Professional Indemnity Insurance Proposal Form for Accountants

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Professional Indemnity Insurance Proposal Form for Accountants"

Transcription

1 QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Accountants IMPORTANT INFORMATION Duty of Disclosure When completing any insurance proposal form it is essential that any material facts or information which might influence the judgement of insurers in fixing the premium, or in determining whether they will accept the risk is disclosed. The onus is on you to decide what may be material and there is no duty on Insurers to make enquiries of you. Failure to disclose material facts may allow insurers to avoid the policy and / or repudiate a claim under it. This duty of disclosure applies equally on taking out a new insurance policy and at renewal and throughout the duration of the policy term. Presentation of the Proposal Form It is important that the proposal form is completed as clearly as possible and the declaration signed by a Partner, Director or Principal of the firm. Failure to present the proposal form in a clear format may affect an underwriter s ability to offer terms. If completing the proposal form by hand, we recommend that you use black ink and write clearly in block capitals. All questions must be answered. If not applicable state N/A. If you run out of space please use the additional sheet provided, or alternatively use your firm s letterhead. To support your application, we recommend that where available you supply any brochures, letters of appointment and terms and conditions. Need our Advice? Should you require any advice or assistance with completing this proposal form, QPI Professional will be glad to help. Please contact us on: of 14

2 General Details 1. Name of Practice (please include all names under which you practice) Date Established Main Office Address Main Office Telephone Number Contact Name Contact Address Practice Website Address 2. Number of branch offices PLEASE LIST ALL BRANCH OFFICES INCLUDING ADDRESSES ON A SEPARATE SHEET WHERE COVER REQUIRED If more than one office exists, please confirm if there is a senior Partner/Director/Member based at each office? If NO, please provide a C.V. of the person overseeing the office. 3. Type of practice and activities undertaken: 4. Professional Associations please indicate which association/s the proposer is a member of: ICAEW ACCA AAT CIMA ICAS CIPFA Other If other please provide details below: 2 of 14

3 5a. Please provide details below of any subsidiary companies which are to be included under this insurance (whether trading or ceased trading) Subsidiary Year Established Year of Cessation 5b. Is cover required for all past activities of the business included in 5a? 6. Is/are the firm(s) or any principal, partner or director a member of a joint venture, consortium, single project partnership or group practice? If YES please supply details: 7. Does the firm(s) or any principal, partner or director carry out any work on behalf of any other business in which they have a controlling or financial interest (other than as a shareholder in a public quoted company)? If YES please supply details below: 3 of 14

4 Staff and Partners 8. Please give details of all Partners, Directors or Members of the Firm (s): Full Name Age Qualifications Date Qualified State how long as Partner/Director/ Member Please use separate sheet for additional Partners, Directors or Members of the Firm (s). 9. Please give details of any consultants to whom work is sub-contracted that require cover Consultants Name Qualifications Fees paid last financial year Does the sub-contractor hold their own PI Insurance? 10. Please advise number of permanent staff (excluding Partners, Directors or Members) Qualified Full Time Qualified Part Time Other Full Time Other Part Time Activities of the Firm 11. Please provide the total gross fee income for the last 5 years Year Ending UK USA/Canada Elsewhere Total / /20 / /20 / /20 / /20 Last completed year Estimate next year 12. If the firm has fees emanating from contracts in the USA /Canada, please state contract values, nature of work and whether the work is carried out from the UK 4 of 14

5 13. If the firm has fees emanating from contracts elsewhere, please state contract values, nature of work and whether the work is carried out from the UK 14. Please give the approximate percentage breakdown of your last Financial Year income / fees in the following categories: 1 Audit, Accountancy & Compliance Tax % (i) Quoted Companies % (ii) Unquoted Companies % (iii) Others (including Farmers, Small traders etc.) % 2 Other Taxation % 3 Payroll Services % 4 Management Consultancy % 5 Consultancy Only % 6 Secretarial and Share Registration % 7 Executorship and Trusteeship % 8 Insolvencies, Liquidations and Receiverships % 9 Insurance, Building Society & Stock Exchange Commissions % 10 Directorships % 11 Computer Consultancy % 12 Corporate Finance, Mergers, Acquisitions % 13 Investment Advice and other Financial Services work % 14 Other Work % Total (please check 1-8 equals 100%) 100% 15. For any activities where you have answered Nil, please give details if you have been engaged in such work in the last 6 years 5 of 14

