do you have a current policy in place? Yes No If Yes, please supply details: Expiry date Insurer/broker Limit of Indemnity Excess 16. Has any Partner, Principal, Director or staff member ever been subject to disciplinary proceedings for professional misconduct? Yes No 17. In the last ten (10) years have any claims for negligence or breach of professional duty been made against the Practice or any of its predecessors in business or any prior Practice or any of its present or former Partners, Principals or Directors, or have circumstances been notified to insurers that might give rise to a claim? Yes No 18. Are any of the Partners, Principals or Directors, AFTER ENQUIRY, aware of any claim or circumstance that might give rise to a claim against the Practice or any prior Practice or any of its present or former Partners, Principals, or Directors which matter is not referred to in question 17 above? Yes No 19. Has the Practice or any Partner, Principal or Director ever been refused this type of insurance, or had similar insurance cancelled, or had an application of renewal declined or had special terms imposed? Yes No If you have answered Yes for any of Questions questions, please provide full details on the Claims Addendum. Accountants PI Insurance Proposal Form Page 5 of 9

6 Addendum Claims addendum. If you have answered Yes to any of the questions of this proposal form, please provide the following details in respect of each matter. If you have more than 2 claims please call the Accountants team on Claim 1: Year of notification Name of insurer (if any) Name of claimant Nature of problem Amount paid or estimated Potential total liability Is matter finalised or outstanding? Claim 2: Year of notification Name of insurer (if any) Name of claimant Nature of problem Amount paid or estimated Potential total liability Is matter finalised or outstanding? Do you have a claims report? Yes No If Yes, please submit form and a member of the Accountants team will be in contact to discuss. Accountants PI Insurance Proposal Form Page 6 of 9

7 Declaration and Agreement 1. I acknowledge that I have read, understood and agreed to the Notice to the Proposed Insured. 2. I acknowledge that if this application is accepted, the insurance cover will be subject to the terms and conditions as set out in the Policy Schedule and Policy Wording. 3. I declare that the information contained in this application form is true and correct and that I have not suppressed nor misstated any facts. 4. Aon is committed to protecting your personal information in accordance with the terms of the Aon Privacy Notice which contains prescribed information that we must disclose to you about the way we handle personal information at Aon. I consent to the use of my personal information in the manner stated in this notice and where I have disclosed personal or sensitive information about any other person, I confirm that I have obtained consent from that person to disclose to you their personal or sensitive information and that Aon may handle their information in accordance with the notice (including that Aon may provide their information to other third parties, including the insurer for any of purposes and for the purposes which we or the third parties may use the information for as outlined in the Aon Privacy Notice). 5. I am authorized to complete and accept this proposal 6. I will inform the insurer of any material alteration to the matters contained in this proposal form before completion of contract of insurance Signature of Partner/Principal/Director Date signed Note: This proposal form can only be actioned once ALL questions have been answered and the above declaration has been signed and dated. Aon may also offer you products and services offered by third parties that we think may interest you and unless you tell us otherwise, we will assume that you consent to the use of your information or any information you provide us about any other person, for such purposes. Further information about our privacy practices (including how you can modify your privacy preferences) is located in the more detailed Aon Australia Group Privacy Policy Statement, a copy of which can also be sent to you on request. Yes, I agree that Aon or any of its group of companies, may be in touch by any means (including SMS or ) to let me know about their goods, services or promotions. To submit your proposal form Scan your signed document and send to Post: Please send your signed document to: Accountants Team, 80 Collins Street Melbourne VIC 3000 Accountants PI Insurance Proposal Form Page 7 of 9

