PROPERTY OWNERS INSURANCE PROPOSAL

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1 PROPERTY OWNERS INSURANCE PROPOSAL Please use BLOCK CAPITALS and tick boxes where applicable. Where requested enter further details in the space provided. If there is insufficient space please continue on a separate sheet of paper. Explanatory notes are included at the end of this form. YOUR DETAILS Name of Proposer in full Postal Address Postcode Tel No: Details of any interested parties Postcode Tel No: Nature of Interest

2 BUILDINGS AND RENT INSURANCE A Details of Properties to be insured Address (including postcode) Occupation and use Buildings Declared Value (see Note 1) Rent Receivable (including any service charges) (See note 2) 1 years current rent 2 years current rent 3 years current rent 4 years current rent 5 years current rent 6 years current rent 7 years current rent 8 years current rent 9 years current rent 10 years current rent Total Buildings Declared Value Total Rent Receivable

3 BUILDINGS AND RENT INSURANCE (continued) B Are all the premises to be insured built of brick, stone or concrete with roofs of entirely incombustible materials? If No, please provide details below: C Please state the Inflation Provision to apply to the Declared Value (our recommended minimum is 30%) (See Note 1A) % D E Do you require the Buildings Declared Value to be Index Linked? (See Note 1A) Other items required in addition to Buildings and Rent please specify F Please tick cover required: (See Note 3) Fire and Specified Perils (Fire, Lightning, Aircraft, Explosion, Earthquake (Fire), Earthquake (Shock), Riot, Malicious Damage, Theft, Sprinkler Leakage, Storm, Flood, Escape of Water or Oil, Impact, Subsidence and Accidental Damage) All Risks including Subsidence Do you require a quotation for Terrorism Cover? (See Note 4) G Do you wish to amend the standard policy excesses? (See Note 5) If Yes, please state the amount of excess preferred

4 PROPERTY OWNERS' PUBLIC LIABILITY INSURANCE (COMPLETE IF COVER REQUIRED) A B Please state the Limit of Indemnity that is required (usual minimum 1,000,000) Under the terms of the lease who is responsible for the upkeep, maintenance and repair of the premises to be insured? If not you, do you retain responsibility for any common parts such as stairways, services, car parks, lifts etc. If 'Yes', please provide details below: C Have you appointed managing agents or a similar company to be responsible under contract for the maintenance, repair and general control or security of the premises? If 'Yes', please provide details below D What actions are being taken in response to the Control of Asbestos at Work Regulations (CAWR) 2002? Are risk assessments carried out and specialists contractors used to locate, assess the condition of, record and remove any asbestos containing materials? Are the specialist contractors required to carry Public Liability insurance including an Indemnity to Principal with no asbestos exclusions or restrictions?

5 EMPLOYERS LIABILITY INSURANCE (COMPLETE IF COVER REQUIRED) A Please state the Limit of Indemnity that is required (minimum is 10,000,000) B What is your total annual wageroll? What proportion of this figure relates to clerical employees? % C Do you have a written Health and Safety policy which is communicated to all of your employees? What is the name and title of the appointed person in your organisation who has responsibility for Health and Safety matter? Name Title Qualifications

6 LEGIONELLOSIS LIABILITY INSURANCE (COMPLETE IF COVER REQUIRED) NOTE: only available with Property Owners' Public Liability (See Note 6) A i) Do you comply with the HSE approved code of practice for the control of Legionella? ii) If so who is the 'appointed person' and their position? Name Title Qualifications iii) What supporting documents are kept? Please list below:

7 GENERAL QUESTIONS Each of the following questions must be answered in full A Please give details of your present Insurer(s) of the covers to which the proposal relates Insurer Expiry Date of Cover B C Have you or any of your directors or partners been involved in any other business in the last 5 years? Have you or any of your directors or partners ever been convicted or charged with (but not yet tried) a criminal offence other than a motoring offence? If 'Yes', to questions B and/or C please provide full details D In respect of any of the covers to which this proposal relates and any business in which you or any of your partners or directors are or have been involved a) has any insurer ever declined a proposal, refused renewal, terminated an insurance or imposed special terms? If 'Yes', please give details. b) have any accidents, losses or claims arisen whether insured or not? If 'Yes', please give details. Date of occurrence Brief details of each incident (whether or not a claim was made) Cost of losses for which no claim was made Cost of claims paid and/or outstanding ADDITIONAL INFORMATION USE THIS SPACE TO PROVIDE FURTHER INFORMATION IN SUPPORT OF ANSWERS GIVEN TO QUESTIONS IN THIS PROPOSAL. PLEASE STATE QUESTION NUMBERS CLEARLY

8 IMPORTANT PLEASE READ THE FOLLOWING CAREFULLY BEFORE YOU SIGN AND DATE THE DECLARATION The questions on this form and any other details we specifically request, relate to facts considered material to underwriting the insurance. If you answer them fully and honestly you will be considered to have fulfilled your duty to disclose material facts. Failure to do so may invalidate your insurance. If in response to any of these questions you are in any doubt whether a fact is material you should disclose it. You should also keep your own record (including copies of letters) of all information supplied to us in arranging this insurance A copy of your completed Proposal is available of request. Please tick box if required We may occasionally send you details of other RSA Insurance plc products and services. Please write to us if you do not want this to happen. No information will be provided without the permission of your usual Insurance Adviser where appropriate. DECLARATION BEFORE SIGNING THE DECLARATION PLEASE CHECK YOUR ANSWERS CAREFULLY PARTICULARLY IF THIS PROPOSAL FORM HAS NOT BEEN COMPLETED BY YOURSELF. I/We declare that the buildings to be insured are kept/will be kept in a well maintained condition and are not specifically exposed to any particular insured cover. I/We declare that to the best of my/our knowledge and belief the answers given are true, and all material information as explained has been disclosed I/We agree that if any answers have been completed by any other person, such person shall for that purpose be regarded as my/our agent and acting on my/our behalf, and not the agent of RSA Insurance Ireland Limited. I/We declare that this Proposal Form is for insurance in the normal terms and conditions of the Insurer s policy and shall be incorporated in and form part of the insurance contract. Signature of Proposer: Date: Position within Company: Signing this proposal form does not bind the proposer or the Insurer to complete the insurance. PLEASE INITIAL ANY ALTERATIONS ON THIS PROPOSAL FORM

