CONTRACTUAL LIABILITY TAKAFUL ENGINEERING CONTRACTORS PROPOSAL FORM

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CONTRACTUAL LIABILITY TAKAFUL ENGINEERING CONTRACTORS PROPOSAL FORM"

Transcription

1 Jubilee General Insurance Company Limited - Window Takaful Operations 3rd Floor, Jubilee Insurance House, I.I. Chundrigar Road, P.O. Box 4795, Karachi UAN: , Tel: (021) , Fax: (021) Website: CONTRACTUAL LIABILITY TAKAFUL ENGINEERING CONTRACTORS PROPOSAL FORM This proposal must be completed by a Partner or Principal of the Practice. All Questions must be answered to enable a quotation to be given. Completing and signing this Proposal does not bind the Proposers or Takaful Operator to complete a Contract of Takaful. If there is insufficient space to answer questions, use an additional sheet and attach it to this form indicating the question to which the answer refers. (Please indicate section number) 1. a) Please state the name and address(es): Name of Practice, together with partner responsible for each office: Address(es) Phone No. Partner(s) in Charge b) Profession of Practice c) Name(s) of former Practice(s) for whom takaful is required : 2. Please state: a) of commencement of current Practice: b) of commencement and cessation of former practice(s) : c) Reason for cessation of former Practice(s) : 3. Please state names of all Partners/ Principals/ Owners of the Practice named above: Page 1 of 7

2 Name(s) Partner/Principal at this Practice Qualifications Qualified 4. If sole Partner/Principal, please answer the following: Is this a part-time occupation? YES / NO If YES please provide brief details of present full time occupation. In either case please complete the Supplementary Questionnaire (Q. 20) 5. Please state names in full of Partners / Principals who have left, retired or died and for whom coverage is required. If none, state none. Name Qualifications How long as Partner / Principal 6. Please state the numbers of: Partners/Principals Qualified staff Draughtsmen Trainee staff, Typists Others 7. State for the whole practice: a) Gross fees received for each of the last five financial years. Account year ending: Month (Please state)... Financial year end Home Contracts PKR PKR PKR PKR PKR PKR Overseas Contracts PKR PKR PKR PKR PKR b) Split of gross fees received in the past financial year: HOME CONTRACTS OVERSEAS CONTRACTS Page 2 of 7

3 i) Consulting engineering a) Civil PKR PKR b) Structure PKR PKR c) Soil & foundation PKR PKR d) Mechanical PKR PKR e) procurement PKR PKR a. materials b. machinery/plant c. consumables ii) Architectural electrical PKR PKR a) heating work PKR PKR iii) Town planning/ quantity surveying PKR PKR iv) structural surveys/ inspection reports/ valuations PKR PKR v) Fees paid to independent specialist consultants, please specify PKR PKR vi) other work please specify PKR PKR TOTAL GROSS FEES PKR PKR c) ESTIMATED GROSS FEES FOR CURRENT FINANCIAL YEAR PKR PKR 8. State the approximate amount of gross fees received for each of the last five financial years which relates to contracts where Latent Defects/Decennial Takaful was arranged in respect of the contract. Financial year end: Home Contracts PKR PKR PKR PKR PKR Overseas Contracts PKR PKR PKR PKR PKR 9. a) Please give approximate % applicable to these specified projects as a % of the total work carried out in the past 12 months: Contents % Contents % Bridges/flyovers/tunnels/dams/mines/refineries Chemicals/petro chemicals/oil Harbours/jetties/sea defences Nuclear/Atomic Projects Marine surveyors Sewage/ water schemes Bulk handling equipment/hoppers/silos Hospital/universities/schools Mechanical plant/equipment Factories Fertilizer/Ammonia/Urea Plant Housing b) Please give approximate % applicable to these specified projects as a % of the total work carried out in the past 12 months: Page 3 of 7

4 Contents % Contents % Industrialized systems building Government Departments Restoration Work Local Authorities Reinforced/ Pressed concrete High rise contracts(10 storeys or more) Soil Testing/foundation/piling/underpinning No of stories in highest block completed in last 10 years c) Proportion of work where Practice both designs and supervises construction % N.B. If the Practice has not been in operation for 12 months, please give estimated answers for the above questions Contents Starting Description of Contract (e.g. hotel, factory etc) Total Contract Value Approx Completion State Professional Services Provided a) Please state the 5 largest contracts where construction has commenced during the past 6 years: b) Please give details of contracts where construction is expected in the next 12 months: 11. a) Does the Practice Undertake any work whatsoever where the end product Of such work is carried out outside Home territory? (If YES please give details) Country Starting Description of Contract Total Contract Value Approx Completion State Professional Services Provided Page 4 of 7