8 Notice to the proposed insured It is a requirement of the Insurance Contracts Act 1984 and the Corporations Act 2001 that the following notices 1, 2, 3, 4, 5 and 6 be brought to your attention before you complete this proposal form. 1. Disclosure of relevant facts Your duty of disclosure Before you enter into a contract of general insurance with an Insurer, you have a duty, under the Insurance Contracts Act, 1984 to disclose to the Insurer every matter that you know, or could reasonably be expected to know, that is relevant to the Insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a contract of general insurance. Your duty however does not require disclosure of a matter: that diminishes the risk to be undertaken by the Insurer that is a common knowledge that your Insurer knows or, in the ordinary course of its business, ought to know as to which compliance with your duty is waived by the Insurer. Non-disclosure If you fail to comply with your duty of disclosure, the Insurer may be entitled to reduce its liability under the contract in respect of a Claim or may cancel the contract. If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the contract from its beginning. The requirement of full and frank disclosure of anything which may be material to the risk for which you seek cover (e.g. claims, whether founded or unfounded), or to the magnitude of the risk, is of the utmost importance with this type of insurance. It is better to err on the side of caution by disclosing anything which might conceivably influence the Insurer s consideration of your proposal 2. Claims made and notified policy This proposal is for a claims made and notified policy of insurance. This means that the policy covers you for claims made against you and notified to the Insurer during the period of cover. This policy does not provide cover in relation to: events that occurred prior to the retroactive date of the policy (if such a date is specified); claims made after the expiry of the period of cover even though the event giving rise to the claim may have occurred during the period of cover; claims notified or arising out of facts or circumstances notified (or which ought reasonably to have been notified) under any previous policy; claims made, threatened or intimated against you prior to the commencement of the period of cover; facts or circumstances which you first became aware of prior to the period of cover, and which you knew or ought reasonably to have known had the potential to give rise to a claim under this policy; claims arising out of circumstances noted on the proposal form for the current period of cover or on any previous proposal form. However, where you give notice in writing to the Insurer of any facts that might give rise to a claim against you as soon as reasonably practicable after you become aware of those facts but before the expiry of the period of cover, the policy will, subject to the terms and conditions, cover you notwithstanding that a claim is only made after the expiry of the period of cover. Upon expiry of the policy no further claims can be made thereunder and the need to maintain insurance or arrangement of Run-Off cover is essential. You should familiarise yourself with our standard form of policy for this type of cover before submitting this proposal. 3. Broker acting as agent of insurer In effecting this contract of insurance the broker will be acting under an authority given to it by the Insurer and the broker will be effecting the contract as agent of the Insurer and not the Insured. 4. Claims notification If you become aware of a claim or of circumstances that could give rise to a claim in the future, you should notify us in writing immediately, so that we can notify your Insurer on your behalf. If you become aware of a claim or of circumstances and you do not notify them during the policy period, you could e left uninsured or facing a reduced payout from your Insurer in respect of that claim or any future related claim. 5. Average provision This policy provides that if a payment in excess of the limit of indemnity available under this policy has to be made to dispose of a claim, the Insurer s liability for costs and expenses incurred with its consent shall be such proportion thereof as the amount of indemnity available under this policy bears to the amount paid to dispose of the claim. Any surplus will be deducted from claim payments. 6. Subrogation agreements Where another person would be liable to compensate you for any loss or damage otherwise covered by the policy, but you have agreed with that person either before or after the loss or damage occurred that you would not seek to recover any monies from that person, the Insurer will not cover you under the policy for any such loss or damage. Aon s privacy statement Aon has always valued the privacy of personal information. When we collect, use, disclose or handle personal information, we will be bound by the Privacy Act If you would like a copy of our Privacy policy, or wish to seek access to or correct the personal information we collected or disclosed about you, please telephone or your Aon contact or access our website aon.com.au. Accountants PI Insurance Proposal Form Page 8 of 9

9 Ace Insurance Limited privacy statement ACE Insurance Limited (ACE) is committed to protecting your privacy. This document provides you with an overview of how we handle your personal information. Our Privacy Policy can be accessed on our website at acegroup.com/au Personal Information Handling Practices Collection, Use and Disclosure We collect your personal information (which may include sensitive information) when you are applying for, changing or renewing an insurance policy with us or when we are processing a claim in order to help us properly administrate your insurance proposal, policy or claim. How to Contact Us If you would like a copy of your personal information, or to correct or update it, please contact our customer relations team on or If you have a complaint or would like more information about how we manage your personal information, please review our Privacy Policy for more details or contact the Privacy Officer, ACE Insurance Limited, GPO Box 4907, Sydney NSW 2001, Tel: or Personal information may be obtained by us directly from you or via a third party such as your insurance intermediary or employer (e.g. in the case of a group insurance policy). When information is provided to us via a third party we use that information on the basis that you have consented or would reasonably expect us to collect your personal information in this way and we take reasonable steps to ensure that you have been made aware of how we handle your personal information. The primary purpose for our collection and use of your personal information is to enable us to provide insurance services to you. Sometimes, we may use your personal information for our marketing campaigns, in relation to new products, services or information that may be of interest to you. We may disclose the information we collect to third parties, including service providers engaged by us to carry out certain business activities on our behalf (such as assessors and call centres in Australia). In some circumstances, in order to provide our services to you, we may need to transfer personal information to other entities within the ACE Group of companies, (such as the regional head offices of ACE located in Singapore, UK or USA) or third parties with whom we, or those other ACE Group entities, have sub-contracted to provide a specific service for us and these may be outside of Australia. In particular, certain business process functions of ACE are performed by a dedicated servicing unit located in the Philippines. Please note that no personal information is disclosed by us to any overseas entity for marketing purposes. In all instances where personal information may be disclosed overseas, in addition to any local data privacy laws, we have measures in place to ensure that those parties hold and use that information in accordance with the consent you have provided and in accordance with our obligations to you under the Privacy Act 1998 (Cth). Your Choices In dealing with us, you agree to us using and disclosing your personal information as set out in this statement and our Privacy Policy. This consent remains valid unless you alter or revoke it by giving written notice to our Privacy Officer. However, should you choose to withdraw your consent it is important for you to understand that this may mean we may not be able to provide you or your organisation with insurance or to respond to any claim. Accountants PI Insurance Proposal Form Page 9 of 9