6 16. If any fees are received in connection with; other work, management consultancy or computer consultancy give brief details of the work undertaken in the box below 17. Are there any changes in the above percentages or any major operations envisaged during the forthcoming year? If YES please give details 18. Is the firm authorised to conduct investment business and/or Financial Services? If YES please give details of your regulatory body 19. Have you or any firm you have acquired, ever carried out any regulated activities as defined in the Financial Services and Markets Act 2000 (other than in connection with general insurance products) as: (a) Financial adviser; Execution only; Tied Agent or Appointed Representative? (b) Introductory agent only If you have answered YES to (a) above, a Financial Services Questionnaire will be required, please contact the QPI office to request this document. If you have answered YES to (b) above please answer the following questions: (i) Do you have any financial interest or controlling interest in the company that you are introducer to? (ii) Can you confirm that gross commission/fees received in any one of the last six financial years as introductory agent did not exceed 10,000 or 10% of your total fee income? (iii) Can you confirm that you only introduce to an independent financial advisor who is authorised and regulated by FSA? 6 of 14

7 20. Please give split of fees for the last financial year between: Fee Amounts No of Clients Total Fees Less than 15,000 15,000 to 40,000 Over 40,000 Totals 21. Please give details of type of business activities for your largest client 22. Does the firm undertake or has the firm previously undertaken work of any description for the following; i) Banks and other Financial Institutions ii) iii) iv) Insurance Companies, Lloyds Syndicates, Lloyd s managing or members agents or Underwriting Agencies Any off-shore companies Entertainment industry clients or sporting professionals If YES, please give details below of the name(s) of clients, fees earned and the services provided in the box below 7 of 14

8 Risk Management 23a. Does the Firm(s) always request satisfactory written references when engaging senior employees? 23b. Is any Partner, Director, Member or Employee allowed to sign cheques on his signature alone? 23c. If YES, please describe circumstances and state limit: 23d. Do all cheques for more than 25,000 require two signatures? 23e. Are employees receiving cash/cheques in the course of their everyday duties required to pay in daily? 23f. How often are checks carried out on all entries in the cash book with paying in books, receipts, counterfoils and vouchers and reconciled with bank statements, including the balance of cash and unrepresented cheques, independently of employees receiving or banking monies in respect of monies belonging to the Firm as well as in trust on behalf of others? Weekly Monthly Quarterly Other 24a. What is the management structure of the Firm(s)? Managing Partner Managing Executive Management Committee Executive Committee Other (please specify): 24b. Have there been any material changes in the management structure within the last three years? 24c. If the Firm(s) is managed by a committee, does this committee meet on a regular or ad hoc basis? regular ad hoc 24d. Does the Firm employ a full time non-accountancy administrator? 8 of 14

9 24e. Does the Firm(s) designate or employ an individual with management responsibility for evaluating or dealing with complaints, actual or potential claims and other such matters? 25. Does the Firm(s) have written risk management procedures which are regularly reviewed and circulated to all staff? If NO please provide full details 26a. Does the firm always use engagement letters? If YES, do the engagement letter outline: i) The scope of services to be performed? ii) Any statement / assumptions upon which the engagement is based? iii) The responsibilities of the client? iv) any limitations / restrictions in respect of any services performed? 26b. Does the client always sign the letter of engagement? 26c. Does the Firm(s) provide advice or services which fall outside the scope of the letter of engagement? 27a. Does the Firm(s) have a written policy specifying the conflicts of interest procedures which include a cross check system and back up? 27b. In the event of a conflict of interest does the Firm(s): Inform the client in writing? Advise the firm to seek independent advice? Continue to act for the client? 27c. Does the Firm(s) undertake any professional services for any client in which any Partner or Accountant holds a partnership / directorship or have any other financial interest? If YES, please provide details: 9 of 14

10 28. Does the Firm(s) have a policy which requires prior approval in writing for an Accountant to serve as an Officer and/or a Director of a client or third party applicable? 29. Does the Firm(s) operate a diary system with a manual back-up? If YES, (a) Are periodic checks made to ensure that the diary system is being strictly followed? (b) Does the diary system provide for accountants being absent or deadlines not being missed? 30. (a) Does the Firm(s) have a file review system which requires randomly selected files to be audited by an accountant other than the accountant handling the file? (b) Does the file review system include Partner to Partner auditing? Please provide any additional information that will assist our understanding of the file review system currently being used: 31. Does the Firm(s) offer and promote continuous training? If YES, please describe the continuous training provided? 10 of 14

