Allianz Professional Indemnity Insurance Financial Planners

Transcription

1 Allianz Global Corporate & Specialty Pacific Allianz Professional Indemnity Insurance Financial Planners Proposal Form

2 General Information The General Information set out below is provided for your (the Insured s) information only. It does not form part of the insurance contract with you, and is not part of the policy. othing contained in the General Information imposes contractual obligations on you, or creates contractual rights. These are contained in the policy and any endorsement. our Duty of Disclosure Before ou (the Insured) enter into the Policy with Us (the Insurer), the Insurance Contracts Act 1984 requires ou to disclose to Us every matter that you know or could reasonably be expected to know is relevant to Our decision whether and on what terms our application for insurance is acceptable and to calculate how much premium is required for our insurance. ou have the same duty to disclose those matters to Us before ou renew, extend, vary or reinstate the Policy. The duty applies until the Policy is entered into, or where relevant, renewed, extended, varied or reinstated (Relevant Time). If anything changes between the time ou provide answers or make disclosure and the Relevant Time, ou need to tell Us. What ou do not need to tell Us ou do not need to tell Us about any matter that: diminishes Our risk; is of common knowledge; We know or should know as an insurer; or We tell ou We do not need to know. What happens if the duty of disclosure is not complied with? If the duty of disclosure is not complied with We may cancel the Policy and/or reduce the amount We pay if ou make a claim. If fraud is involved, We may treat the Policy as if it never existed, and pay nothing. Claims Made This policy operates on a claims made and notified basis. This means that the policy covers you (the Insured) for claims made against you and notified to us (the Insurer) during the Period of Insurance. The policy does not provide cover in relation to Prior Claims/Circumstances (as set out in the relevant exclusion) nor in relation to acts, errors, omissions or other conduct which first takes place before the Retroactive Date of the policy (if such a date is specified). Where you give notice in writing to us 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 insurance, you may have rights under Section 40(3) of the Insurance Contracts Act 1984 to be indemnified in respect of any Claim subsequently made against you arising from those facts notwithstanding that the Claim is made after the expiry of the period of insurance. Any such rights arise under the legislation only. The terms of the policy and the effect of the policy is that you are not covered for Claims made against you after the expiry of the period of insurance unless such Claim is made during the Discovery Period or under the Extension for Run-off After Transaction. Who does the duty apply to? The duty of disclosure applies to ou and everyone that is an insured under the Policy. If ou provide information for another insured, it is as if they provided it to Us.

3 General Insurance Code of Practice We (the Insurer) are a signatory to the General Insurance Code of Practice. The Code aims to raise standards of practice and service in the insurance industry. It: promotes better communication between insurers and customers which will lead to better public understanding of insurance to allow customers to make informed choices, and outlines good standards of practice and service to be met by insurers to enhance their reputation responding efficiently to their customers needs. Dispute Resolution Process We (the Insurer) will do everything possible to provide a quality service to you (the Insured). However, we recognise that occasionally there may be some aspect of our service or a decision we have made that you wish to query or draw to our attention. We have a Complaints and Dispute Resolution Procedure which undertakes to provide an answer to your complaint within fifteen (15) working days. If you would like to make a complaint or access our internal dispute resolution service please contact our nearest office and ask to speak to a dispute resolution specialist. Contact for assistance or confirmation of cover If you need to confirm any policy transaction or clarify any of the information contained in this policy document or if you have any other queries, please contact any of our offices or refer to our website at If this insurance has been issued through an insurance intermediary If your policy has been arranged through our agent, or a broker who is acting under an agency arrangement such as a binder with us, then they are acting as our agent and not as your agent. They will tell you when this is the case. for If our Policy has been arranged by a broker, other than a broker acting under such an agency arrangement with us, then the broker is acting as your agent. Where this Policy has been arranged through an intermediary a commission may be payable by us to them for arranging the insurance. Privacy otice At Allianz, we (the Insurer) give priority to protecting the privacy of your (the Insured s) personal information. We do this by handling personal information in a responsible manner and in accordance with the Privacy Act 1988 (Cth). How We Collect our Personal Information We usually collect your personal information from you or your agents. We may also collect it from our agents and service providers; other insurers and insurance reference bureaus; people who are involved in a claim or assist us in investigating or processing claims, including third parties claiming under your policy, witnesses and medical practitioners; third parties who may be arranging insurance cover for a group that you are a part of; law enforcement, dispute resolution, statutory and regulatory bodies; marketing lists and industry databases; and publicly available sources. Why We Collect our Personal Information We collect your personal information to enable us to provide our products and services, including to process and settle claims; offer our products and services and those of our related companies, brokers, intermediaries and business partners that may interest you; and conduct market or customer research to determine those products or services that may suit you. ou can choose not to receive product or service offerings from us (including product or service offerings from us on behalf of our brokers, intermediaries and/or our business partners) or our related companies by calling the Allianz Direct Marketing Privacy Service Line on , EST 8am to 6pm Monday to Friday, or going to our website s Privacy section at

