PROFESSIONAL LIABILITY INSURANCE SCHEME FOR MEMBERS OF ACPAT SUMMARY OF COVER

Transcription

1 PROFESSIONAL LIABILITY INSURANCE SCHEME FOR MEMBERS OF ACPAT SUMMARY OF COVER This Commercial insurance policy is designed to meet the needs of ACPAT members who wish to protect themselves in the event of professional liabilities arising from their activities as an Animal Physiotherapist. PROFESSIONAL LIABILITIES The policy provides cover in the event of civil (as opposed to criminal) liabilities arising from your Business as described on your certificate of insurance, and provides an indemnity to you/your organisation and any employees whilst acting on your behalf. It includes cover for your liability for the acts or omissions of any sub-contractors but will not (unless we have agreed in writing) provide an indemnity to sub-contractors. The policy combines cover that would be provided by Medical Malpractice, Professional Indemnity & Libel & Slander insurances and covers any amount you may have to pay as compensation up to the limit(s) shown in your certificate. Teaching, training and supervision of animal physiotherapy students included, but does not extend to courses where members issue qualification certificates or run training centres. LIMIT OF INDEMNITY Your chosen limit applies to each and every event, but in respect of claims for pollution or contamination this is also the aggregate limit for such claims in any one period of insurance. Claims for Bloodstock are limited to 100,000 in the aggregate in any one period of insurance. For the purposes of this insurance all claims arising as a result of any one occurrence, or all occurrences of a series attributable to one original cause will be regarded as a single claim. Legal costs are payable by the insurers in addition to the chosen limit of indemnity. There is no excess or deductible under this insurance. The insurers for this product are AXA Insurance UK plc (AXA) as Lead Insurer, and Novae Underwriting Limited underwriting for certain underwriters at Lloyds (Novae). ADDITIONAL COVERS In addition to civil liabilities, the policy provides the following covers: Complaints Advice & Response and Disciplinary Hearings The policy includes professional assistance up to 800 to provide you with guidance in the early stages of a complaint made about you, or any person acting in connection with the business, to your professional body or other regulator. The intention of this cover is to help you submit a response to the complaint. In addition, the policy provides cover for representation at a disciplinary hearing by any professional regulator, including appeals against any judgement given Legal Defence for Criminal Proceedings: The policy provides cover for legal defence following criminal proceedings regarding: Health and Safety at Work etc Act 1974 Part II of the Consumer Protection Act 1987 Part II of the Food Safety Act 1990 Other criminal prosecution where such prosecution is likely to lead to a civil claim under this policy. A limit of 100,000 applies to this section. Court Attendance Costs If you are required to attend court as a witness in connection with a claim under this policy, the policy will reimburse the following amounts: The Insured or any Director or other official Any employee 500 per day 250 per day ACPAT SOC vaxa102014

2 Release of Confidential Information Where you are required by a UK court or tribunal to disclose notes or information of a confidential nature not relating to a complaint or claim against you, the insurance will cover costs to assist with the preparation of arguments as to why they should not be released. In addition, where appropriate, the insurers will pay towards your costs in preparation of a report in lieu of releasing your notes. Cover under this section is limited to 5,000. Public Relations Consultancy Fees In order to minimise or prevent a potential claim against you, cover up to 25,000 is provided. Fees Recovery If a client refuses to pay your fees on the grounds of alleged negligence on your part and threatens a potential counter-claim, the policy will reimburse you with the cost of waiving your fees if this is judged by the insurers to be an effective means of resolving the matter and preventing a legitimate claim from arising. Loss of Documents Cover is provided up to a limit of 50,000 in respect of loss of or damage to documents held in trust by you and for which you are responsible. WHEN DOES THE POLICY OPERATE? The policy is issued on a claims made basis, which means that cover applies when a claim is made against you irrespective of when the incident which gave rise to the claim is alleged to have occurred. Cover will apply to incidents which occurred prior to inception of this policy, as long as when you take out the insurance you are not aware of any such circumstances which could give rise to a claim. RUN-OFF COVER It is important to remember that the insurance can only respond to a claim if the policy is in force at the time the claim is made against you. If you cease to practise or trade by reason of death, retirement or career break, the policy will provide run-off cover free of charge for a period of three years immediately following the final period of insurance, providing you are insured as an Individual or as a Sole Trader Limited Company. If you need run-off cover for a longer period, or if you are a Limited Company with more than one director, or in any other circumstances, you should contact us. MAIN EXCLUSIONS The policy does not provide any cover for the following: Public and Products Liability Risks this cover is provided as part of your CSP membership insurances (this exclusion does not apply in respect of any corporate entities shown as a named insured) Liability to Employees or Students - Any injury to employees arising out of and in the course of their employment with you. (If you have employees or are responsible for students undergoing training or work experience you should talk to us about Employers Liability insurance.) Liabilities which should be insured under other types of policy - Such as Motor Insurance or Employment Practices Liability Business Risks - Such as contracts for supply of services to your business, your insolvency, trading losses, or pension & benefit schemes. Deliberate Acts -Any intentional act, unless this is designed or intended to be part of the Professional Services provided Controlling Interests Any claim arising out of work for a business in which the insured has a controlling interest or is in a position to make a major policy decision on behalf of such business. ACPAT SOC vaxa102014