5 b) Does the Practice work other than from its Home territory offices? c) Does the Practise enter into contracts where the jurisdiction is other than Home territory courts? (If the answer to b) or c) is YES, full details are required i.e. list the jurisdictions and amount or work there from etc.) Details: 12. a) Is the Practice or any Partner/Principal a member of a consortium or Group Practice or engaged with any other Practice or person in a Single Project Partnership? (If YES give the names of other members/partners and their capacities in the consortium/partnership) Details N.B. Special arrangements must be made with Takaful Operator if coverage is required for work done whilst as a member of a consortium. In such cases a copy of the consortium agreement will be required. b) Does this Practice or any Partner/Principal have any association with, or financial interest in any other Practice, Operator or organisation? If YES give full details of the nature of the association together with the name and business of the other firms. 13. When independent or specialist consultants are required for any commission Have you in the past covered, and will you in the future endeavour to cover, that such consultants are appointed directly by and paid by your Participant? for (N.B. Whenever a Participant requires that you engage or employ consultants, you should ask evidence of professional indemnity takaful from them?) 14. Does the practice hold professional indemnity takaful. If YES state: a. Name of takaful operators: b. Limit of Indemnity : c. Excess : d. of Expiry of Coverage: (If the practice has not been covered from its start, advise no. of years continuously covered to date): 15. Has any insurer/takaful operator ever: a) Declined a proposal or renewal for this Practice or any Partner/Principal? Details Page 5 of 7

6 b. Required an increased contribution or imposed special terms? Details c. Cancelled or voided insurance/takaful? (Attach a separate sheet if necessary.) Details 16. For what limit(s) of indemnity do you require a quotation? Limit: (Please state whether you require the limit to be for the total amount during any one year or for each and every claim) Annual aggregate / Any one claim 17. Do you require coverage for replacing lost or damaged documents? If YES, state cover required and state % of above relating to Computer Systems Records) 18. Have any claims for professional negligence, error or omission (successful or otherwise) been made against the Practice or its present and/or past partners during the past 10 years? If YES, give full details, including amounts) (Attach a separate sheet if necessary) Details 19. Are any of the Partners/Principals, after enquiry, aware of any circumstances which may give rise to claim against this Practice or their predecessors in business or any of the present or former Partners/Principals? (If YES give full details) Details Page 6 of 7

7 20. Supplementary questionnaire for single partner operations only Please answer fully, the following: 1. Your Age : of Birth: / / 2. Please give the full experience and qualifications of any assistants whom you employ: Their length of service in your employ: Details: (Please attach a separate sheet if necessary) 3. What formal arrangements have you made with any other practices to assist you when you are Incapacitated or are unable for any reason to attend your business? If applicable, name practices in above: (Attach a separate sheet if necessary) It is essential that every proposer or participant, when seeking a quotation, taking out or renewing an takaful, reveals to the prospective takaful operators any material fact or information (including any material circumstance) which might influence the judgement of an takaful operator in fixing the contribution or in determining whether he will accept the risk. Failure to do so may render the contract or takaful voidable form inception at the option of the takaful operators and enable them to repudiate liability there under. If you have any doubt as to what constitutes a material fact or circumstance please do not hesitate to seek our advice. DECLARATION I/we declare that the statements and particulars in the Proposal are true and that I/we have not misstated or suppressed any material fact. I/we agree that this Proposal together with any other information supplied by me/us shall form the basis of any Contract of Takaful effected thereon. I/we undertake to inform Takaful Operator of any material alteration to these facts occurring before completion of the Contract of Takaful. d this: day of: 20 Signature of Partner/Principal : Name of Firm/ Operator/ Practice : A copy of this proposal should be retained by you for your own records Page 7 of 7

CONTRACTUAL LIABILITY INSURANCE ENGINEERING CONTRACTORS PROPOSAL FORM

CONTRACTUAL LIABILITY INSURANCE ENGINEERING CONTRACTORS PROPOSAL FORM Jubilee General Insurance Company Limited (formerly New Jubilee Insurance Company Limited) Jubilee Insurance House, I.I.Chundrigar Road, Karachi 74000 UAN: 111 654 111, Tel: (021) 32416022-26, Fax: (021)