11 Claims Information 32. After enquiry, have any professional indemnity claims ever been made against the Firm(s) and/or predecessors of the Firm(s) and/or your current and/or retired Partners, Directors or Principal, either individually or otherwise for any negligence, errors, omission, breach of professional duty or the like, whether successful or not? If YES, please supply details: Date of Claim (dd/mm/yy) Claimant Details of Claim, including amounts paid by insurer in respect of damages and legal costs 33. After enquiry, are any of the Partners, Directors or Prinicples aware of any pending claims and/or circumstances existing that may give rise to a professional indemnity claim against the Firm(s) and/or predecessors of the Firm(s) and/or your current and/or retired Partners/Directors/Principals? If YES, please supply details: Date of Circumstance Claimant Details 11 of 14

12 34. Is any Partner, Director or Principal, after enquiry aware of any disciplinary actions taken towards the firm and / or Partner / Director / Principal? 35. Has the Firm(s) sustained any loss through fraud or dishonesty of any person? Is the Firm(s) aware of any allegation or occurrence of fraud or dishonesty at any time committed by any past or present Partners, Director or employee? If YES to either question, please provide details on a separate sheet Previous Coverage 36. Has the firm previously been insured for professional indemnity insurance? (If you are a current client of QPI Professional do not complete) If YES, please supply details: Renewal Date Limit of Indemnity Premium Excess Insurer Name 36a. Has an insurer ever declined a proposal, declined to pay a claim, refused renewal, cancelled the policy or imposed special conditions in respect of professional indemnity insurance? If YES please provide details: Cover Requirements 37. Please specify the limit(s) if indemnity for which quotations are required: GBP GBP GBP GBP GBP Please specify the excess you would be prepared to carry GBP GBP GBP GBP GBP 12 of 14

13 Additional Information Please use this space to provide further information in support of answers given to questions in this proposal. Please state question numbers clearly. 13 of 7

14 Declaration I /We declare that the statements and particulars in this proposal are true and that no material facts have been misstated or supressed after enquiry. I / We agree that this proposal, together with any other information supplied shall form the basis of any contract of insurance effected thereon. I / We undertake to inform the insurers of any material alteration to those facts occurring before the completion of the contract of insurance. Signed: Title: Firm(s): Date: QPI Legal Unit 17 Mobbs Miller House Ardington Road Northampton NN1 5NE Tel: Fax: of 14

Professional Indemnity Insurance Proposal Form for Accountants

Professional Indemnity Insurance Proposal Form for Accountants QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Accountants Short Proposal Form for 1-4 Partner Firms IMPORTANT INFORMATION Duty of Disclosure

More information

Professional Indemnity Select

Professional Indemnity Select Allianz Insurance plc Professional Indemnity Select Accountants Proposal Form Contents Accountants Professional Indemnity Insurance 1 General Information 2 Thank you for choosing Allianz Insurance plc.

More information

Professional Indemnity Insurance Proposal Form for Architects

Professional Indemnity Insurance Proposal Form for Architects QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Architects IMPORTANT INFORMATION Duty of Disclosure When completing any insurance proposal form

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Accountants Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically and

More information

PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS

PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE This proposal form must be completed in ink by a Partner, Principal or Director of the Firm or Company.

More information

Accountants Professional Liability Insurance Proposal

Accountants Professional Liability Insurance Proposal AIG Europe Limited Proposer Details Name of Firm(s) Principal Address line one Principal Address line two City and postcode Telephone number Fax number Website address Does the Firm(s) have any branch

More information

Accountants Professional Indemnity Insurance Proposal

Accountants Professional Indemnity Insurance Proposal Accountants Professional Indemnity Insurance Proposal AIG Europe Limited 30 North Wall Quay International Financial Services Centre Dublin 1 Proposer Details 1. Name(s) of Firm(s) 2. Nature of business

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be answered to enable

More information

Accountant Professional Liability Proposal Form

Accountant Professional Liability Proposal Form Notice: Statement pursuant to Section 25(5) of the Insurance Act (Cap 142) or any amendments thereof; You are to disclose in this application, fully and faithfully, all the facts which you know or ought

More information

Professional Indemnity Insurance for Accountants. Proposal Form

Professional Indemnity Insurance for Accountants. Proposal Form Professional Indemnity Insurance for Accountants Proposal Form Professional Indemnity Insurance for Accountants Proposal Form Please read the following carefully before completing this proposal form. To

More information

HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM ACCOUNTANTS

HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM ACCOUNTANTS HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM ACCOUNTANTS Michael's House 10-12 Alie Street, London E1 8DE Tel: 020 7980 3800 Fax: 020 980 3915 PLEASE READ THE FOLLOWING BEFORE COMPLETING

More information

Accountants Proposal Form

Accountants Proposal Form Accountants Proposal Form Proposal Form IMPORTANT: In this proposal: You / Your refers to all firms to be insured under this arrangement, including any predecessor or previous business for which cover

More information

PROFESSIONAL INDEMNITY INSURANCE

PROFESSIONAL INDEMNITY INSURANCE BDB (UK) Limited 40 Lime Street, London EC3M 7AW PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS PROPOSAL FORM 1 GUIDANCE NOTES This proposal must be completed in ink by a Partner or Director of the Proposer.