3 WHERE AM I COVERED? The policy provides cover for you to work anywhere in the world (providing that you are working from a UK base) and includes work in America or Canada as long as you do not have premises in those territories (please refer to the policy for details). This is a summary only of the cover, together with the main exclusions, and is provided so that you have sufficient details to enable you to make an informed choice. Please refer to the policy wording for full details, or contact us if there is anything specific you would like to discuss. COMPLAINTS PROCEDURE We aim to provide you with a first class service. If we have not delivered the service that you expect or you are concerned with the service provided, we would like the opportunity to put things right. Our complaints process Initially, contact us to raise your concern with Graybrook Insurance Brokers Limited Tel: Fax: enquiry@graybrook.co.uk If your complaint is against AXA alone, we will pass your complaint to their nominated contact within 24 hours. This will also happen if we believe that we cannot resolve your complaint without the involvement of AXA or there is any query relating to the complaint. The complaints procedure of AXA will then apply. If your complaint is not resolved or you are not happy with the response and course of action proposed by AXA, you can progress your complaint to their Head Office, who will carry out a separate investigation on behalf of the Chief Executive. AXA Insurance Commercial complaints AXA House 4 Parklands Lostock Bolton BL6 4SD Tel: Fax: E Mail: customercare@axa-insurance.co.uk Timescales We will acknowledge your complaint within 5 business days of it having been received by us and we will issue you with our final decision letter within 8 weeks. What to do if you are still not satisfied If you are still not satisfied Graybrook Insurance Brokers Limited and AXA are regulated by the Financial Services Authority whose arbitration service is the Financial Ombudsman Service, and you may be able to refer your complaint to them. However, the Financial Ombudsman Service will not adjudicate on any cases where legal action has commenced or where a final decision has not been issued. Financial Ombudsman Service South Quay Plaza 183 Marsh Wall London E14 9SR Telephone: enquiries@financial-ombudsman.org.uk Website: ACPAT SOC vaxa102014

4 Your rights Your rights as a customer to take legal action remain unaffected by the existence or use of any complaint procedures referred to above. For your protection, telephone calls may be recorded or monitored. This insurance is administered by: Graybrook Insurance Brokers Limited 8 Chandlers Way, South Woodham Ferrers, Essex CM3 5TB Tel: Fax: enquiry@graybrook.co.uk Graybrook Insurance Brokers Limited are Authorised and regulated by the Financial Conduct Authority. Registered no and underwritten by: AXA Insurance UK plc (Lead Insurer) AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. And Novae Underwriting Limited underwriting for certain underwriters at Lloyd s Registered in England No Registered Office: 71 Fenchurch Street, London EC3M 4HH. Authorised and regulated by the Financial Conduct Authority. ACPAT SOC vaxa102014

5 STANDARD ENDORSEMENTS Applicable as stated in the Certificate 1 Complaints Advice and Response Extension In the event of any complaint of misconduct against (a) the Insured or (b) any person whilst acting in connection with the Business who is or has been or may become a director officer trustee or committee member or Employee of the Insured or is providing voluntary services for or on behalf of the Insured in respect of Professional Services that may lead to disciplinary proceedings by a professional regulator the Company will indemnify the Insured or at the request of the Insured any other person as specified above against reasonable costs and expenses incurred in preparing a response to the professional regulatory body (a) (b) (c) Provided that such complaint is first made in writing against the Insured or other person as specified above during the Period of Insurance and notified to the Company during or within thirty days after the expiry of the same Period of Insurance the Company shall not indemnify the Insured or other person as specified above in respect of costs or expenses (i) incurred without the written consent of the Company (ii) that can be recovered under any other policy of insurance or from elsewhere the maximum amount payable by the Company in respect of all costs and expenses arising from one complaint or all complaints attributable to the same misconduct shall not exceed the sum of 800 Subject otherwise to the terms Exceptions and Conditions of this policy. 2 Disciplinary Proceedings Extension In the event of any disciplinary proceedings by any professional regulator against (a) the Insured or (b) any person whilst acting in connection with the Business who is or has been or may become a director officer trustee or committee member or Employee of the Insured or is providing voluntary services for or on behalf of the Insured in respect of Professional Services provided by the Insured the Company will indemnify the Insured or at the request of the Insured any other person as specified above against reasonable legal costs and expenses incurred in the defence of such proceedings The Company will also pay for reasonable legal costs and expenses incurred in appealing against any judgement given Provided that (a) (b) the original notice of such disciplinary proceedings is made in writing to the Insured or other person as specified above during the Period of Insurance and notified to the Company during or within 30 days after the expiry of the same Period of Insurance the indemnity granted by this endorsement does not (i) provide for payment of fines penalties or compensation (ii) apply to costs or expenses incurred by the Insured or other person as specified above without the written consent of the Company (ii) apply to costs or expenses recoverable under any legal expenses policy which the Insured or other person as specified above has arranged Subject otherwise to the terms Exceptions and Conditions of this Policy. 3A Run off Liability (Individuals) Extension In the event that the Insured shall cease trading by reason of the death or retirement of the Insured or if the Insured shall take a career break the Company will provide indemnity under this policy for claims first made in writing against the Insured and notified to the Company during the 36 calendar months immediately following the last Period of Insurance as if the claims had been made against the Insured and notified to the Company during the last Period of Insurance Provided that a) such claims arise out of any injury damage act error or omission occurring or committed prior to the expiry of the last Period of Insurance to which this policy applies b) indemnity is not provided by any other insurance All Endorsements across all Schemes v072015