Professional indemnity insurance and optional public liability insurance

Professional indemnity insurance and optional public liability insurance Agricultural Consultants Professional indemnity insurance and optional public liability insurance Proposal form 2011-2012 Please return completed proposal form to: Aon Risk Services Australia Limited ABN

More information

Professional indemnity insurance (including optional public and products liability insurance and employment practices liability insurance)

Professional indemnity insurance (including optional public and products liability insurance and employment practices liability insurance) Veterinarians Professional indemnity insurance (including optional public and products liability insurance and employment practices liability insurance) Proposal form 2011-2012 Please return completed

More information

Professional Indemnity Insurance and optional Public & Products Liability

Professional Indemnity Insurance and optional Public & Products Liability Advantedge Members (Incorporating PLAN, FAST and CHOICE Members) Professional Indemnity Insurance and optional Public & Products Liability Proposal form 2014-2015 Please return completed proposal form

More information

Professional indemnity insurance

Professional indemnity insurance Pest controllers Professional indemnity insurance Proposal form 2011-2012 Please return completed proposal form to your nearest Aon office (back page of proposal) Aon Risk Services Australia Limited ABN

More information

AAMT Massage Therapist Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015

AAMT Massage Therapist Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015 Page 1 of 5 AAMT Proposal Form Combined Malpractice, Public and Products Liability Insurance effective 30 September 2015 Please complete and return this proposal form via post, email or fax using the contact

More information

Public Relations / Marketing Consultants. Professional Indemnity Insurance

Public Relations / Marketing Consultants. Professional Indemnity Insurance Public Relations / Marketing Consultants Public Relations Consultants Marketing Consultants Market Research Consultants Advertising Consultants Graphic Designers Professional Indemnity Insurance Proposal

More information

Consultants Insurance Application

Consultants Insurance Application Consultants Insurance Application Notice to the proposed insured: It is a requirement of the insurance Contracts Act 1984 and the Corporations Act 2001 that the following notices 1., 2., 3., 4., 5. and

More information

Members of the Institute of Arbitrators & Mediators of Australia (IAMA) Professional indemnity insurance and public liability insurance

Members of the Institute of Arbitrators & Mediators of Australia (IAMA) Professional indemnity insurance and public liability insurance Members of the Institute of Arbitrators & Mediators of Australia (IAMA) Professional indemnity insurance and public liability insurance Proposal form 2014-2015 Please return completed proposal form to:

More information

Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program

Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program Professional Indemnity Insurance Application Form Marsh Accountants Insurance Program Phone: 1300 093 634 Email: accountants@marsh.com tice to the Applicant This notice must be read before you complete

More information

Mortgage & Finance Brokers Professional Indemnity Insurance

Mortgage & Finance Brokers Professional Indemnity Insurance Mortgage & Finance Brokers Professional Indemnity Insurance Insurance House is extremely proud of our long standing association with the finance industry which has allowed us to construct a policy which

More information

LEADR Members. Professional indemnity insurance and public liability insurance. Proposal form 2014-2015

LEADR Members. Professional indemnity insurance and public liability insurance. Proposal form 2014-2015 LEADR Members Professional indemnity insurance and public liability insurance Proposal form 2014-2015 Please return completed proposal form to: Aon Risk Services Australia Limited ABN 17 000 434 720 Levels

More information

Professional Indemnity Proposal Form. for. Accountants. Address: 5/3352 Pacific Highway Postal: PO Box 976. Springwood QLD 4127 Springwood QLD 4127

Professional Indemnity Proposal Form. for. Accountants. Address: 5/3352 Pacific Highway Postal: PO Box 976. Springwood QLD 4127 Springwood QLD 4127 Professional Indemnity Proposal Form for Accountants Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email: pidirect@pidirect.com.au

More information

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au ACCOUNTANTS PROFESSIONAL INDEMNITY

More information

QBE PROFESSIONAL LIABILITY. Miscellaneous Risks INSURANCE PROPOSAL PROPOSAL

QBE PROFESSIONAL LIABILITY. Miscellaneous Risks INSURANCE PROPOSAL PROPOSAL QBE PROFESSIONAL LIABILITY Miscellaneous Risks INSURANCE PROPOSAL PROPOSAL Professional Indemnity Insurance tice to the Proposed Insured This notice must be read before you complete the proposal form.