4 Who We Disclose our Personal Information To We may disclose your personal information to others with whom we have business arrangements for the purposes listed in the paragraph above or to enable them to offer their products and services to you. These parties may include insurers, intermediaries, reinsurers, insurance reference bureaus, related companies, our advisers, persons involved in claims, external claims data collectors and verifiers, parties that we have an insurance scheme in place with under which you purchased your policy (such as a financier or motor vehicle manufacturer and/or dealer). Disclosure may also be made to government, law enforcement, dispute resolution, statutory or regulatory bodies, or as required by law. Disclosure Overseas our personal information may be disclosed to other companies in the Allianz Group, business partners, reinsurers and service providers that may be located in Australia or overseas. The countries this information may be disclosed to will vary from time to time, but may include Canada, Germany, ew Zealand, United Kingdom, United States of America and other countries where the Allianz Group has a presence or engages subcontractors. We regularly review the security of our systems used for sending personal information overseas. Any information disclosed may only be used for the purposes of collection detailed above and system administration. Access to our Personal Information and Complaints ou may ask for access to the personal information we hold about you and seek correction by calling EST 8am 6pm, Monday to Friday. Our Privacy Policy contains details about how you may make a complaint about a breach of the privacy principles contained in the Privacy Act 1988 (Cth) and how we deal with complaints. Our Privacy Policy is available at Telephone Call Recording We may record incoming and/or outgoing telephone calls for training or verification purposes. Where we have recorded a telephone call, we can provide you with a copy at your request, where it is reasonable to do so.

5 Details of Proposer 1. a) Policyholder (Legal ame) b) Trading ame c) AB d) Contact Person e) If you intend to claim an Input Tax Credit for the premium paid for this policy, please specify the percentage of the premium you will be claiming: % f) For how many years has the Policyholder carried on business? 2. Policyholder s main office Street Address Suburb State Postcode Telephone Facsimile Website Address Licence Conditions 3. Please state your Australian Financial Services Licence number & attach a copy of your Licence. AFS Licence umber: # 4. Are there any conditions attached to your licence? If es please provide details below Details of the Business 5. How long has the Firm continually carried on business? 6. Please state the current employed staff members of the Firm as follows: a) Principals/partners/directors b) Employees (include all full/part time & casual employees) c) Total current staff 1

6 Income 7. Please state the gross income earned by you; including commissions, fees and other benefits received on behalf of all authorised representatives from the following Professional Services in your previous financial year: Professional Service Gross Annual Income (last 12 mths) Financial planning (including superannuation) advice & services $ Life insurance a) As a broker; or $ b) On behalf of one or more insurers $ on-life insurance (on behalf of one or more insurers only) $ Mortgage broking/origination $ Total gross annual income $ 8. Total Gross Annual Income forecast for your current financial year period $ 9. Total Gross Annual Income forecast for your next financial year period $ Customer Profile for Financial Planning Services 10. a) Please provide a breakdown of the relative size of your financial planning client accounts for your previous financial year, as shown in the table below: Size of client s portfolio (FUM) Up to $100,000 $100,001 - $250,000 $250,001 - $500,000 $500,001 - $1,000,000 $1,000,001 plus Total Approx. number of clients b) Please specify your largest client according to their portfolio size: $ 2