6 3B Run off Liability (Sole Trader Limited Company) Extension In the event that the Business shall cease trading by reason of the death or retirement of the director or if the director shall take a career break the Company will provide indemnity under this policy for claims first made in writing against the Insured and notified to the Company during the 36 calendar months immediately following the last Period of Insurance as if the claims had been made against the Insured and notified to the Company during the last Period of Insurance Provided that a) such claims arise out of any injury damage act error or omission occurring or committed prior to the expiry of the last Period of Insurance to which this policy applies b) indemnity is not provided by any other insurance 3C Run off Liability (Limited Company) Extension In the event that the Business shall cease trading the Company will continue to provide indemnity under this policy for claims made in writing against the Insured and notified to the Company following the last Period of Insurance as if the claims had been made against the Insured and notified to the Company during the last Period of Insurance Provided that a)the Company has agreed to continue to provide indemnity under this Endorsement b)the Insured has continued to pay an annual premium for each consecutive year in which cover as provided by this Endorsement is required c) such claims arise out of any Injury Damage act error or omission occurring or committed prior to the expiry of the last Period of Insurance to which this policy applies d)indemnity is not provided by any other insurance 4 Sub letting of Premises Extension It is noted and agreed that the Business shown on the Certificate is extended to include the letting of room(s) at the Insured s usual business premises. Cover provided by this policy is extended to include the liability of the Insured whilst acting in the capacity as lessor of their usual business premises Provided that (a) (b) indemnity is not already provided by any other insurance any liability attaching to any lessee or any person acting on behalf of such lessee in the use of such premises or in relation to any activities carried out is excluded Subject otherwise to the terms Exceptions and Conditions of this policy. 5 Training Extension It is noted and agreed that the Business shown on the Certificate is extended to include the provision of training in the business activities shown. 8 Bloodstock Limitation of Liability The Company will indemnify the Insured in respect of treatment to Bloodstock Bloodstock shall mean horses which are: (a) entered or eligible for entry in the general stud book kept by Weatherby and Sons or (b) entered in Priors HB stud book and (c) are either in training for or maintained for the purpose of racing under Jockey Club or National Hunt racing rules and registered with Weatherby and Sons for that purpose or (d) registered with a recognised turf authority which is the authority responsible for controlling horse racing in the country concerned Provided that the total amount payable by the Company in respect of all claims in connection with the treatment of Bloodstock shall not exceed 100,000 during any one Period of Insurance 9 The Company shall not indemnify the Insured against liability a) caused by or arising from medical diagnosis or prognosis or failure to medically diagnose other than in circumstances where the client is recommended by the therapist to consult a medical practitioner. b) caused by or arising from the use of general anaesthetic. c) caused by or arising from the giving of any injection or inoculation. d) caused by or arising from the use of X rays. e) caused by or arising from the dispensing manufacture prescription supply or administration of ethical drugs. f) caused by or arising from the dispensing manufacture mixing blending or formulation by the Insured of any products other than products administered or supplied by the Insured in the course of treatment or therapy. 10 The Company shall not indemnify the Insured against liability caused by or arising from any treatment knowingly provided to eczema sufferers. 11 The Company shall not indemnify the Insured against liability caused by or arising from electroencephalography. 12 The Company shall not indemnify the Insured against liability caused by or arising from the manufacture or design by the Insured on any Product Supplied. All Endorsements across all Schemes v072015

7 13 The Company shall not indemnify the Insured against liability caused by or arising from the installation, maintenance or repair of ionisation equipment away from the Insured s own premises. 14 The Company shall not indemnify the Insured against liability caused by or arising from the failure of any treatment or therapy to achieve its desired effect. 15 HLTViii LAV & Aids Exclusion The Company shall not indemnify the Insured against liability for causing or failing to cure or alleviate any condition directly or indirectly caused by or associated with Human T Cell Lymphotropic Associated Virus Type iii (HLTV iii) or Lymphadenopathy Associated Virus (LAV) or the mutants or derivatives thereof or in any way related to Acquired Immune Deficiency Syndrome (AIDS) or any condition of a similar kind howsoever it be named. 16 The Company shall not indemnify the Insured against liability caused by or arising from the conduct of the Business during the course of a surgical operation or dental treatment or for the sole purpose of effecting a surgical operation or dental treatment. 17 The Company shall not indemnify the Insured against liability for any financial loss suffered by any party as a result of the giving of financial advice. 18 The Company shall not indemnify the Insured against liability caused by or arising from the misuse of equipment. 19 Passport Rights Extension The indemnity provided by this policy shall extend to provide indemnity to the Insured against Civil Liability arising out of the business conducted from premises in Eire. Wherever they appear in this policy the words Great Britain, Northern Ireland, the Channel Islands or the Isle of Man are deemed to be extended to include Eire. Where any section refers to specific legislation enacted in Great Britain, Northern Ireland, the Channel Islands or the Isle of Man the indemnity will also apply in respect of similar legislation enacted in Eire but only to the extent that cover would have applied had the legislation in Great Britain, Northern Ireland, the Channel Islands or the Isle of Man been applicable. Definitions attaching to this Extension: 1. Claims payable under this Extension will be in the currency of Great Britain at the official rate of exchange published by the Financial Times of London at the time of the settlement of such claims. The date of settlement of such claims shall be the date on which the amount of claim settlement is agreed between the Insured, the claimant, the Company and any loss adjusters as applicable. 2. For the purposes of this Extension Asbestos shall mean crocidolite amosite, chrysotile fibrous anthophyllite, or fibrous tremolite, or any mixture containing any of those minerals. Exclusions attaching to this Extension: 1. To civil liability of whatsoever nature directly or indirectly caused or contributed to or occurring by the presence of Asbestos, Asbestos dust or Asbestos containing materials, or the release of Asbestos dust, or the exposure of persons or buildings or property to Asbestos, Asbestos dust, or Asbestos containing materials 2. To civil liability arising directly or indirectly out of terrorism Debiting of premiums It is noted and agreed that all premiums and Insurance Premium Tax under this Extension are paid or payable in the United Kingdom in sterling and that the equivalent amount of Eire premium tax and stamp duty will apply. 20 Exception Physiotherapy Treatment United States of America Canada and Australia United States of America and Canada In respect of claims arising out of any physiotherapy treatment Exception 13 is deleted and replaced by the following 13 North American Court Actions arising from any action brought in any court of the United States of America or Canada or elsewhere in the world to enforce a judgement in such territories by way of reciprocal agreement or otherwise Further the Company shall not indemnify the Insured against liability in respect of claims arising out of any physiotherapy treatment carried out in the United States of America or Canada on any persons who are United States of America or Canadian nationals Australia The Company shall not indemnify the Insured against liability in respect of claims arising out of any physiotherapy treatment carried out in Australia other than the treatment of persons who are British athletes, members of British teams or members of staff of other British organisations by whom the Insured has been appointed All Endorsements across all Schemes v072015