More information

CONSULTING ENGINEERS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

CONSULTING ENGINEERS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE HCC International Walsingham House, 35 Seething Lane London EC3N 4AH, United Kingdom main +44 (0)20 7702 4700 facsimile +44 (0)20 7626 4820 CONSULTING ENGINEERS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

More information

Professional Indemnity Insurance Proposal Form for Architects

Professional Indemnity Insurance Proposal Form for Architects Professional Indemnity Insurance Proposal Form for Architects Please complete all questions in ink. If there is insufficient space please supply the information on a separate sheet of paper indicating

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Consulting Engineers Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

ARCHITECTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

ARCHITECTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE HCC International Walsingham House, 35 Seething Lane London EC3N 4AH, United Kingdom main +44 (0)20 7702 4700 facsimile +44 (0)20 7626 4820 ARCHITECTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE IMPORTANT

More information

PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS

PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS Form PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS All questions must be answered to enable a quotation to be given. The completion and signature of this proposal form does not bind the Proposer(s) or the

More information

DESIGN AND CONSTRUCT PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

DESIGN AND CONSTRUCT PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE Monometer House, Rectory Grove Leigh on Sea, Essex, SS9 2HN Office: 01702 713 636 Fax: 01702 713 691 DESIGN AND CONSTRUCT PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE IMPORTANT TICE This proposal must

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Management Consultants Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

Design & Construct Professional Indemnity Insurance Proposal Form

Design & Construct Professional Indemnity Insurance Proposal Form Your Professional Indemnity Specialists www.brian-thornhill.co.uk Design & Construct Professional Indemnity Insurance Proposal Form Please complete this form in BLOCK CAPITALS IMPORTANT INFORMATION This

More information

PROFESSIONAL INDEMNITY INSURANCE ESTATE AGENTS, AUCTIONEERS, SURVEYORS & VALUERS

PROFESSIONAL INDEMNITY INSURANCE ESTATE AGENTS, AUCTIONEERS, SURVEYORS & VALUERS PROFESSIONAL INDEMNITY INSURANCE ESTATE AGENTS, AUCTIONEERS, SURVEYORS & VALUERS This proposal must be completed in ink by a Partner, Director or Principle of the Firm. If there is insufficient space to

More information

PROFESSIONAL INDEMNITY INSURANCE SINGLE PROJECT PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE SINGLE PROJECT PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE SINGLE PROJECT PROPOSAL FORM IMPORTANT NOTICE This proposal form must be completed in ink by the Individual or a Partner, Principal or Director of the Firm or Company.

More information

Surveyors, Estate Agents and other Property Professionals Professional Indemnity Insurance

Surveyors, Estate Agents and other Property Professionals Professional Indemnity Insurance Surveyors, Estate Agents and other Property Professionals Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Media Professionals Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

Professional indemnity insurance Architects proposal form

Professional indemnity insurance Architects proposal form Professional indemnity insurance Architects proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters within

More information

Securus Insurance Limited. Proposal Form. Architects Professional Indemnity

Securus Insurance Limited. Proposal Form. Architects Professional Indemnity Securus Insurance Limited Proposal Form Architects Professional Indemnity Securus Insurance Limited Suite 3, Stafford House Strand Road Portmarnock Co Dublin Phone (01) 8464512 Fax (01) 8464522 Email info@securus.ie

More information

MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM

MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM Please Note: This is a proposal form for a policy relating to claims made against the Insured during the period of the policy only CLAIMS MADE. Please

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Employment & Recruitment Agencies Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink

More information

Professional Indemnity for Architects Proposal Form

Professional Indemnity for Architects Proposal Form Professional Indemnity for Architects Proposal Form 3716 V1 12/03 1. Your Business Title of Practice(s): Profession(s)/Business(es) of Practice of Commencement of Current Practice: of Commencement and

More information

IT PROFESSIONALS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

IT PROFESSIONALS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IT Professionals Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

Professional indemnity insurance BIID members proposal form

Professional indemnity insurance BIID members proposal form Professional indemnity insurance BIID members proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters within

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with our most competitive quotation, it is important

