PROPOSAL FORM Commercial Legal Expenses Insurance Property Owners

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1 PROPOSAL FORM Commercial Legal Expenses Insurance Property Owners TER BTE SHIELD LOGO EXTENDED FOR USE ON WHITE BACKGROUND Abbey Legal Protection is is a a trading division of of Abbey Protection Group Limited, whose ultimate holding company is is Markel Corporation.

2 Proposal Form Full name of proposer (Please list separately all subsidiaries to be covered) Full address of proposer Telephone number Number of leases in property portfolio Aggregated Declared Value of property portfolio Property Portfolio Instruction Please list all properties in portfolio together with number of leases at each. Property 1 Property 2 Property 3 Property 4 Property 5 Please provide details on a separate page if necessary which must be dated. 1

3 Your Insurance History Has any insurer ever refused you commercial legal expenses insurance, imposed special conditions or declined to renew a legal expenses insurance policy? (If yes please provide full details.)* Have you been involved in any disputes or legal proceedings during the last 5 years? (whether they formed part of a Legal Expenses Insurance claim or not) (If yes, please provide details including the names of the third parties, relevant dates, amounts of legal expenses involved and the result of each such legal proceedings.)* After enquiry are you aware of any cause, event or circumstance which may give rise to a claim being made under this insurance? (If yes, please provide details including the names of the third parties, relevant dates, nature of the dispute and estimated fees.)* Existing Circumstances Do you currently have other Legal Expenses insurance? (If yes please provide details including your current insurer.)* Do you wish to contribute towards the cost of a claim by way of an excess? (A voluntary excess will result in a lower premium.) If yes, please state the level of excess you will accept for any one claim: Excess 1,000 2,500 5,000 Any other amount: *Please provide details on a separate page if necessary. 2

4 Declaration I/We warrant that the above statements (and any documents sent with the Proposal Form) are true to the best of our knowledge and belief and Insurers will be informed of any material alterations immediately. If such statements and particulars are written by any other person, such person shall be deemed to have been my/agent for the purpose of filling in the same. I/We hereby agree that this Declaration shall form, subject to my/our acceptance of the quotation, the basis of the contract between me/us and Insurers and I am/we are willing to accept a Policy subject to the terms, conditions and exceptions prescribed by the Insurer therein. Important please read carefully All answers given must be to the best of your knowledge and belief. If you are unsure how to answer a specific question please indicate this in the Proposal Form. Complaints We are dedicated to providing high quality services and want to ensure that we maintain these at all times. If you are not satisfied with any part of the service you have received then you should write to us and we will do our best to resolve the problem. In the first instance please contact: The Customer Services Manager Abbey Legal Protection Minories House 2-5 Minories London EC3N 1BJ Tel: Fax: All material facts must be disclosed and failure to do so may lead to the Policy issued becoming null and void. NB: A material fact is one that is likely to influence acceptance or assessment of this proposal by Insurers. If you are in any doubt as to what constitutes a material fact you should consult your broker or Abbey Legal Protection. Upon request a specimen of the Policy is available. We would advise you to keep a copy of the Proposal Form and all the information supplied to Insurers for the purpose of obtaining this insurance. Signature Broker Stamp Name (printed) Position Date 3

5 PropOwners/PropForm: 2014/02 MAS

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