More information

Find Me A Trainer Insurance Offer

Find Me A Trainer Insurance Offer Find Me A Trainer Insurance Offer Get Covered. Whether you are just starting out or have been in the industry for years, you will need Public Liability and Professional Indemnity insurance that protects

More information

Professional Indemnity Insurance

Professional Indemnity Insurance QBE Insurance (Australia) Limited ABN 78 003 191 035 Professional Indemnity Insurance Application Form Pool Safety Inspectors Notice to the Applicant This notice must be read before you complete the Application

More information

IMPORTANT NOTICES: Your duty, however, does not require disclosure of matter:

IMPORTANT NOTICES: Your duty, however, does not require disclosure of matter: IMPORTANT NOTICES: CLAIMS MADE POLICY This Proposal is for a policy issued by ProRisk on a claims made and notified basis. This means that the policy only covers claims first made against you during the

More information

IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM

IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM Your Professional Indemnity Insurance Policy is issued on a CLAIMS MADE basis. This means that this policy

More information

QBE PROFESSIONAL INDEMNITY ACCOUNTANTS PROPOSAL FORM

QBE PROFESSIONAL INDEMNITY ACCOUNTANTS PROPOSAL FORM QBE Insurance (International) Limited Unique Entity No. S16FC00047K 60 Anson Road #11-01 Mapletree Anson Singapore 079914 Tel: 65-6224 6633 Fax: 65-6433 3270 www.qbe.com.sg QBE PROFESSIONAL INDEMNITY ACCOUNTANTS

More information

AUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA

AUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA Professional Indemnity Insurance Proposal Form AUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA IMPORTANT NOTICE Your Duty of Disclosure Before you enter into a contact of general insurance with any insurer,

More information

Professional Indemnity Insurance Proposal Form

Professional Indemnity Insurance Proposal Form Professional Indemnity Insurance Proposal Form Important Notices Claims Made Insurance This is a proposal for a Claims Made policy of insurance. This means that the policy covers you for any claims made

More information

Professional Indemnity Proposal Form

Professional Indemnity Proposal Form Professional Indemnity Proposal Form BuildSafe Insurance Brokers Pty Ltd ABN 84 109 623 976 AFSL 279367 5 Peninsula Boulevard, Seaford, Vic. 3198 Postal: P. O. Box 2294 Seaford, Vic. 3198 Phone: 1300 763

More information

Professional Indemnity Insurance Proposal.

Professional Indemnity Insurance Proposal. ProJuris Professional Indemnity Professional Indemnity Insurance Proposal. Important information What is a proposal? This proposal tells us information, which we need to know in order to decide whether

More information

Professional indemnity insurance

Professional indemnity insurance Professional indemnity insurance 2014 mini policy for CPA Australia members What is CPA Australia s mini policy? Fenton Green & Co. has arranged a professional indemnity insurance (Pll) mini policy (mini

More information

1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email

1. NAME OF FIRM TO BE INSURED 2. ADDRESS OF FIRM 3. THE FIRM. (please include full names of all entities to be insured) Phone ( ) Email SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au MISCELLANEOUS PROFESSIONAL INDEMNITY

More information

ACE Insurance Limited ELITE II PROFESSIONAL INDEMNITY INSURANCE POLICY

ACE Insurance Limited ELITE II PROFESSIONAL INDEMNITY INSURANCE POLICY ELITE II PROFESSIONAL INDEMNITY INSURANCE POLICY Renewal Proposal Form - Miscellaneous ABN 23 001 642 020 AFSL 239687 Page 1 of 8 ACE ELITE II PROFESSIONAL INDEMNITY INSURANCE RENEWAL PROPOSAL FORM Miscellaneous

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM - ACCOUNTANTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM - ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM - ACCOUNTANTS IMPORTANT Answer all questions. Blanks, dashes, answers known to underwriters or brokers or N/A are not acceptable and will delay consideration

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL NOTICE TO INSURED (Pursuant to the provisions of the Insurance Contracts Act 1984) Your Duty of Disclosure Before you enter into a contract of general insurance with an insurer, you have a duty, under

More information

FINANCIAL PLANNERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL

FINANCIAL PLANNERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FINANCIAL PLANNERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL NOTICE TO THE APPLICANT FOR INSURANCE 1. YOUR DUTY OF DISCLOSURE Before you enter into a contract of general insurance with the insurers, you

More information

REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL

REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into a contract

More information

MISCELLANEOUS CONSULTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM

MISCELLANEOUS CONSULTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM MISCELLANEOUS CONSULTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into

More information

Proposal Form: Directors and Officers Insurance

Proposal Form: Directors and Officers Insurance Proposal Form: Directors and Officers Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Directors & Officers Insurance

More information

Professional Indemnity Insurance for the Planning Profession

Professional Indemnity Insurance for the Planning Profession Professional Indemnity Insurance for the Planning Profession Important Notices Claims Made Policy This Proposal is for a policy issued by the insurer on a claims made and notified basis. This means that

More information

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director

4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au FINANCIAL PLANNERS PROFESSIONAL INDEMNITY

More information

Professional Indemnity Proposal Form. for. Financial Planners

Professional Indemnity Proposal Form. for. Financial Planners Professional Indemnity Proposal Form for Financial Planners Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email: pidirect@pidirect.com.au