More information

MARINE SURVEYORS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

MARINE SURVEYORS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE HCC International Walsingham House, 35 Seething Lane London EC3N 4AH, United Kingdom main +44 (0)20 7702 4700 facsimile +44 (0)20 7626 4820 MARINE SURVEYORS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

More information

HOULDER INSURANCE SERVICES

HOULDER INSURANCE SERVICES HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM ENGINEERS PLEASE READ THE FOLLOWING BEFORE COMPLETING THIS PROPOSAL FORM: ALL QUESTIONS SHOULD BE COMPLETED IN INK. WHERE A QUESTION IS NOT

More information

Engineers, Architects, Surveyors And Relation Professions Professional Indemnity Proposal Form

Engineers, Architects, Surveyors And Relation Professions Professional Indemnity Proposal Form Engineers, Architects, Surveyors And Relation Professions Professional Indemnity Proposal Form Once completed, please sign and return together with any additional sheets and attachments to: Prime Underwriting

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be answered to enable

More information

PROFESSIONAL INDEMNITY ENGINEERS

PROFESSIONAL INDEMNITY ENGINEERS PROFESSIONAL INDEMNITY ENGINEERS PROPOSAL FORM THIS PROPOSAL MUST BE SIGNED BY A PARTNER OR DIRECTOR OF THE BUSINESS. ALL QUESTIONS MUST BE ANSWERED AND ADDITIONAL INFORMATION PROVIDED WHEN REQUESTED TO

More information

Engineers Professional Liability Proposal Form

Engineers Professional Liability Proposal Form Proposer Details Name of insured Firm(s) (including predecessors) Principal Address line one Principal Address line two City and postcode Telephone number Website Date Firm Established Please provide details

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with our most competitive quotation, it

More information

Professional indemnity insurance Design & construct proposal form

Professional indemnity insurance Design & construct proposal form Professional indemnity insurance Design & construct proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters

More information

MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM

MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material fact

More information

Professional Indemnity Insurance Proposal Form for Architects

Professional Indemnity Insurance Proposal Form for Architects QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Architects IMPORTANT INFORMATION Duty of Disclosure When completing any insurance proposal form

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS INTERSURE INSURANCE BROKERS LIMITED PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with

More information

Professional Indemnity Insurance for Miscellaneous Professions Proposal Form

Professional Indemnity Insurance for Miscellaneous Professions Proposal Form Professional Indemnity Insurance for Miscellaneous Professions Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you / your means the individual, company,

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES Howden Insurance Brokers Limited is an official scheme provider of Professional Indemnity for BIBA members Please complete this

More information

MISCELLANEOUS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

MISCELLANEOUS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE HCC International Walsingham House, 35 Seething Lane London EC3N 4AH, United Kingdom main +44 (0)20 7702 4700 facsimile +44 (0)20 7626 4820 MISCELLANEOUS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with our most competitive quotation, it is important

More information

Securus Insurance Limited. Proposal Form. Engineers Professional Indemnity

Securus Insurance Limited. Proposal Form. Engineers Professional Indemnity Securus Insurance Limited Proposal Form Engineers Professional Indemnity Securus Insurance Limited Suite 3, Stafford House Strand Road Portmarnock Co Dublin Phone (01) 8464512 Fax (01) 8464522 Email info@securus.ie

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS PROJECT COVER

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS PROJECT COVER PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS PROJECT COVER I. GENERAL DATA 1. Name of Organization: 2. Address of Head Office: 3. Address of Branch office(s) and name(s)

More information

Professional Indemnity Proposal Form Architects

Professional Indemnity Proposal Form Architects Professional Indemnity Proposal Form Architects GUIDANCE NOTES Completing your proposal form Please complete all questions in full using the Additional Information section or separate sheets where necessary.