7 Investment Product Profile 11. Please list the top 10 investment products (in order) that produced the most income for you in your previous financial year period. Please also specify your fees and commissions and advise whether you rebate commissions on any of these products. Product ame Commission Rates % Fees ($) Total Income earned ($) Up Front Trail Commission Rebated a) b) c) d) e) f) g) h) i) j) 12. Are you authorised by your AFS licence to provide Managed Discretionary Account services? If es please provide details including an example of a client mandate, approximate number of clients and funds invested. 13. a) Do you or anyone authorised by you provide financial planning advice or services in respect of superannuation funds not approved in writing by your Investment Committee? If es please provide on a separate attachment what procedures & guidelines are in place to provide such advice or services with respect to these superannuation funds. Include how you ensure that those authorised by you are providing advice & services within the procedures and guidelines stipulated. b) Have you in the past, do you currently, or do you contemplate in the future providing advice with respect to Self Managed Superannuation Funds (SMSF)? If es, please provide details on a separate attachment of how you determine (or plan to determine) the suitability of your client for a SMSF? If you have provided advice with respect to a SMSF in the past 12 months, please also state the approximate number of clients to whom you have provided such advice? Approx. number of clients # c) Have you in the past, do you currently, or do you contemplate in the future assisting your SMSF clients to purchase real estate? 3

8 If es, please provide details on a separate attachment 14. Have you in the past, do you currently, or do you contemplate in the future recommending any product or service from an entity with which you are associated (financially or otherwise)? If es, please provide details. 15. Do you recommend any of the following investment products? Investment Product Tax effective schemes (with or without ATO product ruling) Approx. number of clients # $ Hedge funds # $ Unlisted securities (for which a liquid market does not exist) Overseas securities (other than as part of a managed fund) Investments in single underlying asset or debt instrument # $ # $ # $ Direct Property # $ Direct share investments # $ Funds under advice In relation to the products above, please provide the investment rationale for each specialised investment product answering the following questions: the names and details of each of the investment products how do you determine the suitability of the investor for these products? what due diligence measures were undertaken prior to selection of these products? what are your procedures for monitoring of the fund managers or investment providers? what are your standard reporting procedures to the investors in these products? how are your benchmarks established in respect of these products? Please note that cover for the above products will only be considered upon receipt and review of the above requested information. 4

9 Optional Extension for Authorised Representatives 16. Do you require cover for your Authorised Representatives (ARs)? Please note that each person or entity who is an AR at the time this insurance is entered into will be required to complete our AR supplementary proposal form, which will include a signed and dated claims declaration, prior to being endorsed to the proposed policy. If es, please list all past or present ARs, including employed ARs, that you require to be covered by this policy on the Schedule of ARs attaching to this proposal form and also provide the following additional information: a) umber of ARs as at the date of this proposal # b) umber of ARs one year previously # c) umber of ARs anticipated in one year s time # Optional Extension for Margin Lending & Gearing 17. Do you require cover for margin lending or gearing (including recommendations made with respect to using home loan equity to purchase investment products)? If es, then please provide the following additional information: a) Do you require the investor to sign a disclosure statement? b) A copy of your margin lending / gearing compliance procedures including: i) An explanation of how you determine the suitability of your client for margin lending / gearing ii) iii) iv) Any maximum gearing ratios that you impose Any diversification requirements that you impose Any cash flow analysis undertaken by you c) Details of your delegation controls for this product; including the minimum qualifications, experience and specific product training that will be required by your authorised staff or representatives to sign-off on margin lending / gearing recommendations. Optional Extension for Life Risk Products 18. Do you require cover for your activities as a life insurance broker or when you act on behalf of one or more insurers? PLEASE OTE: We may be unable to provide cover if fees from life insurance broking activities are greater than 40% of your overall fees. If es, please provide the following additional information: a) Do you have an Australian Financial Services Licence which authorises you to act as a life insurance broker? If es, please state your total gross written premium for the past 12 mths. $ b) Do you act as an authorised representative of a life insurance broker or life insurance company? 5

10 Optional Extension for on-life Risk Products 19. Do you require cover for your activities as an authorised representative when acting on behalf of one or more insurers in respect of non-life insurance products? (ote: We are unable under this policy to provide cover for non-life insurance broking activities) If es, please attach a list of all insurers for which you act as an authorised representative and also provide the following information: a) Do you only recommend or place insurance with regard to your clients personal insurance needs (such as house, motor vehicle and personal accident insurance)? b) Have you ever in the past, do you currently, or do you contemplate in the future recommending or placing any insurance coverage with regard to commercial and/or industrial assets or activities? Optional Extension for Mortgage Services 20. Do you currently, or have you ever in the past conducted mortgage broking or origination activities that you would like included under the proposed policy? If es, please provide the following additional information: a) Are you a current paid-up member of Mortgage Industry Association of Australasia? b) Do you act under any form of delegated authority from a mortgage lending institution? If es, please provide a copy of the relevant contractual agreement(s). c) Do you always provide a documented comparison between the different interest rates and transaction costs of your available pool of products? d) When recommending the refinancing of an existing loan do you always analyse the costs as well as the advantages and disadvantages of proceeding with the refinance? e) Do you always provide written reports to clients? If es, please provide a representative sample copy of a report. f) Please advise the: i) Largest loan size arranged by you in the previous 2 years: $ ii) Average loan size arranged by you in the previous 2 years: $ g) Do you provide advice with respect to Reverse Mortgages? If es, please provide details. 6