More information

Professional Indemnity Insurance Proposal Form for the Horticulture Industry

Professional Indemnity Insurance Proposal Form for the Horticulture Industry Professional Indemnity Insurance Proposal Form for the Horticulture Industry Important Notices Claims Made Insurance This is a proposal for a Claims Made policy of insurance. This means that the policy

More information

REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL

REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL REAL ESTATE AGENTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into an

More information

Proposal Form. Management Consultants Professional Liability Insurance

Proposal Form. Management Consultants Professional Liability Insurance Management Consultants Professional Liability Insurance BusinessGuard AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL 381686, Level 12, 717 Bourke Street, Docklands VIC 3008 Important Notice Claims-Made

More information

Proposal Form. BusinessGuard Accountants Professional Liability Insurance

Proposal Form. BusinessGuard Accountants Professional Liability Insurance BusinessGuard Accountants Professional Liability Insurance Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited on a claims-made and notified basis. This means

More information

Proposal Form. BusinessGuard Specified Professions Professional Liability Insurance

Proposal Form. BusinessGuard Specified Professions Professional Liability Insurance BusinessGuard Specified Professions Professional Liability Insurance An Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL

More information

Commercial Builders Structural Defects Insurance Proposal (Victoria)

Commercial Builders Structural Defects Insurance Proposal (Victoria) Commercial Builders Structural Defects Insurance Proposal (Victoria) NOTICE TO THE APPLICANT FOR INSURANCE IMPORTANT NOTICES Commercial Builders Structural Defects insurance policies issued by AXIS Specialty

More information

Professional Indemnity MISCELLANEOUS PROPOSAL

Professional Indemnity MISCELLANEOUS PROPOSAL Professional Indemnity MISCELLANEOUS PROPOSAL Please complete, sign and return with all attachments to: Name Position Address Email Phone If you have any questions regarding this form, please do not hesitate

More information

Proposal Form: Management Liability Insurance

Proposal Form: Management Liability Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Management Liability Insurance Policy is issued on a CLAIMS MADE basis.

More information

Professional Indemnity Proposal Form. for. Information Technology Consultants

Professional Indemnity Proposal Form. for. Information Technology Consultants Professional Indemnity Proposal Form for Information Technology Consultants Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200

More information

Professional Indemnity Insurance AILA Proposal

Professional Indemnity Insurance AILA Proposal Professional Indemnity Insurance AILA Proposal September 2013 Please return this completed proposal to: Lynn Wainstein Lauren Malkin Tel (03) 9613 1442 Tel (03) 9613 1423 Email Lynn.Wainstein@jlta.com.au

More information

Professional Indemnity Proposal Form. for. Finance & Mortgage Brokers

Professional Indemnity Proposal Form. for. Finance & Mortgage Brokers Professional Indemnity Proposal Form for Finance & Mortgage Brokers Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood QLD 4127 Springwood QLD 4127 Phone: 07 3387 2800 Fax: 07 3208 2200 Email:

More information

Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form

Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form Answer all questions. Blanks and/or dashes, or answers known to underwriters/brokers or N/A are not acceptable and will

More information

SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL

SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into a contract

More information

ACCOUNTANTS, BOOKKEEPERS & RELATED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

ACCOUNTANTS, BOOKKEEPERS & RELATED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ACCOUNTANTS, BOOKKEEPERS & RELATED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant

More information

QBE PROFESSIONAL INDEMNITY SOLICITORS & LAWYERS PROPOSAL FORM

QBE PROFESSIONAL INDEMNITY SOLICITORS & LAWYERS PROPOSAL FORM QBE Insurance (International) Limited Unique Entity No. S16FC00047K 60 Anson Road #11-01 Mapletree Anson Singapore 079914 Tel: 65-6224 6633 Fax: 65-6433 3270 www.qbe.com.sg QBE PROFESSIONAL INDEMNITY SOLICITORS

More information

Accountants Professional Liability Insurance Proposal Form

Accountants Professional Liability Insurance Proposal Form Accountants Professional Liability Insurance Proposal Form AIG Australia Proposal Form American Home Assurance Company AB 67 007 483 267 AFSL o 230903 incorporated with limited liability in the USA, trading

More information

Medical Malpractice Insurance Proposal Form. for. Miscellaneous Medical Professionals

Medical Malpractice Insurance Proposal Form. for. Miscellaneous Medical Professionals Medical Malpractice Insurance Proposal Form for Miscellaneous Medical Professionals Address: 5/3352 Pacific Highway Postal: PO Box 976 Springwood Qld 4127 Springwood Qld 4127 Phone 07 3387 2800 Fax 07

More information

Professional Indemnity Solicitors & Lawyers Proposal Form

Professional Indemnity Solicitors & Lawyers Proposal Form Professional Indemnity Solicitors & Lawyers Proposal Form QBE Insurance (Singapore) Pte Ltd A. tice To The Proposed Insured 1. Disclosure of Relevant Facts Your Duty of Disclosure Before you enter into