More information

Professional Indemnity Insurance Proposal Form For The Design and Consulting Departments of Contractors

Professional Indemnity Insurance Proposal Form For The Design and Consulting Departments of Contractors Professional Indemnity Insurance Proposal Form For The Design and Consulting Departments of Contractors Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you/your

More information

W.R. Berkley Insurance Ireland

W.R. Berkley Insurance Ireland W.R. Berkley Insurance Ireland ARCHITECTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to

More information

UIB UK PROFESSIONAL INDEMNITY

UIB UK PROFESSIONAL INDEMNITY l It is very important that you disclose fully and accurately all material facts. If you require more space please continue on your headed paper, then sign and attach to this form. Material facts are those

More information

CONSULTING GEOLOGIST PROFESSIONAL INDEMNITY PROPOSAL FORM

CONSULTING GEOLOGIST PROFESSIONAL INDEMNITY PROPOSAL FORM Thompson Insurances Corporate and Personal Brokers 16, Upper Grand Canal Street, Dublin 4, Ireland. Tel: + 353 1 481 7700 Fax: + 353 1 6604058 Email info@nti.ie Web Site www.nti.ie CONSULTING GEOLOGIST

More information

Professional Indemnity Insurance Management Consultants Proposal Form

Professional Indemnity Insurance Management Consultants Proposal Form Professional Indemnity Insurance Management Consultants Proposal Form Towergate Lifestyle Suite 4b, 1 Portland Street, Manchester, M1 3BE Tel: 0844 892 1789 Fax: 0844 892 1796 Email: lifestyle@towergate.co.uk

More information

HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM DESIGN & CONSTRUCTION INDUSTRY

HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM DESIGN & CONSTRUCTION INDUSTRY HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM DESIGN & CONSTRUCTION INDUSTRY PLEASE READ THE FOLLOWING BEFORE COMPLETING THIS PROPOSAL FORM: ALL QUESTIONS SHOULD BE COMPLETED IN INK.

More information

Professional Indemnity Insurance

Professional Indemnity Insurance Professional Indemnity Insurance For Members of the Public Relations Institute of Ireland Public Relations Consultants Proposal Form Arranged in co-operation with: W Wood Limited London EC3A 8B United

More information

PROFESSIONAL INDEMNITY ARCHITECTS

PROFESSIONAL INDEMNITY ARCHITECTS PROFEIONAL INDEMNITY ARCHITECT PROPOAL FORM THI PROPOAL MUT BE IGNED BY A PARTNER OR DIRECTOR OF THE BUINE. ALL QUETION MUT BE ANWERED AND ADDITIONAL INFORMATION PROVIDED WHEN REQUETED TO ENABLE A QUOTATION

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters within the

More information

Architects Professional Liability Insurance Proposal

Architects Professional Liability Insurance Proposal AIG Europe Limited Proposer Details Name of Firm(s) Principal Address line one Principal Address line two City and postcode Telephone number Fax number Website address Is the Firm(s) a subsidiary of an

More information

MANAGEMENT CONSULTANTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

MANAGEMENT CONSULTANTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE HCC International Walsingham House, 35 Seething Lane London EC3N 4AH, United Kingdom main +44 (0)20 7702 4700 facsimile +44 (0)20 7626 4820 MANAGEMENT CONSULTANTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE

More information

PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS PROPOSAL FORM THIS PROPOSAL MUST BE SIGNED BY A PARTNER OR DIRECTOR OF THE BUSINESS. ALL QUESTIONS MUST BE ANSWERED AND ADDITIONAL INFORMATION PROVIDED WHEN

More information

Architects. Professional Indemnity. Proposal Form

Architects. Professional Indemnity. Proposal Form Thompson Heath & Bond Limited 107 Leadenhall Street London EC3A 4AF Tel: +44 (0) 20 7469 0100 Fax: +44 (0) 20 7621 0661 www.thbgroup.com Lloyd s Broker Architects Professional Indemnity Proposal Form THB

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR HEALTH & SAFETY CONSULTANTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR HEALTH & SAFETY CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR HEALTH & SAFETY CONSULTANTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be

More information

Professional indemnity insurance Management consultants proposal form

Professional indemnity insurance Management consultants proposal form Professional indemnity insurance Management consultants proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters

More information

HOULDER INSURANCE SERVICES

HOULDER INSURANCE SERVICES HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM ARCHITECTS PLEASE READ THE FOLLOWING BEFORE COMPLETING THIS PROPOSAL FORM: ALL QUESTIONS SHOULD BE COMPLETED IN INK. WHERE A QUESTION IS

More information

PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS

PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE This proposal form must be completed in ink by a Partner, Principal or Director of the Firm or Company.

