For Directors and Officers Professional Indemnity Insurance

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1 Questionnaire & Application Pack For Directors and Officers Professional Indemnity Insurance This pack contains the following documents:- Our FSA Keyfacts document explaining who we are. Our FSA Demands & Needs statement. The questionnaire application for insurance. Our request document to correspond by . If you have any questions you can contact us on

2 about our services Registered Offices : LegalRisks.co.uk (LegalRisks.co.uk is a trading style of Sennet Professional Risks Limited) Company registration # Park Street Deal Kent CT14 6AG 1. The Financial Services Authority (FSA) The FSA is the independent watchdog that regulates financial services. It requires us to give you this document. Use this information to decide if our services are right for you 2. Whose product do we offer? We offer products from the whole market We only offer products from a limited number of companies. Ask us for a list of the companies and products we offer We can only offer products from one company We only offer our own products Ask us for a list of companies and products that we offer. 3. Which services will we provide you with? We will advise and make a recommendation for you after we have assessed you needs You will not receive advice or a recommendation from us. We may ask some questions to narrow down the selection of products that we will provide details on. You will then need to make your own choice about how to proceed. We will provide basic advice on a limited range of stakeholder products and in order to do this we will ask some questions about your income, savings and other circumstances but we will not - conduct a full assessment of your needs - offer advice on whether a non stakeholder product may be more suitable 4. What will you have to pay us for our services? Before we provide you with advice, we will give you our keyfacts guide about the costs of our services. We will tell you how we get paid, and the amount, before we carry out any business for you. 5 Who regulates us? LegalRisks.co.uk [LegalRisks.co.uk is a trading style of Sennet Professional Risks Limited] registered offices 11 Park Street, Deal, Kent. CT14 6AG Legalrisks.co.uk is an Appointed Representative of Griffin Insurance Services Limited. FSA number : You can check this on the FSA s Register by visiting the FSA s web site or by calling them on Loans and Ownership Legal Risks [Legal Risks is a trading style of Sennet Professional Risks Limited Is a privately owned limited liability company, limited by shares. 7 What to do if you have a complaint If you wish to register a complaint, please contact us In writing Write to Mr Paul James, Legalrisks.co.uk, 11 Park Street, Deal, Kent. CT14 6AG. By telephone By If you cannot settle your complaint with us, you may be entitled to refer it to the Financial Services Ombudsman, Financial Ombudsman Service,South Quay Plaza,183 Marsh Wall,London E14 9SR Telephone: is procedure will not prejudice your legal rights. 8 Are we covered by the Financial Services Compensation Scheme (FSCS)? We are covered by the FSCS. You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Most types of investment business are covered 100% of the first 30,000 and 90% of the next 20,000 so the maximum compensation is 48,000. Insurance advising and arranging is covered for 100% of the first 2,000 and 90% of the remainder of the claim, without any upper limit. For compulsory classes of insurance, insurance advising and arranging is covered for 100% of the claim, without any upper limit. If you have any questions you can contact us on

3 Demands and Needs Statement Legalrisks.co.uk operates a policy of clarity and use of plain English. We act for you as an Insurance Intermediary. We will search the insurance market pertinent to your request for insurance coverage. This means if you ask us for a specific insurance type of insurance (office insurance, business insurance, indemnity insurance etc) we will approach specific underwriters who are experts in those fields. How do we do this? To enable us to search for insurance for you we ask you questions about what insurance you need. The best way we can do this is by asking you to fill in a questionnaire (also known as a Proposal Form or Application Form) which contains a range of questions. Each type of insurance has a different type of questionnaire that is designed to give underwriters the information that they require so that they understand your activities and the amount of risks associated to your work. The questionnaire allows you the opportunity to explain your work and requirements for insurance, the scope of cover and amount, often referred to as the limits of indemnity. Very often a Curriculum Vitae will be requested in addition to this. This information will allow underwriters to offer you terms and conditions for your insurance policy. It is essential that all information contained in these questionnaires is accurate and that no details or information which may effect underwriter s decisions is withheld. Any withholding of pertinent information may allow underwriters to limit or refuse payment of claims. Execution only insurance We will not undertake execution only insurance (placement of insurance by demand of the client in preset form with predetermined underwriters) unless in our opinion this permits the client appropriate insurance provisions. Assessment of Demands and Needs Once we have received your completed questionnaire we can review your request for insurance. Depending on the information you provide us we can assist you with advice on the scope of cover and the amount of insurance you may require. We are dependent upon the information which is provided to us as well as the specific requests as to what advice about insurance you need. Our advice to you will not only depend on the information we require but will take into account your ability to purchase. If you are involved with or undertake work within specific types of work that are governed by Law or Institutes or Associations or Societies we will ensure that your insurance is adequate for purpose relative to these needs. Once we have obtained terms and conditions form underwriters we will confirm these to you by means of a quotation. This document will detail the insurance, it s cost and special clauses (conditions that affect the scope of cover) for the insurance cover. We will issue this quotation based on our reading of the questionnaire and the suitability of the underwriters terms so as to afford you the most appropriate insurance. We recommend that you not only consider the immediate necessity or requirement for professional indemnity insurance but other insurances that may be appropriate to your needs such as Office & Contents and Employers Liability. We can advise you on various forms of insurance which are related and are often purchased as packages and how these best fit your requirements. In certain circumstances we may not be the appropriate intermediary to undertake the effecting of the insurance contract. In these circumstances we will advise you and the options open to you. If you have any questions you can contact us on