More information

MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM

MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM IMPORTANT INFORMATION Please read the following information before completing this proposal A. Your Duty of Disclosure Before you enter

More information

Professional Indemnity Insurance AIAST Proposal

Professional Indemnity Insurance AIAST Proposal Professional Indemnity Insurance AIAST Proposal February 2013 Please return this completed proposal to: Bill Hogg or Lynn Wainstein Jardine Lloyd Thompson Pty Ltd Level 17, 607 Bourke Street, Melbourne

More information

IMPORTANT NOTES ABOUT PROFESSIONAL INDEMNITY INSURANCE

IMPORTANT NOTES ABOUT PROFESSIONAL INDEMNITY INSURANCE Page 1 of 6 IMPORTANT NOTES ABOUT PROFESSIONAL INDEMNITY INSURANCE Professional Indemnity insurance is different from most other types of insurance. The policy is issued on a "claims made" basis and a

More information

COMMERCIAL BUILDERS STRUCTURAL DEFECTS INSURANCE PROPOSAL (VICTORIA)

COMMERCIAL BUILDERS STRUCTURAL DEFECTS INSURANCE PROPOSAL (VICTORIA) COMMERCIAL BUILDERS STRUCTURAL DEFECTS INSURANCE PROPOSAL (VICTORIA) NOTICE TO THE APPLICANT FOR INSURANCE IMPORTANT NOTICES Commercial Builders Structural Defects insurance policies issued by Prime Underwriting

More information

PROFESSIONAL INDEMNITY RENEWAL DECLARATION IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS RENEWAL DECLARATION

PROFESSIONAL INDEMNITY RENEWAL DECLARATION IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS RENEWAL DECLARATION PROFESSIONAL INDEMNITY RENEWAL DECLARATION IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS RENEWAL DECLARATION A. Obtaining a Quotation To minimise delays in obtaining

More information

Professional Indemnity Insurance. Proposal Form for Property Consultants

Professional Indemnity Insurance. Proposal Form for Property Consultants Professional Indemnity Insurance Proposal Form for Property Consultants Important Notices PLEASE READ THE FOLLOWING NOTICES BEFORE COMPLETING THIS PROPOSAL FORM. Your Duty of Disclosure Contracts of General

More information

Proposal Form Australian Institute of Horticulture Professional Indemnity Insurance

Proposal Form Australian Institute of Horticulture Professional Indemnity Insurance Proposal Form Australian Institute of Horticulture Professional Indemnity Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL

More information

Institute of Mercantile Agents Combined Professional Indemnity and Public Liability Insurance Proposal Form

Institute of Mercantile Agents Combined Professional Indemnity and Public Liability Insurance Proposal Form Institute of Mercantile Agents Combined Professional Indemnity and Public Liability Insurance Proposal Form Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING

More information

Roderick Insurance Brokers

Roderick Insurance Brokers Roderick Insurance Brokers Professional Indemnity Insurance Application Form Please answer all questions. Blanks and/or dashes, or answers "known to underwriters or brokers" or "N/A" are not acceptable

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT TICES - `CLAIMS MADE CONTRACTS OF INSURANCE Please read the following carefully before completing this proposal form: Your professional indemnity

More information

Proposal Form. BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance

Proposal Form. BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance Important Notice

More information

Breeze Underwriting Application Form Accountants Professional Indemnity Insurance

Breeze Underwriting Application Form Accountants Professional Indemnity Insurance Application Form Accountants Professional Indemnity Insurance Send quotation requests to: Email: distribution@breezeuw.com.au Phone: 1300 556 826 IMPORTANT NOTICES Please read these Important tices before

More information

QBE PROFESSIONAL LIABILITY. Directors & Officers Liability INSURANCE PROPOSAL PROPOSAL

QBE PROFESSIONAL LIABILITY. Directors & Officers Liability INSURANCE PROPOSAL PROPOSAL QBE PROFESSIONAL LIABILITY Directors & Officers Liability INSURANCE PROPOSAL PROPOSAL Directors & Officers Liability tice to the Proposed Insured This notice must be read before you complete the proposal

More information

QBE Professional Indemnity Insurance

QBE Professional Indemnity Insurance QBE Insurance (International) Limited Unique Entity No. S16FC00047K 60 Anson Road #11-01 Mapletree Anson Singapore 079914 QBE Professional Indemnity Insurance Tel: 65-6224 6633 Fax: 65-6433 3270 www.qbe.com.sg

More information

Professional Indemnity Insurance BDA Proposal

Professional Indemnity Insurance BDA Proposal Professional Indemnity Insurance BDA Proposal September 2012 Please return this completed proposal to: Kathleen Sutherland Unit 10, Building I1, 22 Powers Road Seven Hills NSW 2147 Tel 02 8824 1600 Fax

