HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM INFORMATION TECHNOLOGY INDUSTRY

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Megan Evans
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1 HOULDER INSURNCE SERVICES PROFESSIONL INDEMNITY PROPOSL FORM INFORMTION TECHNOLOGY INDUSTRY Michael's House, lie Street, London, E1 8DE

2 PLESE RED THE FOLLOWING BEFORE COMPLETING THIS PROPOSL FORM: LL QUESTIONS SHOULD BE COMPLETED IN INK. WHERE QUESTION IS NOT PPLICBLE TO YOUR PRTICULR CIRCUMSTNCES, PLESE WRITE N/. PLESE TICK THE YES OR NO BOXES. IF THERE IS INSUFFICIENT SPCE TO NSWER QUESTIONS PLESE USE N DDITIONL SHEET ND TTCH IT TO THIS PROPOSL FORM. COMPLETING ND SIGNING THIS PROPOSL FORM DOES NOT BIND THE PROPOSER OR INSURERS TO COMPLETE THIS INSURNCE. IF THIS PROPOSL RELTES TO NEW BUSINESS OR VENTURE, PLESE COMPLETE THE QUESTIONS S FR S POSSIBLE, GIVING ESTIMTED OR NTICIPTED INFORMTION.

IF THERE IS INSUFFICIENT SPCE TO NSWER QUESTIONS PLESE USE N DDITIONL SHEET ND TTCH IT TO THIS PROPOSL FORM.

3 SECTION(1): DETILS OF PROPOSER 1 Name of Individual or Firm requiring cover: 2 a) Principal address: Post Code: b) If other locations please specify town/city only: 3 Date established: 4 Please provide details of all Partners, Principals and Directors: Length of time Name Qualifications Date Qualified ge position held Please attach a CV for any unqualified Partner, Principal or Director SECTION (2): DETILS BOUT YOUR BUSINESS 1 Please advise the total number of: a) Partners, Principals or Directors b) Qualified staff c) ll other staff 2 If you are a sole Practitioner please advise: a) Details of your full time occupation (if any) b) What arrangements are in place in the event of sickness or holidays to ensure continuance of the business? PPLIT 3

Principal or Director SECTION (2): DETILS BOUT YOUR BUSINESS 1 Please advise the total number of: a) Partners, Principals or Directors b) Qualified staff c) ll other staff 2 If you are a

4 3 a) Do you engage consultants or sub-contractors? YES NO If YES please give details of the nature of activities undertaken by such consultants or sub-contractors b) Do you check that the consultant or sub-contractor YES NO i) has appropriate qualifications ii) maintains professional indemnity insurance? YES NO 4 Please give details of membership of any ssociation or Professional Body 5 Do you use standard Contract Conditions/Letter of ppointment YES NO If YES please attach a copy If NO please provide details of how you define your duties to your client: 6 Is work undertaken for any entity in which any Partner, Principal or YES NO Director of the Proposer is able to exercise a controlling interest? If YES please give full details and income derived from this source:- 7 re you associated financially or otherwise with any other entity? YES NO If YES please give full details:- PPLIT 4

qualifications ii) maintains professional indemnity insurance?

5 8 re you a member of a Consortium or Joint Venture? YES NO If cover is required in respect of your own liability as a member of the consortium please provide the following:- a) Name of Consortium b) Type of services being provided c) nnual income/fees received from the Consortium 9 a) Please confirm the gross fees for the last 2 completed financial years and estimates for the current and forthcoming years: Territorial Split Year End Gross fees U.K Overseas (excl. US/Canada US/Canada) % % % % % % % % % % % % b) Please confirm the largest fee derived from any one entity: c) Please advise the average fee earned per entity: d) Please advise fees paid to consultants/sub-contractors 10 Please confirm the approximate division of work undertaken during the last complete financial year between the following market sectors: Government Work % Military Work % Finance House % erospace Industry % Commercial Firms % Leisure Industry % Manufacturing/Industrial Firms % Construction % Health Care/Medical Services % Other Work % (please give details below) PPLIT 5

received from the Consortium 9 a) Please confirm the gross fees for the last 2 completed financial years and estimates for the current and forthcoming years: Territorial Split Year End Gross fees U.