4 Client Information Sheet - Your Questionnaire. Proposal forms and Information So that underwriters can fully assess you and your business they require information about your activities. This information is compiled by means of completing a questionnaire or proposal form. In this form you will be asked questions about yourself, your company and its activities. It is imperative that you answer these questions as fully as possible and declare all details that may be pertinent to the future insurance contract. Incorrect answers or withholding of pertinent information could lead to underwriters having the right not to pay claims or repudiating the policy. What sort of information? Underwriters want to know who you are, how much experience you and your company have and exactly what you do. The questionnaire will ask you all of these details. Sometimes it is a good idea to provide additional information. For instance, if a sole trader or two partner practice, provision of CVs is a good way forward. If you have company brochure it is a good idea to supply this. The clearer and fuller the information the better, this will allow us to obtain the most appropriate terms for you. If your company has not started trading then underwriters will require good estimates of what you intend to do and the amount you expect to earn or turnover. If your company provides consultancy or training services then clearly describe what you consult in or what you train people for. If you or your company use standard terms of trade then a copy of these will help underwriters to understand how you work and how you control the work with your clients. If you have any questions about what should be disclosed please contact us for clarification. The questionnaire forms part of the insurance contract, so it is important that all information is clear, factual and that no information that could affect the insurance terms is withheld. As part of the insurance contract the questionnaire must be hand signed and dated by you declaring its accuracy. What happens once the Questionnaire is returned to Legalrisks.co.uk? Once Legalrisks.co.uk has received the questionnaire and any additional information we will approach various underwriters for you so as to obtain the most appropriate scope of insurance for your needs. These terms will be provided to you in the form of a quote. If you have any questions about the terms or conditions of the quote you must ask for clarification. Sometimes underwriters apply conditions or need additional information and you must be aware of these terms. Please ask us what they mean. In certain circumstances you may instruct us to effect insurance that may not be appropriate. In such circumstances we will advise you of the appropriateness and reserve the right to withdraw our services. As your agent we are legally bound to act in your best interest at all times. For further information on what happens during the process of insurance please visit our web site at Please complete the following questionnaire, check all the details, sign and date the document, enclose any accompanying information and return it to us By post to : or By to : Freepost RRXS-STER-CSEG Legalrisks.co.uk 11 Park Street Deal CT14 6AG or By fax to : If you have any questions you can contact us on

5 Directors and Officers Liability Insurance Proposal Form 1.a Company Name / Title of Insured 1.b Main Address 1.c Company Registration number 2.a Address of Registered Office (Name and Address) Post Code 2.b Address Telephone Number Facsimile Number Web Site Address Post Code 3 Is the Company registered in England and Wales and / or Scotland? (Channel Islands and Isle of Mann are not included as within above for the purpose of this form) If not registered in England and Wales and / or Scotland then please state country of registration 4.a Is the Company a subsidiary of another company? If yes please advise:- 4.b Name of ultimate holding company 4.c Country of Registration 5 Date Company Established / / Date Financial Year End / 6 If cover is required for an Associated or Subsidiary Company please provide details (Name and Address) Post Code