More information

Professional Indemnity Financial Advisors Proposal Form

Professional Indemnity Financial Advisors Proposal Form Professional Indemnity Financial Advisors Proposal Form QBE Insurance (Singapore) Pte Ltd A. tice To The Proposed Insured 1. Disclosure of Relevant Facts Your Duty of Disclosure Before you enter into a

More information

Combined Professional Indemnity and Public Liability Insurance Proposal Form

Combined Professional Indemnity and Public Liability Insurance Proposal Form Combined Professional Indemnity and Public Liability Insurance Proposal Form Australian Institute of Landscape Designers and Managers Ltd and Australian Institute of Horticulture Inc Important Notice Relating

More information

Professional Indemnity Proposal Form

Professional Indemnity Proposal Form Professional Indemnity Proposal Form IMPORTANT NOTES This insurance cover is based upon representations given to us by you. Should any particulars have changed or be incorrect you must notify us immediately.

More information

Proposal Form. Architects Professional Indemnity

Proposal Form. Architects Professional Indemnity Proposal Form Architects Professional Indemnity Important Notices Please read these notices before completing the Proposal Form. Your Duty of Disclosure Before you enter into a contract of general insurance

More information

Liability Insurance Proposal

Liability Insurance Proposal Liability Insurance Proposal For Information Technology Entities Woodina Underwriting Agency Pty Ltd AFS Licence No. 418755 NOTICE TO INSURED (Pursuant to the provisions of the Insurance Contracts Act

More information

Professional Indemnity Proposal

Professional Indemnity Proposal Professional Indemnity Proposal IMPORTANT NOTICES Your Duty Of Disclosure This Policy is subject to the Insurance Contracts Act 1984. Under that Act you have a duty of disclosure. Before you take out insurance

More information

Proposal Form Information Technology Liability Insurance

Proposal Form Information Technology Liability Insurance Proposal Form Information Technology Liability Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Information Technology

More information

CRM BROKERS PROFESSIONAL INDEMNITY INSURANCE VALUERS PROPOSAL FORM

CRM BROKERS PROFESSIONAL INDEMNITY INSURANCE VALUERS PROPOSAL FORM CRM BROKERS PROFESSIONAL INDEMNITY INSURANCE VALUERS PROPOSAL FORM NOTICE TO THE PROPOSED INSURED (pursuant to the provisions of the Insurance Contracts Act 1984) IMPOTANT NOTICES Your Duty of Disclosure

More information

Claims Made Policy (applies to Professional Indemnity only) Your Duty of Disclosure. Excess. Your Legal Liability. Waiver of Rights.

Claims Made Policy (applies to Professional Indemnity only) Your Duty of Disclosure. Excess. Your Legal Liability. Waiver of Rights. Proposal Form Professional Indemnity & Public Liability Insurance for Swimming Pool Inspectors Arranged through ASR Underwriting Agencies Pty Ltd Underwritten by Certain Underwriters at Lloyd s IMPORTANT

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information for your adviser to submit on your

More information

DIRECTORS & OFFICERS LIABILITY INSURANCE PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL

DIRECTORS & OFFICERS LIABILITY INSURANCE PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL DIRECTORS & OFFICERS LIABILITY INSURANCE PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Obtaining a Quotation To minimise delays in obtaining

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable & will delay consideration of this proposal.

More information

MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM

MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM MEDICAL ESTABLISHMENTS MEDICAL MALPRACTICE INSURANCE PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter

More information

Professional Indemnity API VALUERS PROPOSAL FORM

Professional Indemnity API VALUERS PROPOSAL FORM Professional Indemnity API VALUERS PROPOSAL FORM Please return this completed proposal to: Perrymans General Insurance Brokers PO Box 596, Kent Town SA 5071 Fax: 08 8362 3131 Email: api@perrymans.com If

More information

Accounting professionals

Accounting professionals Professional Indemnity Insurance Proposal Form Accountant/Bookkeepers/Tax Agents Commercial & General Insurance Brokers (Aust) Pty Ltd Suite 4, 1016 Doncaster Road Doncaster East Victoria 3109 Phone: 1300

More information

BUSINESS, EXECUTIVE, LIFE COACHES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

BUSINESS, EXECUTIVE, LIFE COACHES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM BUSINESS, EXECUTIVE, LIFE COACHES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information

More information

Professional Indemnity Insurance Application Form for Eligible Midwives

Professional Indemnity Insurance Application Form for Eligible Midwives Professional Indemnity Insurance Application Form for Eligible Midwives This Form will be used by MIGA to consider your application for Professional Indemnity Insurance with MIGA and for your automatic

More information

Professional Indemnity Insurance Proposal Form Management Consultants (with Recruitment / On-Hired Labour Addendum)