6 11 Please confirm the approximate division of work undertaken during the last complete financial year between the following activities:- Packaged Software % Turnkey Systems % Custom Software Development % Hardware Sale/Supply/Maintenance/Installation % Systems nalysis/software Design % Software Maintenance % Data Processing/Bureau % System udit % Facilities Management % Training Services % Business Consultancy % Strategic Planning % Data/Voice Communications Consultancy % Other Work % (please give details below) 12 a) If you supply Package Software was this written originally by you or on your behalf? Please provide an approximate split of software written by you or on your behalf and software you are distributing for a third party: Own software % Third party software % b) Do you have access to standby equipment in event of problems with any computers YES NO or ancillary equipment. If YES please give details c) Do you ensure that duplicate computer systems records are maintained by yourselves YES NO or your clients and kept separately from the original records? If NO please give reasons: 13 Please provide details of the 3 largest contracts undertaken in the Client Fee earned Total Contract Date Date Value Commenced Finished i) ii) iii) PPLIT 6

% Business Consultancy % Strategic Planning % Data/Voice Communications Consultancy % Other Work % (please give details below) 12 a) If you supply Package Software was this written originally by you

7 14 a) Have any major changes to your activities or structure taken place in the past 2 years? YES NO If YES please provide details: b) re any major changes expected to your activities or structure in the next year? YES NO If YES please provide details: c) Have you carried out any activities other than those disclosed in this Proposal? YES NO If YES please provide details: SECTION(3): YOUR P.I. REQUIREMENTS 1 Have you previously been insured or currently have Professional Indemnity Insurance YES NO in force? If YES please advise: a) Name of Insurers b) Renewal Date c) Limit of Indemnity d) Excess e) The number of consecutive years you have been insured 2 What Limit of Indemnity do you require? 250, ,000 1,000,000 Other (Please specify amount): PPLIT 7

YES NO If YES please provide details: c) Have you carried out any activities other than those disclosed in this Proposal? YES NO If YES please provide details: SECTION(3): YOUR P.I. REQUIREMENTS 1 Have you previously been insured or currently have Professional Indemnity Insurance YES NO in force?

8 SECTION (4): PREVIOUS INSURNCE & CLIMS HISTORY 1 In respect of the Proposer or any Partner, Principal or Director has any Insurer ever cancelled, YES NO declined to provide or renew any Professional Indemnity Insurance or imposed special terms? If YES please give details: 2 Has any Partner, Principal, Director or Employee been subject to disciplinary proceedings by YES NO any ssociation or Professional Body? If YES please give details: 3 a) Has any claim, whether successful or not ever been made against the Proposer or its YES NO predecessors in business or any past or present Partner, Principal, Director or Employee? If YES please give details of dates, amount claimed, allegations and current position PLESE NOTE: If any Partner, Principal, Director or Employee is aware of any claim relating to activities carried out by them in previous practice or employment, details should be disclosed under this question: b) re you or any Partner, Principal, Director or Employee FTER FULL ENQUIRY aware YES NO of any circumstance or any circumstances which may give rise to a claim against the Proposer, its predecessors in business or any past or present Partner, Principal, Director or Employee? If YES please give full details: I/We declare that the statements and particulars given in this Proposal are correct and that no material fact has been omitted. I/We agree that this Proposal together with any other information supplied shall form the basis of the contract. Signature Position Date PLESE NOTE: It is necessary for you to disclose all Material Facts which may influence us in acceptance or assessment of this Proposal. Failure to do so could invalidate this insurance. If you are in doubt whether any fact is material you should disclose it. PPLIT 8

If YES please give details: 2 Has any Partner, Principal, Director or Employee been subject to disciplinary proceedings by YES NO any ssociation or Professional Body?

9 YER SUPPLEMENTRY QUESTIONNIRE Q1 Does your products function depend on date related calculations? Q2 re the date functions in your software compatible with your customers hardware? (i.e. 2 or 4 digit dates and how they are actually read by the hardware?) Q3 Does your acceptance testing include year 2000 compatibility testing? Q4 Does your five year customer support take into account the date change at the millennium? Q5 Does any software you are currently selling require any date modification? nd are you planning to do any? (If not, why not?) Q6 re you selling updates to previous software to ensure year 2000 compatibility? (If not, why not?) Signed:.. Dated: PPLIT 9

) Q3 Does your acceptance testing include year 2000 compatibility testing? Q4 Does your five year customer support take into account the date change at the millennium?

HOULDER INSURANCE SERVICES

HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM ENGINEERS PLEASE READ THE FOLLOWING BEFORE COMPLETING THIS PROPOSAL FORM: ALL QUESTIONS SHOULD BE COMPLETED IN INK. WHERE A QUESTION IS NOT