6 7 Has the Company continually carried on business for at least twelve months? If please advise date since the Company has continuously carried on business (Also please provide a copy of the Business Plan) 8 Has there been a management buy-in (MBI) or management buy-out (MBO) within the last two years? If please state date of and what type of action MBI or MBO (Also please provide a brief written explanation of why this action was undertaken and the expected results) 9 Please state the nature of the business activities of the Company and what type of Company (e.g. Private, Public etc) 10.a Are there any shareholders who are not Directors or Officers of the Company or their relatives? 10.b Are the Company shares traded or are there plans to trade in any way? 10.c Are there any plans for the Company to be merged or acquired? 10.d Has the Capital Structure of the company altered during the past three years? If the answer to any of the above if please give details 11 If any one individual or company (apart from the Directors and Officers of the Company) has a shareholding of more than 20% please give full details of name(s) and amount held 12 If the Company is represented in North America and / or Australia please give full details of operations and turnover

7 13.a Are the companies shares traded in any way? If please answer the following questions 13.b Is the company listed on any stock exchange? If please state the name and country of the Exchange 13.c Date when the Company was first listed 13.d Please advise total number of:- A Shares B Shares Registered Issued 13.e Is the company listed on the Unlisted Securities Market? 13.f Are the Companies shares traded in any other way? If please provide details Only answer 14.a if your Company is a Private Limited company Company s shares are T traded in any way The Company is not a Financial Institution (For the purposes of this question a Financial Institution is a bank, insurance company, venture capital company, building society, investment trust etc) IF YOUR COMPANY IS T IN THIS SECTOR GO TO QUESTION 15) 14.a What was the turnover of the Company in its last financial year 14.b Into which of the following work categories does the Company s main area of business fall Construction and Extraction Distribution, wholesale and transportation Financial, business and support services Leisure and tourism Sports and social clubs Manufacturing Retail Other If Other please provide full details

8 14.c Is the Company or any of its subsidiaries a dot.com trading company? If please advise individual www. addresses, copies of trading terms, disclaimers and full details of anti fraud / theft / credit card misuse techniques applied on an attached information sheet. 14.d Do any persons other than the Directors of the Company or their family members own shares of the Company? If please complete the following:- 14.e Are all such shares owned by the Company s parent or ultimate holding company? If, which of the following circumstances apply? i) No one shareholder holds (directly or indirectly) more than 15% of the share ii) A Financial Institution holds (directly or indirectly) less than 50% of the share iii) iii) A shareholder who is not a Financial Institution holds (directly or indirectly) more than 15% of the share A financial Institution holds (directly or indirectly) 50% or more of the share If either iii) or iv) please provide details of who, what percentage, split of shareholding and if that shareholder is an active member in the day to day running of the business 14.f Please advise if there are either plans to trade the Company s shares over the next twelve months or for the Company to be merged or acquired If please provide full details 14.g Please advise the total consolidated assets for the company (fixed plus current) of the Company including subsidiaries by location (if Rest of World please advise country) United Kingdom North America Rest of World Figures should be taken from the Company s latest audited accounts or for new companies use the management projections

9 14.h Please advise that the Company i) Has not had a pre-tax loss or negative net worth in any of its last two complete financial years and that one is not expected for the current financial year ii) Neither the Company nor any of its subsidiaries are insolvent, in liquidation, the subject of a windingup petition or have issued notices of meeting to consider a resolution for liquidation iii) Neither the Company or any of its subsidiaries are the subject of an administration order or an application for an administration order iv) The Company and its subsidiaries are able to pay their debts as they fall due v) The Company or its subsidiaries has not changed its auditors within the last two years If please provide full explanation This set of questions relates if the Company is outside of Question 14 A Public Listed Company or Falls 15.a Have any of the following key Personnel terminated their relationship with the Company (or had their relationship with the Company terminated) since the Company s last annual report and accounts were issued? i) Chairman / President ii) Chief Executive / Operating Officer iii) Finance Director / Finance Officer If please provide full reasons as to why 15.b Has the Company or any of its subsidiaries made any acquisitions or disposals during the past eighteen months? If please provide full details of transaction 15.c Has the Company filed any registration statement for a public offering within the past twelve months If please provide full details 15.d Has the Company issued any shares (ordinary or otherwise) during the past twelve months