8 22 Equipment hired out or lent by the insured for purposes of treatment The Activity insured as shown on the Certificate of insurance is deemed to include hiring out or loan of therapeutic equipment. The Company will indemnity the Insured against Civil Liability arising from therapeutic equipment hired out or lent by the Insured to any client for the purpose of continued treatment provided that such equipment is used only for its intended purposes. Equipment Warranty It is warranted that all such equipment is supplied in good serviceable condition and that prior to use a demonstration on the correct use of such equipment is provided by a qualified member of the insured s business who is supplying the equipment to the intended user, together with a full set of written instructions. Intended users must sign a receipt confirming they have received instructions in the correct use of the equipment, have read and fully understand the instructions for use and will only use the equipment for its intended purpose. 23 Retroactive Date The Company shall not indemnify the Insured against liability arising out of any claim for Civil Liability Costs or Damage otherwise eligible for indemnity under this policy where the cause of such claim occurred or was alleged to have occurred prior to the Retroactive Date specified in the Certificate. 24 Healthcare Professionals Statutory Registration & Insurance Requirements It is a condition of this policy that all healthcare professionals whether Directors, Partners, Employees or subcontractors, employed or engaged by the Insured are suitably qualified and maintain registration with any statutory regulatory body where required. It is a further requirement that all self employed persons and subcontractors maintain Professional and Public Liability Insurance in their own name. 25 Chiropractic Endorsement It is a condition precedent to liability that any Chiropractor engaged by the Insured must be registered with the General Chiropractic Council and maintains Professional Indemnity Insurance for a minimum limit of 5,000, Exclusion of Treatment to Professional Footballers (Physiotherapists) This Policy excludes claims arising from the treatment of Professional Footballers after the 1 st July, 2015 who: are currently part of any National Team or Squad are employed by or otherwise contracted to any Club playing in the top two divisions of any Professional Football League (including for the avoidance of doubt Players on loan from such Clubs to lower league Clubs) This exclusion shall also apply to treatments where the Insured or any employee or sub contractor of the Insured provides insured activities to any other professional footballer or club under a formal agreement or Contract. This exclusion, however, shall not apply to treatments involving Samaritan Acts, Disability or Female Footballers or Players in the Welsh or Northern Ireland Professional Football Leagues or Football Leagues in the Channel Islands or the Isle of Man. Subject otherwise to the terms, conditions and exclusions of this Policy. All Endorsements across all Schemes v072015

9 Important Notes All practitioners must maintain membership of both ACPAT and CSP including students. All Healthcare practitioners must maintain HCPC Registration where applicable. All other Healthcare practitioners must hold current and appropriate qualifications in respect of the activities insured, written evidence of which must be produced on request or made available prior to insurers dealing with any claim under the policy. It is a condition of Corporate Cover that all practitioners (including students) engaged by the business also maintain their own individual Professional & Public Liability insurance (unless they are noted as a named insured on the Certificate). Only the activities shown in the Certificate will be insured (insurance for other activities are available on request). Temporary overseas work is included up to a maximum of 60 days in any 12 month period, but restrictions apply in USA and Canada and for non U.K. domiciled students. The insurance arranged is on a Claims Made basis and it is therefore important you notify us of any circumstances about which you are currently aware which could lead to a potential claim under your existing policy. These circumstances will then be registered with your insurers, prior to expiry of your current certificate as any known circumstances or claims cannot be brought forward to the new or renewed policy. Employers Liability insurance is recommended if you have students or employees in your care (extension available on request). This cover does not include Public/Product Liability Insurance for individual members which is provided to all ACPAT/CSP members as a benefit of CSP membership. Please note the policy provides no days of grace which will expire on the due date unless renewal is otherwise agreed. In the event of cancellation or termination of this policy, please ensure you have appropriate cover to deal with future claims arising from your previous work (the run off insurance provisions under this policy are only available in the event of career breaks, death or retirement. If you are Ceasing to Trade: If you cease to practice or trade by reason of death, retirement or career break, the policy will provide run off cover free of charge for a period of three years. Disclosure Warning and Changes in Circumstances: Please remember it is your legal duty to disclose, before inception or renewal of the insurance contract, all material matters relating to the risk (i.e. information which would influence the judgment of a prudent insurer in determining whether to underwrite the risk and if so, upon which terms and premium). If all such information is not disclosed, insurers have the right to avoid the contract from its commencement which may lead to claims not being met. If you believe that you may not have complied with this duty, you should contact us immediately. Policy Terms & Conditions: Please take time to visit the ACPAT Members section of our website ww.graybrook.co.uk/acpatmembers for a full copy of the policy terms, conditions and options that are available. If you are not able to access the internet, a full copy of the policy can be sent to you by post on request. Important Notes v pto