More information

THIS APPLICATION IS FOR A CLAIMS MADE POLICY

THIS APPLICATION IS FOR A CLAIMS MADE POLICY PEMBROKE SYNDICATE 4000 MISCELLANEOUS ERRORS & OMISSIONS INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS MADE POLICY ALL QUESTIONS MUST BE ANSWERED COMPLETELY. DO NOT LEAVE ANY SPACE BLANK. INDICATE

More information

Building and Engineering Contractors Proposal Form

Building and Engineering Contractors Proposal Form Building and Engineering Contractors Proposal Form This Proposal form must be completed in ink, signed and dated by a Principal, Partner or Director of the Proposer. All questions must be answered and

More information

INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM

INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material

More information

Professional Indemnity Insurance Proposal Form Architects and Civil Engineers - Annual Cover

Professional Indemnity Insurance Proposal Form Architects and Civil Engineers - Annual Cover Professional Indemnity Insurance Proposal Form Architects and Civil Engineers - Annual Cover te: This Proposal must be completed in full by a Partner of the Firm. Unless the Proposal is fully completed

More information

Insurance Proposal Form for New Applicants

Insurance Proposal Form for New Applicants C/- Aon New Zealand Professional Risks Insurance Proposal Form for New Applicants P O Box 2517 Wellington 6140 Tel (04) 819 4000 Fax (04) 819 4106 E-mail: abacus@aon.co.nz Website: www.abacus.org.nz This

More information

Professional Indemnity Insurance Proposal Form Architects and Civil Engineers Annual Cover

Professional Indemnity Insurance Proposal Form Architects and Civil Engineers Annual Cover Professional Indemnity Insurance Proposal Form Architects and Civil Engineers Annual Cover I. General data 1. Name of proposer in full 2. Address of head office 3. Address of branch office(s) and name(s)

More information

PROFESSIONAL INDEMNITY PROPOSAL FORM

PROFESSIONAL INDEMNITY PROPOSAL FORM PROFESSIONAL INDEMNITY PROPOSAL FORM For the Design and Consulting Department of Electrical and Mechanical Services Contractors Please answer all questions. It is appreciated that for some Proposers, certain

More information

Miscellaneous Professional Indemnity Insurance Proposal form

Miscellaneous Professional Indemnity Insurance Proposal form Miscellaneous Professional Indemnity Insurance Proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters with

More information

New ACE Professional Indemnity Insurance Scheme PROPOSAL FORM. for members of the Association for Consultancy and Engineering

New ACE Professional Indemnity Insurance Scheme PROPOSAL FORM. for members of the Association for Consultancy and Engineering New ACE Professional Indemnity Insurance Scheme PROPOSAL FORM for members of the Association for Consultancy and Engineering PLEASE READ THE FOLLOWING BEFORE COMPLETING THE PROPOSAL FORM Please note that

More information

Professional Indemnity Insurance. Proposal for PROFESSIONAL RISKS. 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB

Professional Indemnity Insurance. Proposal for PROFESSIONAL RISKS. 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Professional Indemnity Insurance Proposal for IT Consultants PROFESSIONAL RISKS 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Tel 020 7623 4957 Fax 020 7623 4958 PROFESSIONAL RISKS Kerry London

More information

Professional Indemnity Insurance Proposal Form for Architects

Professional Indemnity Insurance Proposal Form for Architects JMD Ross Insurance Brokers Pty Ltd ABN 59 001 706 289 Level 6, 1 Chandos Street PO Box 411 St Leonards NSW 2065 St Leonards NSW 1590 Tel: 02 9906 1199 Fax: 02 9906 1007 Email: jmdross@jmdross.com.au JMD

More information

Professional Indemnity Insurance for Chartered Surveyors Proposal Form

Professional Indemnity Insurance for Chartered Surveyors Proposal Form Professional Indemnity Insurance for Chartered Surveyors Proposal Form Professional Indemnity Insurance for Chartered Surveyors Proposal Form Please read the following carefully before completing this

More information

Professional Indemnity Proposal Form Project Management

Professional Indemnity Proposal Form Project Management Professional Indemnity Proposal Form Project Management GUIDANCE NOTES Completing your proposal form Please complete all questions in full using the Additional Information section or separate sheets where

More information

Accountants. Professional Indemnity Proposal Form. Vantage Professional Risks. 41 Eastcheap London EC3M 1DT