10 If please provide details of type, number and reason THE FOLLOWING QUESTIONS APPLY TO ALL APPLICANTS. 16.a Does the Company have any Subsidiaries or any assets or employees in North American or Australia If Yes please answer the following questions 16.b Are such subsidiaries wholly owned? If then please confirm:- i) Who owns the minority interest? ii) What proportion of the share capital is the minority interest? 16.c What are the total gross consolidated assets of the Company and / or its Subsidiaries in North America or Australia? Please answer in local currency. 16.d Please state the number of employees in these operations 16.e Does the Company or any of its subsidiaries have any of their stock, shares or debentures issued in these Countries? If please confirm:- i) When was the last offer / tender issue made? ii) Was the offer subject to the United States Security Act 1933 and / or the Securities Exchange Act 1934 and/ or amendments made thereto? iv) Was a 20 F filing or similar filing made to the ISA Regularity Authorities? 17 Has Directors and Officers Liability Insurance been held during any of the past three years? If please advise:- i) Policy period ii) Limit of Indemnity iii) Current Insurers 18.a Has any insurer declined a proposal, renewal or terminated an insurance involving the Proposers?

11 18.b Are the Proposers, AFTER ENQUIRY, aware of any circumstance or incident which might give rise to a claim against the Company or any Director or Officer? If please give details 18.c If an insurance similar to that now proposed were now in effect or had been in effect would any claim, prosecution, proceedings or investigation which has been made or which is now pending against any persons proposed for insurance have fallen within the scope of such insurance? If please give details 19.a What is the limit of indemnity required? 100, , ,000 1,000,000 Other 19.b What is the amount of excess which your Company or Firm would be prepared to carry? 500 1,000 2,500 Other It is likely that underwriters may impose a compulsory excess THE COMPANY S LAST TWO ANNUAL REPORTS, TOGETHER WITH ANY EXPLANATORY BROCHURES OF THE COMPANY SHOULD BE SUBMITTED WITH THIS PROPOSAL FORM. IN THE EVENT OF NEW COMPANY PLEASE SUBMIT THE LATEST BUSINESS PLAN.

12 This page forms your declaration to underwriters and can also be used to provide any additional information that you might want to provide pertinent to your Firm that may assist underwriters in their decision making process. In all cases underwriters will require you to sign and date this form. If you present this proposal form to us electronically (by ) you will eventually be required to sign and date this form. I/We declare that the statements and particulars in this proposal are true and that I/We have not mis-stated or suppressed any material facts. I/We agree that this proposal, together with any other information supplied by me/us shall form the basis of any Contract of Insurance effected thereon. I/We undertake to inform insurers of any material alteration to these facts occurring before completion of the Contract of Insurance. Returning this proposal does not bind the Proposer or Underwriter to complete this insurance but does authorise 'Sennet Professional Risks Limited' to seek terms on my/our behalf from Insurers including current Insurer's if any. Signed: Date: (This must be signed by a Partner, Director or equivalent ranking employee) All information provided to us and then to underwriters is governed by the DATA PROTECTION ACT Sennet Professional Risks Limited and Underwriters act strictly in accordance with the Act its principals and tenets and any subsequent amendments thereto. If you have any questions you can contact us on

13 E Correspondence Agreement Form This is an agreement between :- Name of Client Address : and Legalrisks.co.uk (being a trading style of Sennet Professional Risks Limited Company Registration ) Legalrisks.co.uk requests the Clients agreement to correspond by means of and other electronic forms of communication. Legalrisks.co.uk will keep copies of all E documents and correspondence on a permanent basis and make such available to the client whensoever requested. Legalrisks.co.uk is bound by the Data Protection Act 1998 registration # Z X and will maintain all records pertinent to the client under compliance thereto. We hereby agree to accept electronic correspondence between ourselves and Legalrisks.co.uk as legal documents and an acceptable means of correspondence. Signed For and on behalf or Legalrisks.co.uk Date 09/07/2008 Signed For and on Behalf of the Client Date This document must only be signed by the Principal, a Senior Director or other such person who has the authority or authorisation of the Company to undertake such an agreement. If you have any questions you can contact us on

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