CRM BROKERS PROFESSIONAL INDEMNITY INSURANCE VALUERS PROPOSAL FORM

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1 CRM BROKERS PROFESSIONAL INDEMNITY INSURANCE VALUERS PROPOSAL FORM NOTICE TO THE PROPOSED INSURED (pursuant to the provisions of the Insurance Contracts Act 1984) IMPOTANT NOTICES Your Duty of Disclosure Before you enter into a contract of general insurance with an Insurer, you have a duty, under the Insurance Contracts Act 1984, to disclose to the Insurer every matter that you know, or could reasonably be expected to know, is relevant to the Insurer s decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a contract of general insurance. Your duty however does not require disclosure of any matter:- - that diminishes the risk to be undertaken by the Insurer; - that is of common knowledge; - that you Insurer knows or, in the ordinary course of its business, ought to know; - as to which compliance with your duty is waived by the Insurer It is important that all information contained in this application is understood by you and is correct, as you will be bound by your answers and by the information provided by you in this application. You should obtain advice before you sign this application if you do not properly understand any part of it. Your duty of disclosure continues after the application has been completed up until the contract of insurance is entered into. Non-Disclosure If you fail to comply with your duty of disclosure, the Insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the contract from its beginning.

2 Claims Made Contract Subject to its terms and conditions the Policy will cover your civil liability for any claim:- - first made against you during the Policy Period; - resulting from any circumstance of which you become aware during the Policy Period which could give rise to a future claim against you provided you immediately inform us in writing of such circumstances within the Policy Period. The Policy will NOT cover your civil liability resulting from any claim, matter, occurrence or circumstance arising from any breach of a duty owed in a professional capacity in connection with the Firm s Business which was committed or alleged to have been committed of which you were aware before commencement of the Policy Period. Change of Risk or Circumstances You should advise the Insurer as soon as practicable of any change to your normal business as disclosed in the Proposal, such as changes in location, acquisitions and new overseas activities. Subrogation Where you have agreed with another person or company, who would otherwise be liable to compensate you for any loss or damage which is covered by the Policy, that you will not seek to recover such loss or damage from that person, the Insurer will not cover you, to the extent permitted by law, for such loss or damage.

3 PLEASE ANSWER ALL QUESTIONS FULLY (strokes are not sufficient). IF THERE IS INSUFFICIENT SPACE. PLEASE GIVE DETAILS ON YOUR LETTERHEAD. THE PROPONENT ALONE IS RESPONSIBLE FOR THE ACCURACY OF ALL INFORMATION FURNISHED IN CONNECTION WITH THE PROPOSAL. WHERE APPLICABLE TICK TO INDICATE ANSWER. 1. Full name of all persons and/or entities to be insured. (It is essential that you specify the names of all entities including service, administrative or nominee companies and subsidiaries that you wish to be covered by this policy). ABN: 2. Address(es) of Firm (if more than one please give each) Ph No. Fax No Date the Firm was established / / 4. Please supply the following details: Name of all Partners / Principals/Directors Age Qualifications Date Qualified Period Practicing as Partner / Principal / Director This Firm Prev. Firm

4 5. Please advise total number of: (a) Partners/Directors/Principals (b) Qualified Staff Valuers(employed; including Valuer Partners/Directors/Principals) (c) Sub-Contractor Valuers working in Insured s Business solely for Insured and to be in the proposed Policy (d) Other Sub-Contractor Valuers to Insured, Covered by their own Professional Indemnity Policy (Please provide a list and details of any Claims against these Sub-Contractor Valuers) (e) Non Valuer Staff TOTAL 6. State Percentage of Practice relating to Activities: Domestic Property % Industrial or Commercial Property % Municipal / Council Valuations % Rural Property % Hotel / Licensed Premises % Plant & Machinery % Producers Groups Surveys & Negotiations % Total =100 %

5 7. Please state the approximate percentage of income for each of the following: Estate Agency ( General Practice) % Valuations % Estate / Property Management % Rent Collecting % Auctioneering % Loss Assessors and Adjusters % Insurance Agents % Project Managers (supply details) % Other (supply details on your letterhead) % Total =100 % 8. (a) Please give the total annual gross fees for the current year and an estimate for the coming 12 month period: Australia Overseas Current Year $ $ Coming Year $ $ Previous Year $ $ Please state the date of your financial year 8. (b) Please provide approximate percentage of your activities (based on fee income) applicable to each State: (must total 100%) NSW VIC QLD SA WA TAS NT ACT Overseas % % % % % % % % %

6 9. Do you have any Professional Indemnity Insurance Cover currently in place? If YES, please state: (a) Name of Insurer: (b) Limit of Indemnity: (c) Annual Premium: (d) Deductible: (e) Expiry Date of the Policy: (f) Retroactivity Date: 10. (a) Has the name of the business ever been changed? (b) Has any other business amalgamated or merged with you? (c) Have you purchased any other business? If you have answered Yes to either (a), (b) or (c), please supply details. 11. Is any Partner, Principal or Director connected or associated (financially or otherwise) with any other business? If Yes, please supply details. 12. Have any Claims ever been made against you, your firm, your partners or their predecessors in business individually or otherwise.