10 Public and Products Liability Insurance The Company shall not indemnify any individual named insured member against claims for which cover is provided under policy number UCPMH with Travelers Insurance Company Limited or any policy issued in continuance or substitution thereof It is further warranted the aforementioned policy and individual membership of the Association of Chartered Physiotherapists in Animal Therapy and of the Chartered Society of Physiotherapy remain in force for the duration of policy number RKK unless otherwise agreed in writing by the Company Claims Occurring Cover for Non UK or Temporarily UK Domiciled Students Should the Insured not normally be permanently domiciled in the Territorial Limits as specified in Definition 17 a) then Section A 1 Indemnity to the Insured is cancelled and the following substituted therefore Section A 1 Indemnity to the Insured In consideration of payment of the premium the Company will indemnify the Insured in the terms of this policy against Civil Liability consequent upon any claim or claims arising from any incident occurring during the Period of Insurance specified in the certificate and incurred in respect of animal physiotherapy carried out in the UK under the supervision of an Animal Physiotherapist, Veterinary Surgeon or Healthcare Professional who holds the relevant UK qualifications and where action is brought in a UK court Student Warranty It is warranted that all activities carried out whilst in training or on work experience shall only be whilst under the direct supervision and control of a qualified Category A ACPAT member or Veterinary Surgeon or other suitably qualified person Further it is a requirement that the student shall fully record each session to show the techniques practised and that these techniques must not fall outside of what has been taught and signed off on their course to date. Important Notes v pto

11 Professional Liability Insurance for Individual ACPAT Members Your Information Full name of Proposer Business Name (if applicable) Note this form is not suitable for members trading as a corporate entity Please ask for a separate application form ACPAT Membership Number CSP Membership Number ACPAT Membership Category Category A Category B Correspondence address Estimated turnover for the next 12 months Contact telephone number Mobile Number Contact address Postcode: In the next 12 months will you be working outside of the UK? Yes No If Yes please confirm the number of days you will be working outside of the UK Business or Occupation The policy provides cover for liability arising from Animal Physiotherapy only Please state qualifications to undertake Animal Physiotherapy Limits of Indemnity & Cover Options Professional Liability Insurance (please tick limit required) 100, ,000 1 Million Bloodstock claims limited to 100,000 in all in any period of insurance (definition of bloodstock available on request) Public / Products Liability Insurance Not included - Provided as part of PLI Cover with ACPAT/CSP Membership Employers Liability Cover If you require Employers Liability cover ( 10m limit) please tick this box Note: This option is not available in isolation Number of employees Do you require cover for students? Yes No Employers PAYE Reference Number The Employers PAYE reference number is usually in the format of either NNN/Aannnnn or NNN/Annnnn, where N/n is a number and A/a is a letter (e.g. 012/Ab34567) Please refer to your quotation letter or charges information sheet for costs ACPAT Individual Proposal Form vaxa102014

12 Disclosure of Material Facts Declaration Please answer the following: (a) To the best of your knowledge and belief have there been any claims made against you in respect of any of the covers now proposed? Yes No (b) Are you aware of any existing circumstances which may give rise to a claim? Yes No (c) Do you undertake any work in the USA, or its territories and possessions, or in Canada? Yes No (d) Has any Insurer declined a proposal or refused to renew insurance? Yes No If you have answered Yes to any of the above questions, please provide details below Policy Start Date Please note that cover will not commence until Quotation issued and accepted. The policy will run for 12 months from the agreed date. I declare that to the best of my knowledge or belief the particulars and statements given in this proposal and any other information provided in connection with this proposal are true and complete and this proposal, declaration and information shall be the basis of the contract between myself and the insurer. I agree to accept the insurer s standard form of policy and endorsements for this insurance. I confirm that all persons carrying out activities in accordance with the Business or Occupation as defined above are suitably qualified to do so Signature Important It is necessary for you to inform us of all facts which are likely to influence us in the acceptance of your insurance. Failure to do so could invalidate this insurance. If you are in any doubt whether a fact may influence us you should disclose it. Important Information Personal Data The insurers for policies written under this scheme are AXA Insurance UK Plc (AXA) and Novae Underwriting Limited underwriting for certain underwriters at Lloyd s (Novae). The scheme is administered on their behalf by Graybrook Insurance Brokers Limited. To set up administer your policy AXA, Novae and Graybrook Insurance Brokers Limited will hold and use information about you supplied by you. They may send it in confidence for processing to other companies acting on their instructions including those located outside the European Economic Area. Date Graybrook Insurance Brokers Limited may also send you details of their other products and services. Please tick this box if you do not wish to receive such details CUE - Insurers pass information to the Claims and Underwriting Exchange register, run by Insurance Database Services Limited (IDS Ltd). The aim is to help us to check information provided and also to prevent fraudulent claims. When we deal with your request for insurance, we may search the register. When you tell us about an incident (such as fire, water damage or theft) which may or may not give rise to a claim, we will pass information relating to it to the register. You can ask for more information about this. IPT - Insurance Premium Tax The Finance Act 1994 requires us to levy Insurance Premium Tax at the prevailing rate on insurance premiums. For further information, please ask us. This Scheme is administered by: Graybrook Insurance Brokers Limited, 8 Chandlers Way,South Woodham Ferrers, Essex, CM3 5TB Web: enquiry@graybrook.co.uk - Tel: Fax: Graybrook Insurance Brokers Limited are Authorised and regulated by the Financial Conduct Authority. Registered No This scheme is underwritten by: AXA Insurance UK plc (Lead Insurer) AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. and Novae Underwriting Limited underwriting for certain underwriters at Lloyd s Registered in England No Registered Office: 71 Fenchurch Street, London EC3M 4HH. Authorised and regulated by the Financial Conduct Authority. ACPAT Individual Proposal Form vaxa102014