More information

IMPORTANT NOTICE REGARDING COMPLETION OF THIS ACCOUNTANTS PROPOSAL FORM

IMPORTANT NOTICE REGARDING COMPLETION OF THIS ACCOUNTANTS PROPOSAL FORM IMPORTANT NOTICE REGARDING COMPLETION OF THIS ACCOUNTANTS PROPOSAL FORM 1. Disclosure - Any material fact must be disclosed to Insurers. - A material fact is any information which may alter the judgment

More information

Securus Insurance Limited. Proposal Form. Accountants Professional Indemnity

Securus Insurance Limited. Proposal Form. Accountants Professional Indemnity Securus Insurance Limited Proposal Form Accountants Professional Indemnity Securus Insurance Limited Suite 3, Stafford House Strand Road Portmarnock Co Dublin Phone (01) 8464512 Fax (01) 8464522 Email

More information

PROPOSAL FORM FOR IT CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE

PROPOSAL FORM FOR IT CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR IT CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE Precision Underwriting (UK) Limited, 3 rd Floor, 14 Cullum Street, London, EC3M 7JJ. T: +44 (0) 20 7398 0800 F: +44 (0) 20 7398 0801 E:

More information

IMPORTANT POINTS. Please ensure all questions are answered fully, where there is insufficient space please supply information on a separate sheet.

IMPORTANT POINTS. Please ensure all questions are answered fully, where there is insufficient space please supply information on a separate sheet. IMPORTANT POINTS Please ensure all questions are answered fully, where there is insufficient space please supply information on a separate sheet. The questions must be answered to the best of your knowledge

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with our most competitive quotation, it is important

More information

Accountants. Professional Indemnity Proposal Form. Vantage Professional Risks. 41 Eastcheap London EC3M 1DT

Accountants. Professional Indemnity Proposal Form. Vantage Professional Risks. 41 Eastcheap London EC3M 1DT Professional Indemnity Proposal Form Accountants Vantage Professional Risks 41 Eastcheap London EC3M 1DT Telephone 020 7655 8020 Email: pi@vantageinsurance.co.uk www.vantageprofessionalrisks.co.uk IMPORTANT

More information

Accountants Application Form

Accountants Application Form Accountants Application Form Application Form IMPORTANT: In this application: You / Your refers to all firms to be insured under this arrangement, including any predecessor or previous business for which

More information

Professional Indemnity Insurance for Accountants Proposal Form

Professional Indemnity Insurance for Accountants Proposal Form Professional Indemnity Insurance for Accountants Proposal Form Professional Indemnity Insurance for Accountants Proposal Form Please read the following carefully before completing this proposal form. To

More information

100,000 250,000 500,000 1,000,000 2,000,000 Other Please Specify:

100,000 250,000 500,000 1,000,000 2,000,000 Other Please Specify: Intersure Insurance Brokers Limited Prospect House, 63 rth Street, Sudbury, Suffolk CO10 1RE Telephone: 01787 313133 Fax: 01787 313656 e-mail:enquiries@intersure.net www.intersureinsurance.com PROPOSAL

More information

Professional Indemnity Proposal Form

Professional Indemnity Proposal Form Professional Indemnity Proposal Form Accountants Please complete the whole form to the best of your ability, clarifying any areas where necessary and continuing on a separate sheet if required. A website,

More information

ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM

ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material fact

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR PRIVATE MEDICAL INSURANCE BROKERS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions

More information

Professional Indemnity Proposal Form Accountants

Professional Indemnity Proposal Form Accountants Professional Indemnity Proposal Form Accountants GUIDANCE NOTES Completing your proposal form Please complete all questions in full using the Additional Information section or separate sheets where necessary.