Accountants. Professional Indemnity Proposal Form. Vantage Professional Risks. 41 Eastcheap London EC3M 1DT Professional Indemnity Proposal Form Accountants Vantage Professional Risks 41 Eastcheap London EC3M 1DT Telephone 020 7655 8020 Email: pi@vantageinsurance.co.uk www.vantageprofessionalrisks.co.uk IMPORTANT

More information

Surveyors & Real Estate Professional Liability Proposal Form

Surveyors & Real Estate Professional Liability Proposal Form AIG Insurance Hong Kong Limited Surveyors & Real Estate Professional Liability Proposal Form I. Applicant Details Name of Insured: Address(es): Web Site Address: Establishment Date: II. Business Activities

More information

Architects and Engineers Professional Liability Proposal Form

Architects and Engineers Professional Liability Proposal Form Notice:Statement pursuant to Section 25(5) of the Insurance Act (Cap 142) or any amendments thereof; You are to disclose in this application, fully and faithfully, all the facts which you know or ought

More information

Professional Indemnity Proposal For Miscellaneous Occupations

Professional Indemnity Proposal For Miscellaneous Occupations P 1800 096 829 F 1800 096 680 A.F.S Licence 244370 A.C.N 096 939 169 Professional Indemnity Proposal For Miscellaneous Occupations IMPORTANT NOTICE This Proposal Form must be typed, or completed in ink

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be answered to enable

More information

Professional Indemnity Select

Professional Indemnity Select Allianz Insurance plc Professional Indemnity Select Architects Proposal Form Contents Architects Professional Indemnity Insurance 1 General Information 2 Thank you for choosing Allianz Insurance plc. We

More information

THIS APPLICATION IS FOR A CLAIMS MADE POLICY

THIS APPLICATION IS FOR A CLAIMS MADE POLICY PEMBROKE SYNDICATE 4000 ACTUARIES ERRORS AND OMISSIONS INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS MADE POLICY ALL QUESTIONS MUST BE ANSWERED COMPLETELY. DO NOT LEAVE ANY SPACE BLANK. INDICATE

More information

Engineers, Architects, Surveyors and Relation Professions

Engineers, Architects, Surveyors and Relation Professions Application Form Professional Indemnity Insurance Send quotation requests to: Email: distribution@breezeuw.com.au Phone: 1300 556 826 Engineers, Architects, Surveyors and Relation Professions IMPORTANT

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES - 1 - P a g e CONTENTS 1. ADVICE ON COMPLETING THE PROPOSAL FORM 2. PROPOSAL FORM 3. BINDING AUTHORITY QUESTIONNAIRE 4. OTHER

More information

ARCHITECTS AND ENGINEERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

ARCHITECTS AND ENGINEERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND ENGINEERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM 1. General information 1.1 Name of the proposed : 1.2 Please provide a full description of your activities 1.3 Please provide details

More information

Professional Indemnity Insurance Debt Management Consultants Proposal Form

Professional Indemnity Insurance Debt Management Consultants Proposal Form Professional Indemnity Insurance Debt Management Consultants Proposal Form Towergate Lifestyle Suite 6 The South West Centre Troutbeck Road, Sheffield, South Yorkshire S7 2QA Tel: 0114 250 0011 Fax: 0114

More information

Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form

Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Please read the following carefully before

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR PRIVATE MEDICAL INSURANCE BROKERS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions

More information

Security Consultants. Professional Indemnity. Proposal Form

Security Consultants. Professional Indemnity. Proposal Form Thompson Heath & Bond Limited 107 Leadenhall Street London EC3A 4AF Tel: +44 (0) 20 7469 0100 Fax: +44 (0) 20 7621 0661 www.thbgroup.com Lloyd s Broker Security Consultants Professional Indemnity Proposal

More information

Design and Construct. Professional Indemnity Insurance proposal form

Design and Construct. Professional Indemnity Insurance proposal form Design and Construct Professional Indemnity Insurance proposal form Please complete all the questions in this proposal form in black ink, continuing your answers on page 7 where there is insufficient space.

