1. Provide the following information on personnel for which you have responded Yes to either question 23b. or 23c.: Professional Designations Earned

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1 Hanover Professional Portfolio Accountants Professional Liability Insurance Financial Planning & Investment Advisory Services Supplement Underwritten by The Hanover Insurance Company THIS POLICY PROVIDES COVERAGE ON A CLAIMS-MADE BASIS. SUBJECT TO ITS TERMS, THIS POLICY APPLIES ONLY TO CLAIMS FIRST MADE AGAINST THE INSUREDS DURING THE POLICY PERIOD OR ANY APPLICABLE EXTENDED REPORTING PERIOD. THE LIMIT OF LIABILITY CAN BE COMPLETELY EXHAUSTED BY CLAIMS EXPENSES AND CLAIMS EXPENSES WILL BE APPLIED AGAINST THE DEDUCTIBLE. WE WILL HAVE NO LIABILITY FOR CLAIMS EXPENSES OR THE AMOUNT OF ANY JUDGEMENT OR SETTLEMENT IN EXCESS OF THE APPLICABLE LIMIT OF LIABILITY. PLEASE READ THE ENTIRE POLICY CAREFULLY. 1. Provide the following information on personnel for which you have responded Yes to either question 23b. or 23c.: Name Professional Designations Earned 2. Is your firm or any firm affiliate, a Registered Investments Advisor? Yes No 3. If any persons in your firm or firm affiliates registered with the National Association of Securities Dealers (NASD)* as a representative or principal, complete the following box: Name of Representative NASD Examinations Passed (List Series) Name of Broker / Dealer *A complete listing of all securities examinations administered by NASD is available on the Internet at Coverage may be available for registered representatives by endorsement to your policy subject to underwriting approval. Would you like a quotation? Yes No 4. Indicate the amount of gross revenues on an accrual basis earned by the firm, firm affiliates, and their personnel from financial planning, asset management, investment advisory services, and product sales. All such revenues should be included in Item 17 of the associated application. a. Last Fiscal Year b. Estimate for Current Fiscal Year c. Projection for Next Fiscal Year $ $ $ 5. From the amounts listed in 4.a. above, provide the percentage of revenue derived from the following areas of practice. Total of all items must equal 100%. Referrals to 3 rd parties **Describe Below % Non-discretionary Asset Management % Preparation of Financial Plans % Discretionary Asset Management % Page 1 of 5

2 Sale of Securities % Other Investment Advisory Services *Describe below % Sale of Insurance Products % Other Services *Describe below % *Describe: **Describe method of compensation: 6. Indicate which products personnel recommend, manage, refer and/or sell AND estimate the percentage of revenue earned from recommending and/or selling the following classes of products. (For example, Class A = 80%, Class B = 15%, Class C = 5% and Class D = 0%). Class A Class A = % Mutual Funds Yes No Variable Annuities Yes No Fixed Annuities Yes No Life/Health/Disability/Accident Insurance Yes No Class B Class B = % Property/Casualty Insurance Yes No Listed Stocks/Bonds Yes No Class C Class C = % Unlisted Stocks/Bonds Yes No Foreign Securities Yes No Options and Futures Yes No REITs Yes No Private Placements Yes No General and Limited Partnerships Yes No Viatical Agreements Yes No Class D Class D = % Derivatives Yes No Hedge Funds/Funds of Hedge Funds Yes No Other *Describe Below Yes No *Describe: 7. For asset/portfolio management, provide the following: Estimate For Current Last Fiscal Year Year Total funds under discretionary management $ $ Total number of discretionary accounts Total funds under non-discretionary management $ $ Total number of non-discretionary accounts Page 2 of 5

3 8. Within the past 3 years, have any personnel recommended any non-public investments to clients in which the firm, firm affiliates or their personnel have an ownership interest? Yes No If yes, please provide details: 9. Do the firm and firm affiliates obtain a signed engagement letter or written agreement updated annually outlining the client s investment objectives and the services the firm will perform? Yes No If no, please explain:: 10. Is any person in your firm or any firm affiliate licensed as life/health/accident/disability insurance agent or broker? Yes No a. If yes, coverage may be available for life/health/accident/disability insurance agents by endorsement to your policy subject to underwriting approval. Would you like quotation? Yes No b. Provide their names and complete the following table: Estimate For Current Last Fiscal Year Year Annual Premium Volume $ $ Annual Insurance Commissions $ $ Number of Policies c. Within the past 3 years, have the agents placed business with any non-admitted carrier or any carrier with an A.M. Best rating less than B? Yes No d. Do the life/health/accident/disability insurance agents have errors & omissions insurance? Yes No If yes, attach as copy of their current Declarations Page. 11. Does your firm, firm affiliates or their personnel have discretionary authority to invest for any employee benefit plan? Yes No If yes, please provide the following on a separate sheet: a. Names of employee benefit plans. b. Total amount of assets under your management for each plan. c. Copy of written agreement under which you are rendering services. Coverage may be available for acting as a benefit plan fiduciary by endorsement to your policy subject to underwriting approval. Would you like a quotation? Yes No Are additional sheets attached? Yes No Page 3 of 5

4 The undersigned, acting on behalf of all Applicants, declares that the statements above are true and complete to the best knowledge of all persons to be insured and that I/we have not suppressed or misstated any facts and I/we understand that this supplement becomes part of the application. Date Signature/Title (Chief Executive Officer, President, Chief Financial Officer, Managing Partner or Owner) (Print Name) (Print Title) Produced By: Agent: Agency: Agent Signature: Agency Taxpayer ID or SS No.: Agent License No.: Address (Street, City, State, Zip): NOTICE TO ARIZONA AND MISSOURI APPLICANTS: Claim Expenses are Inside the Policy Limits. All claim expenses shall first be subtracted from the limit of liability, with the remainder, if any, being the amount available to pay for damages. NOTICE TO ARKANSAS, LOUISIANA AND WEST VIRGINIA APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. NOTICE TO COLORADO APPLICANTS: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provide false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies. NOTICE TO DISTRICT OF COLUMBIA APPLICANTS: Warning: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits if false information materially related to a claim was provided by the applicant. NOTICE TO FLORIDA APPLICANTS: Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. NOTICE TO HAWAII APPLICANTS: For your protection, Hawaii law requires you to be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment, or both. NOTICE TO IDAHO AND OKLAHOMA APPLICANTS: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. NOTICE TO KENTUCKY APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime Page 4 of 5

5 NOTICE TO MAINE, TENNESSEE, VIRGINIA, AND WASHINGTON APPLICANTS: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. NOTICE TO MARYLAND APPLICANTS: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. NOTICE TO MICHIGAN AND MINNESOTA APPLICANTS: Any person who knowingly and with intent to defraud an insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent act, which is a crime and subjects the person to criminal and civil penalties. NOTICE TO NEW JERSEY APPLICANTS: Any person who knowingly includes any false or misleading information on an application for an insurance policy or files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. NOTICE TO NEW MEXICO AND RHODE ISLAND APPLICANTS: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to civil fines and criminal penalties. NOTICE TO OHIO APPLICANTS: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. NOTICE TO OREGON APPLICANTS: Any person who knowingly and with intent to defraud or solicit another to defraud any insurance company: (1) by submitting an application, or (2) by filing a claim containing a false statement as to any material fact, may be violating state law. NOTICE TO PENNSYLVANIA APPLICANTS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. NOTICE TO VERMONT APPLICANTS: Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law Page 5 of 5

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