More information

SPECIFIED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

SPECIFIED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM P.O. Box 1882 PC 114, Jibroo, Sultanate of Oman Tel. No.+968 24577 677 Fax +968 24577 678 SPECIFIED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM SECTION 1 Proposer Details 1. Name(s) of Firm(s)

More information

PROFESSIONAL INDEMNITY INSURANCE

PROFESSIONAL INDEMNITY INSURANCE PROFESSIONAL INDEMNITY INSURANCE Accountants Proposal Form A FULL POLICY WORDING IS AVAILABLE ON REQUEST Please ask your broker, usual RSA contact or see our website, www.rsabroker.com Please complete

More information

Accountants Professional Indemnity Insurance

Accountants Professional Indemnity Insurance Accountants Professional Indemnity Insurance Instructions Please provide a full answer to every question. A Partner/Director/Principal must sign and date this form and any separate sheets on behalf of

More information

Questionnaire & Application Pack. For. Business Consultants Professional Indemnity Insurance. This pack contains the following documents:-

Questionnaire & Application Pack. For. Business Consultants Professional Indemnity Insurance. This pack contains the following documents:- Questionnaire & Application Pack For Business Consultants Professional Indemnity Insurance. This pack contains the following documents:- Our FSA Keyfacts document explaining who we are. Our FSA Demands

More information

Accountants Professional Indemnity Insurance Proposal Form

Accountants Professional Indemnity Insurance Proposal Form Accountants Professional Indemnity Insurance Proposal Form Instructions This proposal form must be completed by a Principal, Director, Partner or Company Secretary of the Proposer. If there is insufficient

More information

Construction Professional Liability Insurance Proposal

Construction Professional Liability Insurance Proposal AIG Europe Limited Proposer Details Name of Firm(s) Principal Address line one Principal Address line two City and postcode Telephone number Fax number Website address Is the Firm(s) a subsidiary of an

More information

Professional indemnity CIOT and ATT members proposal form

Professional indemnity CIOT and ATT members proposal form You must complete the general information section, the claims section and read and sign the declaration. General information You must complete this section. Company name Main address Please provide similar

More information

Multimedia Professional Indemnity Insurance Proposal

Multimedia Professional Indemnity Insurance Proposal SIGNING THIS PROPOSAL DOES NOT BIND THE PROPOSER TO COMPLETE THIS INSURANCE Multimedia Professional Indemnity Insurance Proposal 1. (a) Name of Firm(s) (b) Company registration number: (c) Address(es)

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR HEALTH & SAFETY CONSULTANTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR HEALTH & SAFETY CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR HEALTH & SAFETY CONSULTANTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be

More information

PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS

PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS Form PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS All questions must be answered to enable a quotation to be given. The completion and signature of this proposal form does not bind the Proposer(s) or the

More information

IMPORTANT NOTICE REGARDING COMPLETION OF THIS MANAGEMENT CONSULTANTS PROPOSAL FORM

IMPORTANT NOTICE REGARDING COMPLETION OF THIS MANAGEMENT CONSULTANTS PROPOSAL FORM IMPORTANT NOTICE REGARDING COMPLETION OF THIS MANAGEMENT CONSULTANTS PROPOSAL FORM 1. Disclosure - Any material fact must be disclosed to Insurers. - A material fact is any information which may alter

More information

Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form

Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Please read the following carefully before

More information

Insurance Brokers Professional Liability Proposal Form

Insurance Brokers Professional Liability Proposal Form Insurance Brokers Professional Liability Proposer Details 1. Name of Firm(s) 2. Principal address Postcode Tel No. Website 3. Date Firm Established 4. Please provide details of any subsidiary companies

More information

Professional Indemnity Insurance. Proposal for PROFESSIONAL RISKS. 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB

Professional Indemnity Insurance. Proposal for PROFESSIONAL RISKS. 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Professional Indemnity Insurance Proposal for IT Consultants PROFESSIONAL RISKS 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Tel 020 7623 4957 Fax 020 7623 4958 PROFESSIONAL RISKS Kerry London

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS INTERSURE INSURANCE BROKERS LIMITED PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with

More information

Professional Indemnity Proposal Form Business & Management Consultants

Professional Indemnity Proposal Form Business & Management Consultants Professional Indemnity Proposal Form Business & Management Consultants This form does not apply to: IT Consultancy. Please see the IT Professions proposal form GUIDANCE NOTES Completing your proposal form

More information

PROFESSIONAL INDEMNITY INSURANCE

PROFESSIONAL INDEMNITY INSURANCE PROFESSIONAL INDEMNITY INSURANCE MISCELLANEOUS PROPOSAL FORM GUIDANCE TES This proposal must be completed in ink by a Partner or Director of the Proposer. Please use your headed notepaper to provide full

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES Howden Insurance Brokers Limited is an official scheme provider of Professional Indemnity for BIBA members Please complete this

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be answered to enable

More information

Management Consultants Professional Liability Proposal Form

Management Consultants Professional Liability Proposal Form AIG Insurance Hong Kong Limited Management Consultants Professional Liability Proposal Form I. APPLICANT DETAILS Name of Insured: Address(es): Web Site Address: Establishment Date: II. BUSINESS ACTIVITIES