7 Ensure that details of any or all past or current claims are disclosed including any claims from previous businesses (attach details on your letterhead) Level 29, Chifley Tower, 2 Chifley Square, Sydney Are any of the Partners/Principals/Staff, AFTER ENQUIRY, aware of any circumstances which may give rise to a claim against the Firm or their predecessors in business or any of the present or Former Partners? If YES, please provide further details: 14. Automatic Policy Extensions: Breaches of the Trade Practices Act 1974 (non criminal) Unintentional Libel/Slander/Defamation Dishonesty of Employees Joint Venture Cover (Insured s liability only) Severability Cover Consultants, Sub-Contractors and Agents Cover (Insured s liability only) Loss of Documents (Property Damage) 15. Optional Policy Extensions does the firm require the Policy to be extended to cover: One Reinstatement of the Limit of Indemnity Previous Business Indemnity (Principals) (NB if Previous Indemnity (Principals) is required, please attach a list (on your letterhead) of the previous Businesses/Practices that Insured s Principals were associated with and performed Professional Services for. Please include details of Previous continued Professional Indemnity Insurance held and the details of any Claims made against these Policies at Previous Firms.) 16. (a) Please state the approximate percentage of the Firm/Company s Valuation income derived from mortgage valuation work? % (b) What approximate percentage of the above is for second and/or third mortgage valuations? % 17. (a) Average Value of Properties Last 12 months $

8 (b) Maximum Value of any one Property in the last 3 years $ Level 29, Chifley Tower, 2 Chifley Square, Sydney Valuations in the last 3 years in excess of $2,000,000. (a) Please provide details of ALL valuations in excess of $2,000,000 (b) Please advise which individual/s undertook the valuation/s and confirm relevant experience (c) What was/were the purpose/s of the valuation/s? (d) What was/were the purpose/s of the valuation/s?

9 (e) What was/were the value/s involved? (f) Please name the properties that have subsequently been sold and advise the selling prices. (g) If the selling price of any property varies by more than 15% from the valuation given does the assured expect any problems to arise? (h) What was/were the type/s and purposes of the building/s involved?

10 (i) Has/have the file/s been revisited since the valuation/s took place? (j) Please confirm that no problem/s has/have arisen since the valuations took place which is likely to give rise to a claim. 19. Please select the amount of Indemnity required: $1,000,000 $2,000,000 $5,000,000 $10,000,000 Other please state 20. In respect of any VALUATIONS: (a) Please advise the percentage of gross fees derived from valuations performed for any of the following: Equity Lenders (banks, building societies, credit unions) % Property Developers % Private Lenders % Solicitors mortgage funds % Finance or Mortgage brokers %

11 (b) Do you provide Restricted Access Valuations or Assessments (RV s)? Level 29, Chifley Tower, 2 Chifley Square, Sydney 2000 If yes, do all restricted valuations / assessments fully comply with the Australian Property Institute Restricted Access Assessment Supporting Memorandum? If no, please provide full details of all steps taken to mitigate any increased risk arising from such non- compliance. (c) Please describe risk management procedures in respect of valuation activities.

12 DECLARATION Level 29, Chifley Tower, 2 Chifley Square, Sydney SIGNING THIS PROPOSAL FORM DOES NOT BIND THE PROPOSER OR THE INSURER TO COMPLETE THIS INSURANCE The undersigned declares that the statement and particulars in this proposal form are true and that no material facts have been misstated or suppressed after enquiry. The undersigned agree that should any information given by us alter between the date of this proposal and the inception date of the insurance to which this proposal relates, the undersigned will give immediate notice thereof. The undersigned agrees that the Underwriters may use and disclose our personal information in accordance with the Privacy Statement at the beginning of this Proposal. The undersigned agrees that this proposal, together with any other information supplied by us shall form the basis of any contact of insurance effected thereon. TO BE SIGNED BY THE INSURED FOR WHOM THIS INSURANCE IS INTENDED FOR: SIGNATURE DATE NAME POSITION

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