No. of Principals, partners, officers and professionals. qualification

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1 Note: 1. Completion of this Proposal Form does not bind the Proposer in any way into contract between him and the Company. 2. Please answer ALL questions fully 3. This professional indemnity insurance policy will be issued on a Claims Made Basis. The cover applicable at the time of a circumstance or a claim been reported will be the cover applicable, subject to the retroactive date stated on the Schedule page of the policy documentation. 1. NAME OF PROPOSER: ADDRESS: TEL NO.: FAX NO.: VAT REG. NO: Corporation Partnership Individual 2. Year established: 3. Is the Proposer controlled, owned or associated with any other from, corporation or company? YES NO If YES, please give details. 4. State the total gross income / fees (VAT inc.) for the past three years derived from insured activities as well as projected figures for the forthcoming year. 5. Staff Current Projected Year ending 20 R Last Completed Financial Year Year ending 20 R No. of Principals, partners, officers and professionals No. of Non-professional employees (clerks, secretaries etc.) Name in full of all partners principals/ key employees Professional qualification Date qualified How long partner/ principal in practice 6. Does the Proposer belong to any professional association(s)? 7. Does the Proposer use a written contract with clients? YES NO Please attach a copy of your standard contract.

2 8. Does the Proposer have any Risk Management Procedures in place to assist in preventing claims? YES NO If Yes, please provide details below 9. What percentage of the Proposer s business involves sub-contracting to others: Does the Proposer use a written contract with such sub-contractors? YES NO Do you limit your liability under contract? YES NO Please attach a copy of your standard contract. 10. Is any work undertaken currently or planned to be undertaken outside of South Africa? COUNTRY Nature of WORK Revenues 11. Does the Proposer currently have PI cover in place? YES NO If Yes, please provide: Name of Insurer: Expiry Date: Limit of Indemnity: R Retroactive Date: Deductible: Premium: 12. Limit of indemnity required: R 1,000,000 R 5,000,000 R 10,000,000 Other 13. Has any similar insurance ever been declined or cancelled? YES NO If Yes, attach explanation. 14. Does any person to be insured have knowledge or information of any act, error or omission which might reasonably be expected to give rise to a claim against him or the Proposer? YES NO If so, attach full particulars.

3 15. Have any PI claims been made against any proposed Insured(s) during the past five years. YES NO If so, attach full particulars. All written statement and materials furnished to the company which this application is submitted (herein called the company) in conjunction with this application are hereby incorporated by reference into this application and made a part thereof. This application does not bind the applicant to buy, or the company to issue the insurance, but it is agreed that this form shall be the basis of the contract should a policy be issued, and it will be attached to and made a part of the policy. The undersigned applicant declares that the statements set forth in this application are true. The applicant further declares that if the information supplied on this application changes between the date of this application and the time when the policy is issued \, the applicant will immediately notify the company of such changes, and the company may withdraw or modify any outstanding quotations and/or authorisation or agreement to find the insurance. PROPOSER S SIGNATURE: Date D D M M Y Y Y Y TITLE: Cont.

4 1. Please describe in detail the outsourcing activities for which coverage is desired: 2. Please detail what countries you provide outsourcing services in, where calls inbound and outbound calls are located and detail any overseas coverage you require. 3. For the income / fees listed in Question 4, please give the approximate percentage derived from each of the activities listed ACTIVITY OF INCOME / FEES Inbound/Outbound Telemarketing and Survey Telephone, or Online Support Services Marketing/Promotion of Third Party s Products or Services Customer Relationship Management Data Handling and Processing Back Office (payroll, human resources, book-keeping, accounts payable, accounts receivable and travel support) Technology Services Telecommunication Services Other (please describe below in detail) 4. Indicate the market(s) for your outsourcing services MARKET OF INCOME / FEES Aerospace Communications/Transport

5 Construction/Mining/Agriculture Education Financial Institutions Government (Military) Government (non-military) Healthcare/Medical Home Use Manufacturing/Industrial Trade: Retail/Wholesale Other (please describe below) 5. Please answer the following questions if you provide Call Centre Services a) What is the ratio of Customer Support Representatives to Trainers? b) Please provide brief details of training given to Customer Support Representatives c) Are all calls recorded and how long are they retained for? d) Are all calls monitored on a random basis by experiences supervisors? Yes No e) Do the Customer Support Representatives have access to the client s server or database? Yes No Proposer s Signature: Title: Date D D M M Y Y Y Y