More information

Management Consultants Professional Liability Proposal Form

Management Consultants Professional Liability Proposal Form Notice:Statement pursuant to Section 25(5) of the Insurance Act (Cap 142) or any amendments thereof; You are to disclose in this application, fully and faithfully, all the facts which you know or ought

More information

Bailiff and Private Investigators Professional Liability Insurance Proposal

Bailiff and Private Investigators Professional Liability Insurance Proposal AIG Europe Limited Bailiff and Private Investigators Professional Liability Insurance Proposal Proposer Details Name of Firm(s) Principal Address line one Principal Address line two City and postcode Telephone

More information

Professional Indemnity Insurance for Motor Traders Financial Product Sales. Proposal Form

Professional Indemnity Insurance for Motor Traders Financial Product Sales. Proposal Form Professional Indemnity Insurance for Motor Traders Financial Product Sales Proposal Form Professional Indemnity Insurance for Motor Traders Financial Product Sales Proposal Form Please read the following

More information

Professional Indemnity Insurance Management Consultants Proposal Form

Professional Indemnity Insurance Management Consultants Proposal Form Professional Indemnity Insurance Management Consultants Proposal Form Towergate Lifestyle Suite 4b, 1 Portland Street, Manchester, M1 3BE Tel: 0844 892 1789 Fax: 0844 892 1796 Email: lifestyle@towergate.co.uk

More information

Professional Indemnity Insurance Debt Management Consultants Proposal Form

Professional Indemnity Insurance Debt Management Consultants Proposal Form Professional Indemnity Insurance Debt Management Consultants Proposal Form The PI Desk Ltd Suite B, Sheffield Business Centre Europa Link, Sheffield, South Yorkshire, S9 1XZ Tel: 0114 242 1176 Fax: 0114

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM Please answer all questions fully and if you have a brochure or any other information concerning your business please attach to this proposal. 1. Name of

More information

Professional Indemnity Insurance for Insurance Intermediaries Proposal Form

Professional Indemnity Insurance for Insurance Intermediaries Proposal Form Professional Indemnity Insurance for Insurance Intermediaries Proposal Form Professional Indemnity Insurance for Insurance Intermediaries Proposal Form Please read the following carefully before completing

More information

Professional Indemnity Insurance for Specialist Consultants Proposal Form

Professional Indemnity Insurance for Specialist Consultants Proposal Form Professional Indemnity Insurance for Specialist Consultants Proposal Form Professional Indemnity Insurance for Specialist Consultants Proposal Form Please read the following carefully before completing

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Management Consultants Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM

MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material fact

More information

Architects Professional Liability Insurance Proposal

Architects Professional Liability Insurance Proposal AIG Europe Limited Proposer Details Name of Firm(s) Principal Address line one Principal Address line two City and postcode Telephone number Fax number Website address Is the Firm(s) a subsidiary of an

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Employment & Recruitment Agencies Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink

More information

Professional Indemnity Select

Professional Indemnity Select Allianz Insurance plc Professional Indemnity Select Insurance Brokers Proposal Form Insurance Professional Brokers Indemnity Professional Policy Overview Indemnity Select Insurance Brokers Professional

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters within the

More information

QBE Professional Indemnity Proposal Form Accountants

QBE Professional Indemnity Proposal Form Accountants Notice to the Proposed Insured QBE Professional Indemnity Proposal Form Your duty of disclosure If a proposer does not fully and faithfully give the facts as he knows them or ought to know them, he may

More information

Professional Indemnity Insurance for the Media Industry Advertising, Marketing, Public Relations and Sales Promotions

Professional Indemnity Insurance for the Media Industry Advertising, Marketing, Public Relations and Sales Promotions Professional Indemnity Insurance for the Media Industry Advertising, Marketing, Public Relations and Sales Promotions Proposal Form Professional Indemnity Insurance for the Media Industry Advertising,

More information

Business Process Outsourcing/ Call Center Professional Liability Proposal Form

Business Process Outsourcing/ Call Center Professional Liability Proposal Form Business Process Outsourcing/ Call Center Professional Liability Proposal Form I. APPLICANT DETAILS Name of Insured: Address(es): Web Site Address: Establishment Date: II. BUSINESS ACTIVITIES 2. Please

More information

Business Process Outsourcing / Call Center Professional Liability Proposal Form

Business Process Outsourcing / Call Center Professional Liability Proposal Form AIG Insurance Hong Kong Limited Business Process Outsourcing / Call Center Professional Liability Proposal Form I. APPLICANT DETAILS Name of Insured: Address(es): Web Site Address: Establishment Date:

More information

PROFESSIONAL INDEMNITY INSURANCE

PROFESSIONAL INDEMNITY INSURANCE BDB (UK) Limited 40 Lime Street, London EC3M 7AW PROFESSIONAL INDEMNITY INSURANCE INSURANCE CONSULTANTS & FINANCIAL ADVISERS PROPOSAL FORM 1 THIS PROPOSAL MUST BE SIGNED BY A PARTNER OR DIRECTOR OF THE

More information

THIS APPLICATION IS FOR A CLAIMS MADE POLICY

THIS APPLICATION IS FOR A CLAIMS MADE POLICY PEMBROKE SYNDICATE 4000 ACTUARIES ERRORS AND OMISSIONS INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS MADE POLICY ALL QUESTIONS MUST BE ANSWERED COMPLETELY. DO NOT LEAVE ANY SPACE BLANK. INDICATE

More information

Miscellaneous Professional Indemnity Insurance Proposal form

Miscellaneous Professional Indemnity Insurance Proposal form Miscellaneous Professional Indemnity Insurance Proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters with

More information

Professional Indemnity Insurance (Accountants)

Professional Indemnity Insurance (Accountants) Proposal Form Professional Indemnity Insurance (Accountants) ADNIC is a Public Joint Stock Company incorporated in the United Arab Emirates by Law No. (4) of 1972, and it is governed by the provisions

More information

Management Consultants. Professional Indemnity. Proposal Form

Management Consultants. Professional Indemnity. Proposal Form Thompson Heath & Bond Limited 107 Leadenhall Street London EC3A 4AF Tel: +44 (0) 20 7469 0100 Fax: +44 (0) 20 7621 0661 www.thbgroup.com Lloyd s Broker Management Consultants Professional Indemnity Proposal

More information

INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM

INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material

More information

ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM

ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM Centry Gothic Please read the following questions carefully and answer them all providing additional information where required. Should you require more

More information

Management Consultants Professional Indemnity Insurance Proposal Form

Management Consultants Professional Indemnity Insurance Proposal Form Management Consultants Professional Indemnity Insurance Proposal Form Important Notes Please read efore completing this form: a) If you are unsure whether this proposal is suitale for your usiness or require

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ADVERTISING AGENTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with our most competitive quotation, it

More information

IT PROFESSIONALS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

IT PROFESSIONALS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IT Professionals Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

Securus Insurance Limited. Proposal Form. Miscellaneous Professional Indemnity

Securus Insurance Limited. Proposal Form. Miscellaneous Professional Indemnity Securus Insurance Limited Proposal Form Miscellaneous Professional Indemnity Securus Insurance Limited Unit C2, Airside Enterprise Centre Swords Co Dublin Phone (01) 8074550 Fax (01) 8074553 Email info@securus.ie

More information

Questionnaire & Application Pack. For I T and Computer Consultants Professional Indemnity Insurance. This pack contains the following documents:-

Questionnaire & Application Pack. For I T and Computer Consultants Professional Indemnity Insurance. This pack contains the following documents:- Questionnaire & Application Pack For I T and Computer Consultants Professional Indemnity Insurance This pack contains the following documents:- Our FSA Keyfacts document explaining who we are. Our FSA

More information

PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ARCHITECTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with our most competitive quotation, it is important

More information

Professional Indemnity Insurance for Miscellaneous Professions Proposal Form

Professional Indemnity Insurance for Miscellaneous Professions Proposal Form Professional Indemnity Insurance for Miscellaneous Professions Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you / your means the individual, company,

More information

Proposal Form for Accountants. Professional Indemnity Insurance

Proposal Form for Accountants. Professional Indemnity Insurance Proposal Form for Accountants Professional Indemnity Insurance About This Proposal Form Please have a Principal, Partner or Director of the business fill out, sign and date this form. The information given

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Consulting Engineers Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

APPLICATION FORM. Professional Indemnity Insurance

APPLICATION FORM. Professional Indemnity Insurance APPLICATION FORM Professional Indemnity Insurance Accountants/Auditors Instructions to the applicant. A. Please answer all questions. The information is required to make an underwriting and pricing evaluation.