13 ACPAT Individual Rate Chart vaxa Rate Chart ACPAT Members Professional Liability Insurance Limit of Indemnity for Professional Liability Insurance with Gross Income up to 100,000 Cat A Members (Qualified) 100, ,000 1,000,000 Premium Broker & Administration Fee Total Payable Limit of Indemnity for Professional Liability Insurance with Gross Income between 100, ,000 Cat A Members (Qualified) 100, ,000 1,000,000 Premium Broker & Administration Fee Total Payable Limit of Indemnity for Professional Liability Insurance with Gross Income between 200, ,000 Cat A Members (Qualified) 100, ,000 1,000,000 Premium Broker & Administration Fee Total Payable Limit of Indemnity for Professional Liability Insurance with Gross Income between 350, ,000 Cat A Members (Qualified) 100, ,000 1,000,000 Premium Broker & Administration Fee Total Payable For Incomes above 500,000 please contact Graybrook Insurance Brokers Limited Limit of Indemnity for Professional Liability Insurance Cat B Members (Students) 100, ,000 1,000,000 Premium Broker & Administration Fee Total Payable The above charges apply per ACPAT Member and include Insurance Premium Tax, Broker & Administration Fees Employers Liability Insurance To include this cover up to 10,000,000 please add the following extra charges (this insurance is not available in isolation) Students 1 3 Employees Premium Broker & Administration Fee Total Payable Rates for more than 3 employees available on request Administered by GRAYBROOK INSURANCE BROKERS LIMITED authorised and regulated by the Financial Conduct Authority Registered No Chandlers Way, South Woodham Ferrers, Essex. CM3 5TB Telephone No Fax No enquiry@graybrook.co.uk Website: Underwritten by AXA Insurance UK plc. (Lead Insurer) AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority and Novae Underwriting Limited underwriting for certain underwriters at Lloyds Registered in England No Registered Office: 71 Fenchurch Street, London. EC3M 4HH Authorised and regulated by the Financial Conduct Authority

14 Ways to Pay v Ways to pay your premium We accept payment by the following methods By Cheque Cheques should be made payable to Graybrook Insurance Brokers Limited and sent to Graybrook Insurance Brokers Limited, 8 Chandlers Way, South Woodham Ferrers, Essex CM3 5TB By BACS (Bank Transfer) Payment Reference: If you are renewing a policy, please use the Policy/Certificate Number If you are taking out a new policy, please use the insured name Bank Name: Barclays Bank Plc Sort Code: Account Name: Graybrook Insurance Brokers Limited Account Number: By Credit / Debit Card We accept the following cards: Visa Debit, Maestro, Visa Credit* and MasterCard* *there is a 3% handling fee on all Visa Credit Card and MasterCard transactions Please enter your card details and return this form to Graybrook Insurance Brokers Limited, 8 Chandlers Way, South Woodham Ferrers, Essex CM3 5TB or call us on For Office Use Only Date Processed Auth. Code Policy No. Premium 3% Handling Fee Total Due Card Type (delete as appropriate) Visa Debit Maestro Visa Credit* MasterCard* *there is a 3% handling fee on all Visa Credit Card and MasterCard transactions Payment Amount Cardholders Signature Card Holder Telephone Number Card Number Security Code Issue No. (Last 3 digits on the back of the card) Start Date Expiry Date House No. Postcode Monthly Instalment Facility Only available on premiums (inclusive of Insurance Premium Tax and Fees) of 200 and over Where it is not possible to pay premiums monthly direct to your insurers, you may apply to Close Premium Finance for a loan in respect of the amount due. The loan is repayable by Direct Debit over 10 monthly instalments, subject to an interest charge of 5.4% on the total amount borrowed. On completion, the amount financed will be transferred to Graybrook Insurance Brokers Limited for payment of the premium due to your insurer. Please carefully read the Important Notes overleaf before choosing this option. If you do not maintain your repayments under the agreement your policy may be cancelled and you could incur additional charges. Although there are other premium finance providers available, we have selected Close Premium Finance for their experience and competitive interest rates in this market. Please enter you details below and return this form to Graybrook Insurance Brokers Limited, 8 Chandlers Way, South Woodham Ferrers, Essex CM3 5TB or call us on For Office CPF Reference Premium Start / Renewal Date Use Only Policy Holder Policy Number Signature Position Date Correspondence Address Postcode Telephone Number Account Name Account Number Sort Code If you are a sole trader or trade as a non LLP partnership please state the date of birth of either a Director or one of the partners If you trade as a Limited Company of Limited Liability Partnership (LLP) please enter the company/partnership registration number Graybrook is a trading style of Graybrook Insurance Brokers Limited, who are registered in England & Wales. Registered Number Graybrook Insurance Brokers Limited are Authorised and regulated by the Financial Conduct Authority. Registered Number