9 NOTES How to Calculate your Sums Insured 1. Buildings Your Declared Value must represent the full rebuilding costs (not market value) applying at the commencement of the period without any deduction for wear and tear or any provision for inflation. Buildings include the following in addition to the building itself, to the extent to which you are responsible for them: foundations landlord's fixtures and fittings (including fixed glass and fitted carpets and tenants improvements for which the landlord is responsible in or around the Buildings) furnishings and other contents of common parts of the buildings (contents of furnished accommodation should be included under a separate item) walls, gates, fences and Services gangways, pedestrian malls and pedestrian access bridges telephone, electricity, gas and water services, drains and sewers land, roads, pavements, car parks and hardstanding Services include: telephone, gas, electricity, water mains, drains and sewers, electrical instruments, meters, piping, cabling and accessories thereon extending from the building to the perimeter of the premises or to the public mains (including those underground). The sum insured must also take into account: professional fees (such as architects and surveyors) incurred in rebuilding cost of removing debris from the site, including demolition, shoring and propping up any extra costs necessary to comply with EC and Public Authorities' Stipulations VAT does not need to be included 1A Inflation Provision Our cover is on the Day One Basis, which has become established as the most popular inflation scheme. Under this method the sum insured comprises two components: - the Declared Value as described above under Buildings the Inflation Provision being a percentage uplift selected to cover inflation during the insurance year and during the period of rebuilding assuming that a loss occurs on the last day of the period of insurance. This rebuilding period should allow for the time it would take to draw up plans, obtain permission to build, seek tenders and select a contractor. For larger properties particularly, a limit of 30% is often desirable although this will vary according to the current trend in buildings costs. There is also available an arrangement for index-linking the Day One Declared Value under this insurance. This option is on the conventional monthly update and is recommended mainly for smaller properties where values are less likely to be regularly reviewed. This does not avoid the need for periodic reviews for individual properties because the index is based on average tender costs for all types of construction around the UK.

10 2. Rent Receivable The sums insured must represent the actual annual rent and service charges at the commencement of the period of insurance multiplied by the indemnity period (in years). The indemnity period should represent the maximum time you consider it is likely to take to rebuild your premises following the serious damage plus the additional time it would take to find a new lessee if the original lessee is not obliged to return to the property under the terms of the lease. As a minimum the period selected should be that specified in any rent cessor clause. An uplift of 100% will be added to this base figure to cover any increases arising from rent reviews. REMEMBER: It is important that your sums insured are adequate or you may find that your claim will not be settled in full. Buildings and Rent cover 3. Fire & Specified Perils/All Risks Two options of your policy wording are available, one which sets out details of each peril covered and one on an All Risks basis where only excluded covers and causes are listed. Both options effectively provide the same level of cover if all the specified perils are selected, so it is a matter of your own preference. If there are any covers not required, the Fire and Specified Perils option should be selected and you should delete those covers not required. 4. Terrorism The basic policy contains an exclusion in respect of all loss or damage in consequence of Terrorism. However, this cover can be provided under a specific Terrorism section subject to an additional premium. Cover will be for the full sums insured requested in respect of premises in England, Scotland and Wales but limited to a maximum of 10,000,000 in respect of premises on the Isle of Man or the Channel Islands. Cover is not available in Northern Ireland or elsewhere in the world. 5. Excesses The standard excesses are: Malicious Damage - Storm and Flood - Escape of Water or Oil - Impact - Theft - Accidental Damage 1,000 - Subsidence You may wish to have a higher excess in return for a reduction in premium or a lower excess for an additional premium.

11 6. Liability Cover Our standard policy does not cover liability relating to the legionella bacterium, and any occurrences of Legionnaires Disease, as this is not caused by a sudden incident as defined in the policy. If an extension is required to cover this liability, please complete the relevant part of this form. 7. Law Applicable The parties to the Policy have the right to choose the law applicable to the Policy. Unless the parties agree otherwise in writing any dispute concerning the interpretation of this Proposal or the Policy shall be governed and construed in accordance with English law and shall be resolved within the non-exclusive jurisdiction of the courts of England and Wales. 8. Data Protection Act All personal information supplied by you will be treated in confidence by RSA Insurance Ireland Limited and will not be disclosed to any third parties except where your consent has been received or where permitted by law. In order to provide you with products and services this information will be held in data systems of RSA Insurance Ireland Limited or our agents or subcontractors. RSA Insurance Ireland Limited may pass your personal data to other companies for processing on its behalf. Some of these companies may be based outside Europe in countries which may not have laws to protect your personal data, but in all cases the Group will ensure that it is kept securely and only used for the purposes for which you provided it. Details of the companies and countries involved can be provided to you on request. RSA Insurance Ireland Limited is registered in Ireland under number with registered office at RSA House, Dundrum Town Centre, Sandyford Road, Dundrum, Dublin 16 and regulated by the Central bank of Ireland

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