More information

CONSULTING ENGINEERS PROFESSIONAL INDEMNITY PROPOSAL FORM

CONSULTING ENGINEERS PROFESSIONAL INDEMNITY PROPOSAL FORM CONSULTING ENGINEERS PROFESSIONAL INDEMNITY PROPOSAL FORM Please read the following questions carefully and answer them all providing additional information where required. Should you require more space

More information

ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM

ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material fact

More information

(Accountants) Proposal Form

(Accountants) Proposal Form Office Use: Company Ref Pos Caunce O Hara & Co Ltd City Wharf New Bailey Street Manchester M3 5ER Tel: 0161 833 2100 Fax: 0161 839 2100 (Accountants) Proposal Form PLEASE ENCLOSE WITH THIS PROPOSAL FORM:

More information

Architects and Engineers Professional Liability Proposal Form

Architects and Engineers Professional Liability Proposal Form AIG Insurance Hong Kong Limited Architects and Engineers Professional Liability Proposal Form I. Applicant Details Name of Insured: Address(es): Web Site Address: Establishment Date: II. Business Activities

More information

Professional Indemnity Proposal Form Surveyors

Professional Indemnity Proposal Form Surveyors Professional Indemnity Proposal Form Surveyors GUIDANCE NOTES Completing your proposal form Please complete all questions in full using the Additional Information section or separate sheets where necessary.

More information

PROFESSIONAL INDEMNITY PROPOSAL FORM

PROFESSIONAL INDEMNITY PROPOSAL FORM AAO Pana Insurance Brokers Sdn Bhd 29-1, Dataran Prima Business Centre, Jalan PJU 1/41, 47301 Petaling Jaya Tel : 03-7880 9277 Fax : 03-7880 8689 Web site : www.aaogroup.com PROFESSIONAL INDEMNITY PROPOSAL

More information

MISCELLANEOUS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL

MISCELLANEOUS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL MISCELLANEOUS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance for a purpose related to your

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS ANNUAL COVER

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS ANNUAL COVER PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS ANNUAL COVER I. GENERAL DATA 1. Name of Organization: 2. Address of Head Office: 3. Address of Branch office(s) and name(s)

More information

MARKETFORM : SYNDICATE 2468 PROPOSAL FORM FOR DESIGN CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE

MARKETFORM : SYNDICATE 2468 PROPOSAL FORM FOR DESIGN CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE MARKETFORM : SYNDICATE 2468 BROKER / INSURANCE AGENT PROPOSAL FORM FOR DESIGN CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE PLEASE READ THESE GUIDANCE NOTES BEFORE COMPLETING THE PROPOSAL FORM. WHERE FURTHER

More information

Proposal Form Professional Indemnity Insurance for Design Industry Firms and Consultants

Proposal Form Professional Indemnity Insurance for Design Industry Firms and Consultants Proposal Form Professional Indemnity Insurance for Design Industry Firms and Consultants To assist with the completion of this Proposal Form, the following words will mean:- Principal is any equity/salaried

More information

Professional Indemnity Insurance for Professional Risks of building and engineering contractors Proposal Form

Professional Indemnity Insurance for Professional Risks of building and engineering contractors Proposal Form Professional Indemnity Insurance for Professional Risks of building and engineering contractors Proposal Form Professional Indemnity Insurance for Construction Industry Professionals Proposal Form Please

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS PROJECT COVER

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS PROJECT COVER PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM ARCHITECTS AND CONSULTING ENGINEERS PROJECT COVER I. General data Name of firm. Address of head office. Address of branch office(s) and name(s) of resident

More information

Professional Indemnity Proposal Form Business & Management Consultants

Professional Indemnity Proposal Form Business & Management Consultants Professional Indemnity Proposal Form Business & Management Consultants This form does not apply to: IT Consultancy. Please see the IT Professions proposal form GUIDANCE NOTES Completing your proposal form

More information

ARCHITECTS PROFESSIONAL INDEMNITY PROPOSAL FORM

ARCHITECTS PROFESSIONAL INDEMNITY PROPOSAL FORM ARCHITECTS PROFESSIONAL INDEMNITY PROPOSAL FORM Please read the following questions carefully and answer them all providing additional information where required. Should you require more space please provide

More information

Professional indemnity insurance Environmental consultants proposal form

Professional indemnity insurance Environmental consultants proposal form Professional indemnity insurance Environmental consultants proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block

More information

Professional Indemnity Insurance Architects and Consulting Engineers Single Project Cover

Professional Indemnity Insurance Architects and Consulting Engineers Single Project Cover Professional Indemnity Insurance Architects and Consulting Engineers Single Project Cover Proposal Form ADNIC is a Public Joint Stock Company incorporated in the United Arab Emirates by Law No. (4) of

More information