11 h) Please list below the top five mortgage lending institutions (in order) from which you derived the most income in the previous financial year: Mortgage lending institution Commission Rate % Total income earned a) $ b) $ c) $ d) $ e) $ General Information 21. To ensure you obtain a quote as quickly as possible please ensure that the following information is attached to your proposal form (tick es if attached): a) The most recent ational Quality Assessment Programs (QAP) audit and your most recent self-assessment b) A copy of your Complaints and your Breaches Register. c) A sample Financial Services Guide. d) A representative Statement of Advice / Financial Plan (not a generic template). e) A current Approved Products List (including risk and mortgage products, if relevant to your application). f) Details of your processes and procedures for determining products to be added or removed from your Approved Products List (including procedures for providing guidelines on products not approved by your Investment Committee) g) A copy and/or description of your processes and procedures for recruiting, training and monitoring authorised staff and authorised representatives. h) Any other documents requested as part of your answers to questions in any of the preceding sections. 7

12 Claims Information 22. After enquiry of the Partners/Principals/Directors and employees, has there been or is there now pending a claim against the Policyholder, its Subsidiaries, it s predecessors in business or it s current or former Partners/ Principals/Directors or employees for a Civil Liability in the performance of the Policyholder s Professional Services? If es, please give details (if insufficient room below, provide details on a piece of your letterhead). 23. After enquiry of the Partners/Principals/Directors and employees is the Policyholder or any of its Subsidiaries aware of any circumstance or incident which may give rise to a claim against the Policyholder, its Subsidiaries or it s Partners/Principals/Directors or employees? If es, please give details (if insufficient room below, provide details on a piece of your letterhead). 24. After enquiry of the Partners/Principals/Directors and employees is the Policyholder or any of its Subsidiaries aware of any prosecution or investigation (actual or pending) of the Policyholder, any Subsidiary, or any Partner / Principal/Director or employees under any International, Commonwealth, State or Local statute, legislation, regulation or By Law? If es, please give details (if insufficient room below, provide details on a piece of your letterhead). 25. After enquiry of the Partners/Principals/Directors and employees, has the Policyholder, any Subsidiary or any Partner/Principal/Director or employee ever been subject to any disciplinary action, been fined or penalised, or been the subject of an inquiry investigating or alleging professional misconduct? If es, please give details (if insufficient room below, provide details on a piece of your letterhead). 8

13 Details of Current Insurance 26. As at today s date does the Policyholder have Professional Indemnity Insurance currently in force that has been paid for? If es, please state a) Insurer b) Indemnity Limit c) Expiry Date / / d) Retroactive Date 27. Has the Policyholder ever had any Insurer decline a proposal, imposed any special terms, cancelled or refused to renew a Professional Indemnity Insurance Policy? If es, please give details (if insufficient room below, provide details on a piece of your letterhead). 28. What limit(s) of liability does the Policyholder require quotations for? $1 million $2 million $5 million $10 million $15 million $20 million 29. What self insured retention is the Policyholder prepared to carry? $1,000 $2,000 $5,000 $10,000 Other: 9