15 Important Notes from Close Premium Finance What is Premium Finance? Premium finance is the easy way to pay for insurance. It is a loan that allows you to spread the payment for your premium over a period of time. This is where Close Premium Finance comes in. Through your broker we lend you the money for your premium at a competitive rate of interest. You then repay the loan through an instalment plan that allows you to manage your cashflow more easily. Who are Close Premium Finance? Close Premium Finance is part of the Close Brothers Group, the largest independent, quoted merchant banking group in the UK. Founded in the City of London in 1878, the Close Brothers Group now employs over 2,200 people and has total assets of 4bn. Close Premium Finance introduced the concept of premium finance to the UK in 1977 and currently funds over 2bn of insurance premiums every year. However size isn t everything. We also lead the premium finance industry in product innovation and service, and have been voted Best Premium Finance Provider 8 times in the last 12 years by insurance brokers. We are determined not to rest on our laurels and we always aim to give the highest possible standard of service. What are the benefits of using Close Premium Finance? We work closely with your broker to help you manage your premium payments. We use a cutting edge technology called i-prompt to help brokers deal with your questions as swiftly and efficiently as possible, and because your broker can access our online service, paperwork is kept to a minimum. The system is very flexible, so if you want to change your repayment date or add another policy to your premium it can be dealt with electronically, with one call. How do I pay? All monthly instalments are paid by direct debit. Are there any extra charges? As you would expect from most finance companies we do charge interest and fees. Our interest rate is highly competitive (please ask you broker for details), and our other fees and charges are as below: Missed Payments/Default Fees Fee in the event of a default in the minimum monthly payment - 40 Cancellation Fee in the event of the loan cancellation due to defaults - 15 Sundry Fee in the event of unusual activity on the account 15 In addition to the above, administration fees of up to may be applied. A service fee may be incurred for a positive Mid Term Adjustment of up to Am I tied to any insurance company? Close Premium Finance is independent so your broker is free to recommend the best policies. We simply forward the funds for your premium to your broker who then forwards it to the insurance company. How do I renew? We will invite renewal through your broker, well in advance of your renewal date. You will not be required to sign any further documentation. If you have any further questions, please contact your broker, or contact Close Premium Finance via their website or by telephone on CPF Information Sheet v082013

16 OUR TERMS OF BUSINESS FOR GENERAL INSURANCE This agreement is issued on behalf of Graybrook Insurance Brokers Ltd and supersedes all previous terms you may have received from us. Please keep this document with your policy(ies) for future reference as it sets out the terms upon which we agree to act for you and contains details of our regulatory obligations. It also contains some of the responsibilities expected from you. Please contact us immediately if there is anything in this document which you do not understand or with which you disagree. Financial Conduct Authority Graybrook Insurance Brokers Limited is authorised and regulated by the Financial Conduct Authority (FCA). The FCA regulates the financial services industry in the UK and their address is 25 The North Colonnade, Canary Wharf, London, E14 5HS. You can check this on the Financial Services Register by visiting or by contacting the FCA on Our Financial Services Register number is Who we are and how to contact us Correspondence Address Graybrook Insurance Brokers Limited Telephone: Chandlers Way Fax: South Woodham Ferrers Essex enquiry@graybrook.co.uk CM3 5TB Website: The Company s registered address is: 1208/1210 London Road Leigh-on-Sea Essex SS9 2UA Graybrook is a trading style of Graybrook Insurance Brokers Limited, who are Registered in England and Wales. Registered Number Our Principles We believe in ethical behaviour and the provision of exceptional customer service. Our Commitments We Will: Ensure that all our advertising and promotional material is clear, fair and not misleading Only advise you on matters on which we have knowledge Seek from you the information needed to enable us to fulfil our responsibilities to you Provide you with sufficient information to enable you to make informed decisions on your insurance Avoid conflicts of interest, but where unavoidable, manage it to avoid prejudice to any party Not unfairly put our own interests above our duty to you Handle complaints fairly and promptly Scope of Services We are insurance intermediaries (brokers). Occasionally we act as the agent of another intermediary. Our services include:- Arranging and advising on your non investment insurance needs Providing you with information on insurance products suitable for your requirements Negotiating insurance covers with insurers Assisting you with ongoing changes to your requirements Assisting you when making a claim We offer products from a limited number of insurers for: Professional Indemnity Insurance Medical Malpractice Insurance Management Liability General Liability General Non Liability Insurance You may ask us for a list of the insurers we deal with for these products. We only offer products in respect of the following specialist categories from a single insurer:- Complementary Healthcare Practitioners Liability (AXA) Educational Consultants (AXA) Private Practice Insurance (Aviva) Where products are supplied from a single insurer the terms have been especially negotiated for Members of Professional Bodies, Trade Unions or Trade Associations. Our recommendations are based on a combination of value for money, quality of service and financial security, appropriate to your circumstance and expressed needs. However, we cannot and do not provide a guarantee in regard to the financial reliability of any insurance provider. Unless you advise us otherwise we will act on the understanding that we have your authority to agree to insurance policy wordings on your behalf. We do not accept liability for claims, settlements or return premiums relating to policies held with an insurer who has become insolvent. We will, however, provide every assistance in submitting your claim to the liquidators, administrators or receivers etc. Client Categorisation We will take into account the following FCA definitions during our dealings with you: Consumer any natural person acting for purposes outside his trade, business or profession. Commercial a client who is not a consumer. All clients are dealt with as commercial clients. Confidential Information We will treat all your personal information as private and confidential and will only disclose this in the normal course of arranging and administering your insurance or arranging finance or handling claims on your behalf. Steps will be taken to ensure that the information is kept up to date and not kept for longer than necessary. We may use the information to provide you with details about other services or products we consider may be of interest unless you advise us in writing that you do not wish us to do so. We will not disclose personal information about you to any other party except:- When you ask us or give us permission To the Financial Conduct Authority (FCA) in order for it to fulfil its regulatory function Where we are compelled to disclose the information by Law We are registered under the Data Protection Act 1998 and undertake to comply with the Act in all our dealings with personal data.