More information

Professional Indemnity Insurance Design and Construct Industry Proposal Form

Professional Indemnity Insurance Design and Construct Industry Proposal Form Professional Indemnity Insurance Design and Construct Industry Proposal Form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block

More information

Professional indemnity insurance Insurance brokers & IFA s proposal form

Professional indemnity insurance Insurance brokers & IFA s proposal form Professional indemnity insurance Insurance brokers & IFA s proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block

More information

CATLIN HONG KONG LTD MISCELLANEOUS PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

CATLIN HONG KONG LTD MISCELLANEOUS PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM CATLIN HONG KONG LTD MISCELLANEOUS PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER REGARDING COMPLETION OF THIS PROPOSAL FORM 1) Disclosure Any material fact

More information

Professional indemnity insurance Mortgage brokers & IFA s proposal form

Professional indemnity insurance Mortgage brokers & IFA s proposal form Professional indemnity insurance Mortgage brokers & IFA s proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters

More information

Architects Professional Indemnity Proposal Form

Architects Professional Indemnity Proposal Form Please answer all questions leaving no blank spaces. If you have insufficient space to complete any of your answers, please continue on your headed paper. This form must be signed and dated by a Partner,

More information

Security Consultants. Professional Indemnity. Proposal Form

Security Consultants. Professional Indemnity. Proposal Form Thompson Heath & Bond Limited 107 Leadenhall Street London EC3A 4AF Tel: +44 (0) 20 7469 0100 Fax: +44 (0) 20 7621 0661 www.thbgroup.com Lloyd s Broker Security Consultants Professional Indemnity Proposal

More information

Professions TechGuard Proposal Form

Professions TechGuard Proposal Form Proposer Details Name of Firm(s) Principal Address of Company line one Principal Address of Company line two City and postcode Telephone number Fax number Website Date Firm(s) was Established If less than

More information

A ccountants. Professional Indemnity Insurance. Proposal for. 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB

A ccountants. Professional Indemnity Insurance. Proposal for. 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Professional Indemnity Insurance Proposal for A ccountants 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Tel 020 7623 4957 Fax 020 7623 4958 Kerry London Ltd, Professional Risks, 2 nd Floor,

More information

Surveyors & Real Estate Professional Liability Proposal Form

Surveyors & Real Estate Professional Liability Proposal Form Notice:Statement pursuant to Section 25(5) of the Insurance Act (Cap 142) or any amendments thereof; You are to disclose in this application, fully and faithfully, all the facts which you know or ought

More information

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM

IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Media Professionals Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically

More information

Information Technology Consultants Proposal Form

Information Technology Consultants Proposal Form Proposal Form This Proposal form must be completed in ink, signed and dated by a Principal, Partner or Director of the Proposer. All questions must be answered and where appropriate not applicable or n/a

More information

Professional Indemnity Insurance Claims Management Consultants Proposal Form

Professional Indemnity Insurance Claims Management Consultants Proposal Form Professional Indemnity Insurance Claims Management Consultants Proposal Form The PI Desk Ltd Suite B, Sheffield Business Centre Europa Link, Sheffield, South Yorkshire, S9 1XZ Tel: 0114 242 1176 Fax: 0114

More information

Professional Indemnity Insurance Debt Management Consultants Proposal Form

Professional Indemnity Insurance Debt Management Consultants Proposal Form Professional Indemnity Insurance Debt Management Consultants Proposal Form Towergate Lifestyle Suite 6 The South West Centre Troutbeck Road, Sheffield, South Yorkshire S7 2QA Tel: 0114 250 0011 Fax: 0114

More information

Surveyors & Real Estate Professional Liability Proposal Form

Surveyors & Real Estate Professional Liability Proposal Form AIG Insurance Hong Kong Limited Surveyors & Real Estate Professional Liability Proposal Form I. Applicant Details Name of Insured: Address(es): Web Site Address: Establishment Date: II. Business Activities

More information

Professional indemnity insurance Management consultants proposal form

Professional indemnity insurance Management consultants proposal form Professional indemnity insurance Management consultants proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters

More information

Professional Indemnity Insurance for Insurance Brokers and Intermediaries

Professional Indemnity Insurance for Insurance Brokers and Intermediaries Professional Indemnity Insurance for Insurance Brokers and Intermediaries Proposal Form Important tice 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the individual,

More information

THIS APPLICATION IS FOR A CLAIMS MADE POLICY

THIS APPLICATION IS FOR A CLAIMS MADE POLICY PEMBROKE SYNDICATE 4000 MISCELLANEOUS ERRORS & OMISSIONS INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS MADE POLICY ALL QUESTIONS MUST BE ANSWERED COMPLETELY. DO NOT LEAVE ANY SPACE BLANK. INDICATE

More information

Professional Indemnity Insurance Proposal Form Miscellaneous

Professional Indemnity Insurance Proposal Form Miscellaneous Commercial & General Insurance Brokers (Aust) Pty Ltd Suite 4, 1016 Doncaster Road Doncaster East Victoria 3109 Phone: 1300 764 244 Fax: 03 8841 4299 Email: pi@cgib.com.au Web: www.cgib.com.au AFS License:

More information