14 Optional Extension for Breach of Privacy 30. a) Would the Policyholder like a quotation for Breach of Privacy coverage? b) If es has any Claim arising from a Breach Of Privacy ever been made against the Policyholder, its Subsidiaries or, after enquiry of the Partners/Principals/Directors, is the Policyholder or its Subsidiaries aware of any circumstances which may give rise to a Claim against the Policyholder, its Subsidiaries, or any its Partners/Principals/Directors or employees? If es, please supply the relevant details and advise what precautions have been taken to prevent a recurrence (if insufficient room below, provide details on a piece of your letterhead). Optional Extension for Employment Practices Liability 31. a) Would you like a quotation for Employment Practices Liability coverage? b) If es has any Claim arising from employment practices liability ever been made against the Policyholder, or any Subsidiary or, after enquiry of the Partners/Principals/Directors, is the Policyholder or any Subsidiary aware of any circumstances which may give rise to a Claim against the Policyholder or any Subsidiary or any its Partners/Principals/Directors or employees? If es, please supply the relevant details and advise what precautions have been taken to prevent a recurrence (if insufficient room below, provide details on a piece of your letterhead). Optional Extension for Officers Liability 32. a) Would you like a quotation for Officers Liability coverage? b) If es has any Claim arising from any directors or officers liability ever been made against any Partners/Principals/Directors or, after enquiry of the Partners/Principals/Directors, is the Policyholder or its Subsidiaries aware of any circumstances which may give rise to a Claim against any its Partners/Principals/Directors? If es, please supply the relevant details and advise what precautions have been taken to prevent a recurrence (if insufficient room below, provide details on a piece of your letterhead). 10

15 Optional Extension for Fidelity 33. a) Would the Policyholder like a quotation for Fidelity Insurance coverage? b) As at today s date, does the Policyholder currently have any fidelity guarantee/crime insurance? If es, a) Insurer b) Indemnity Limit c) Expiry Date / / d) Deductible c) Has the Policyholder or any Subsidiary ever sustained any loss through the fraud or dishonesty of any employee, or after enquiry of the Partners/Principals/Directors, is the Policyholder aware of any circumstances which may give rise to a loss against the Policyholder or any Subsidiary? If es, please supply the relevant details and advise what precautions have been taken to prevent a recurrence (if insufficient room below, provide details on a piece of your letterhead). d) Are monies, securities and/or negotiable instruments subject to control by a Partner, Principal or Director, or by at least two Employees? e) Is bank reconciliation carried out by someone not authorised to deposit into or withdraw from the bank accounts? f) When recruiting or promoting employees to positions or trust involving handling of stock, money, financial or treasury functions, does the Policyholder undertake independent checks in their employment history? Optional Extension for Workplace Statutory Liability 34. a) Would the Policyholder like a quotation for Workplace Statutory Liability coverage? b) If es has any Claim arising from workplace safety ever been made against the Policyholder or any Subsidiary or, after enquiry of the Partners/Principals/Directors, is the Policyholder or any Subsidiary aware of any circumstances which may give rise to a Claim against the Policyholder or any Subsidiary or any its Partners/Principals/Directors or employees? If es, please supply the relevant details and advise what precautions have been taken to prevent a recurrence (if insufficient room below, provide details on a piece of your letterhead). 11

16 Stamp Duty 35. For the purpose of calculating Stamp Duty please state the percentage of the Policyholder s gross income/fees that was earned in each state in the previous financial period: SW VIC QLD SA WA TAS ACT T Overseas* *If es to overseas operations,, please give details of the name of the client(s), the country they are located within and what service(s) are provided (if insufficient room below, provide details on a piece of your letterhead). Declaration Please ote: Signing the Declaration does not bind the proposer or the Insurer to complete this insurance. I declare that I have made all necessary inquiries into the accuracy of the responses given in this proposal and confirm that the statements and particulars given in this proposal are true and complete and that no material facts have been omitted, misstated or suppressed. I agree that should any of the information given by me alter between the date of this proposal and the inception date of the insurance to which this proposal relates, I will give immediate notice thereof to the insurer. I acknowledge receipt of the notices included in the cover sheet of this proposal and that I have read and understood the content of them. I confirm that I am authorised by the proposing Policyholder (and its partners/principals/directors if applicable) to complete this proposal form and to accept the quotation terms for this insurance on behalf of the Policyholder and its Subsidiaries (and its partners/principals/directors if applicable). ame: Title: Signature: Date: 12

17 Allianz Australia Insurance Limited 2 Market Street Sydney SW Australia Phone: Fax: Disclaimer & Copyright Copyright 2014 Allianz Australia Ltd. All rights reserved. The material contained in this publication is designed to provide general information only. Whilst every effort has been made to ensure that the information provided is accurate, this information is provided without any representation or warranty of any kind about its accuracy and Allianz Australia Limited cannot be held responsible for any mistakes or omissions.