17 If at any time you wish us or any company associated with us to cease processing your personal data, sensitive persona data, or contacting for marketing purposes, please contact William Hulse at the correspondence address shown on this document. Risk Information The terms of any insurance that we arrange on your behalf will be based upon the information provided by you. When applying for or amending your insurance policy, your insurer will ask a number of questions to assess the risk prior to agreeing cover. It is your duty to ensure that you answer all questions raised by insurers honestly and reasonably. These questions are designed to enable the insurer to obtain a comprehensive picture of the nature of the risk to be insured and enable the insurer to be in a position to offer terms which are designed to meet your demands and needs. If you fail to tell the insurer something when asked, or, if you answer carelessly or act deliberately or recklessly in making misrepresentations when answering questions, your policy may leave you with no insurance protection; insurers may not pay a part or all of your claim and may cancel your policy. You may find it difficult to re-arrange cover because you did not tell an insurer everything when asked, and you will have to disclose this fact when you re-apply for insurance. Payment Methods We have agency agreements in place with most insurers which permit us to act as their agent in handling premium payments, claims payments and premium returns. In these circumstances insurers through the agency agreement grant what is called a risk transfer. This means that when you pay a premium to us, the insurer deems this to be payment from them. Claims monies and return premiums paid by insurers through us are not deemed to be paid until received by you. We normally accept payment by cheque, electronic transfer, credit card or debit card. In addition some clients may be able to spread payments through an insurer s instalment plan or a credit scheme with a finance provider, for which there is likely to be an additional charge. We will provide full details of available payment options when providing quotations and at renewal. Payments due must be paid to us by the inception or renewal date unless otherwise agreed. Failure to meet this requirement may result in insurers cancelling the policy and imposing a time on risk charge. Our Remuneration We normally receive commission from the insurance provider as a percentage of the premium and an administration fee where we carry out work on behalf of insurers in preparing and issuing Certificates, New Business and Renewal Documents. Any such fees will be advised to you before you incur the liability to pay them and will be separately itemised. We also receive commission from providers of Premium Financing companies, where with your agreement we have made such arrangements on your behalf. We may also receive additional income from insurers by way of volume, growth or profitability payments. In the event of a policy being cancelled mid-term and not replaced by another policy, we reserve the right to retain any administration fees or commission earned on the original transaction. Confirmation of Cover Cover will not commence until your proposed risk has been accepted and the premium paid. Confirmation that cover has been effected or renewed (including any mid-term changes that may arise) will be confirmed in writing. Cancellation of Policies You should make any request for the cancellation of a policy in writing and any relevant certificate of insurance must be returned to us or the insurer concerned. If you wish to cancel your policy, you may be entitled to a refund of part of your premium as long as no claims have occurred. The refund may not necessarily be proportionate to the remaining period of cover and may not be available where the policy is subject to a minimum or deposit premium or where current certificates have not been returned or where there is an outstanding balance owing. Failure to maintain instalments on any premium financing facility arranged either direct with insurers or through a finance provider will usually result in termination of the policy unless alternative provisions have been agreed. Claims All claims, potential claims or circumstances which may lead to a claim should be reported immediately either to ourselves or to the insurer concerned. Failure to notify claims within the insurer s required timescales may result in your claim being rejected. It is your duty to disclose all relevant and material information and provide every assistance to your insurers to enable them to deal quickly and effectively with the claim on your behalf. Please note that in respect of policies arranged on a claims made basis, claims notified after expiry or termination of the policy will not be insured unless run-off cover has been arranged. Complaints Any complaints about our service may be expressed verbally or in writing and should be directed to William Hulse, the Managing Director at the correspondence address shown in this document. It is our policy to respond fairly and promptly to any complaints received within a maximum of five days and providing a full response or updates within eight weeks, although in most cases this may be sooner. If you cannot settle your complaint with us, you may be entitled to refer it to the Financial Ombudsman Service. The contact details are: Telephone: Website: Financial Services Compensation Scheme (FSCS) We are covered by the Financial Services Compensation Scheme (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. Insurance advising and arranging is covered for 90% 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. Further information about the compensation scheme arrangements is available from the FSCS on: Telephone: Website: Governing Law This agreement sets out the terms of our relationship with you and will be governed in accordance with English Law and any dispute arising will be subject to the jurisdiction of English Courts of Law. Version AXA Version