Professional Indemnity Insurance Proposal Form Management Consultants (with Recruitment / On-Hired Labour Addendum) Professional Indemnity Insurance Proposal Form Management Consultants (with Recruitment / On-Hired Labour Addendum) IMPORTANT NOTICE Your Duty of Disclosure Before you enter into a contact of general insurance

More information

Professional Indemnity Proposal form

Professional Indemnity Proposal form Important Information Please read this first Professional Indemnity Proposal form Important facts relating to this proposal form You should read the following advice before proceeding to complete this

More information

Proposal Form. Information Technology Combined Professional and Public & Technology Products Liability. Page 1 of 13

Proposal Form. Information Technology Combined Professional and Public & Technology Products Liability. Page 1 of 13 Information Technology Combined Professional and Public & Technology Products Liability Page 1 of 13 Information Technology Combined Professional and Public & Technology Products Liability IMPORTANT NOTICE

More information

Proposal Form. BusinessGuard Recruitment and Personnel Consultants Professional Liability Insurance

Proposal Form. BusinessGuard Recruitment and Personnel Consultants Professional Liability Insurance Recruitment and Personnel Consultants Professional Liability Insurance An Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL

More information

SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL

SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL SOLICITORS EXCESS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT INFORMATION: PLEASE READ THE FOLLOWING INFORMATION BEFORE COMPLETING THIS PROPOSAL A. Your Duty of Disclosure Before you enter into an insurance

More information

Proposal Form. BusinessGuard Insurance Brokers Professional Liability Insurance

Proposal Form. BusinessGuard Insurance Brokers Professional Liability Insurance BusinessGuard Insurance Brokers Professional Liability Insurance BusinessGuard Insurance Brokers Professional Liability Insurance This policy is issued by AIG Australia Limited on a claims-made and notified

More information

Professional Indemnity Insurance Proposal Form for Actuaries (short form)

Professional Indemnity Insurance Proposal Form for Actuaries (short form) Professional Indemnity Insurance Proposal Form for Actuaries (short form) Marsh Pty Ltd ABN 86 004 651 512 Darling Park Tower 3 201 Sussex Street SYDNEY NSW 2000 PO Box H176 AUSTRALIA SQUARE NSW 1215 Telephone

More information

Miscellaneous Professional Indemnity Insurance

Miscellaneous Professional Indemnity Insurance Miscellaneous Professional Indemnity Insurance Proposal Form 1. All questions must be answered giving full and complete answers. 2. Please ensure that this Proposal Form is Signed and Dated. 3. All fee

More information

IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM

IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM IMPORTANT NOTICE PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM Your Professional Indemnity Insurance Policy is issued on a CLAIMS MADE basis. This means that this policy

More information

Proposal Form. BusinessGuard Financial Planners Professional Liability Insurance

Proposal Form. BusinessGuard Financial Planners Professional Liability Insurance BusinessGuard Financial Planners Professional Liability Insurance AIG Australia Limited (AIG) ABN 93 004 727 753 AFSL No 381686 Sydney: Head Office: Level 19, 2 Park Street, NSW 2000 (1300 030 886) Melbourne:

More information

ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM

ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM Australian Indemnity ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information for

More information

Professional Indemnity Proposal Form Agricultural Consultants

Professional Indemnity Proposal Form Agricultural Consultants Rivers Insurance Brokers Pty Ltd (t) 07 3028 9494 PO Box 518, Annerley Qld 4103 (f) 07 3891 3111 23 Balaclava Street, Woolloongabba Qld 4102 ABN 28 010 242 681 AFS Lic. 247093 admin@riversinsurance.com.au

More information

Professional Indemnity Insurance Proposal Form Miscellaneous

Professional Indemnity Insurance Proposal Form Miscellaneous Commercial & General Insurance Brokers (Aust) Pty Ltd Suite 4, 1016 Doncaster Road Doncaster East Victoria 3109 Phone: 1300 764 244 Fax: 03 8841 4299 Email: pi@cgib.com.au Web: www.cgib.com.au AFS License:

More information

Liability Package for Associations and Non-profit Organisations

Liability Package for Associations and Non-profit Organisations Liability Package for Associations and n-profit Organisations Answer all questions. Blanks or dashes, or answers known to underwriters or brokers or N/A are unacceptable & will delay consideration of this

More information

PROFESSIONAL INDEMNITY GENERAL LIABILITY AND MANAGEMENT LIABILITY INSURANCE COMBINED PROPOSAL (RECRUITMENT SERVICES)

PROFESSIONAL INDEMNITY GENERAL LIABILITY AND MANAGEMENT LIABILITY INSURANCE COMBINED PROPOSAL (RECRUITMENT SERVICES) PROFESSIONAL INDEMNITY GENERAL LIABILITY AND MANAGEMENT LIABILITY INSURANCE COMBINED PROPOSAL (RECRUITMENT SERVICES) IMPORTANT NOTICES: CLAIMS MADE POLICY: This Proposal is for a policy issued by ProRisk

More information