AIG Business Protection data capture form Financial questions about the business

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1 AIG Business Protection data capture form Financial questions about the business Questions for the cover owner Guidance for the intermediary Is this an application form? This is not an application form. We only accept online applications and we do not need a copy of this form. This form is only intended to help you capture the information our online system will ask for and we will base our decision on the information entered into it. You will need to faithfully transfer the answers your client provides on this form into our online system. Please be aware that our online system generates questions based on your client s age, sex, medical history and covers applied for, so the online questions may differ from those on this form and you may need to call your client for more information. Guidance for the cover owner Is this an application form? This is not an application form. We only accept online applications. Your financial adviser will transfer the information you provide on this form into our online application system. AIG Life Limited will not receive a copy of this form and we will base our decision on the answers your adviser enters into our online system. Once your cover starts, we will send you a policy pack, including a copy of the application details we received. Please check the application details carefully and inform us of any errors or omissions - it is your responsibility to make sure they are correct. Please be aware that any misleading, inaccurate or incomplete answers may lead to your policy being cancelled, or a future claim being reduced or rejected. It is very important that you check these details carefully. What happens if the answers are not honest, accurate and complete? We use the answers you provide to assess the benefits and the terms of the cover we can offer you. It is very important that our assessment is accurate and it is your responsibility to make sure that the information we use is honest, accurate and complete, so please take care when answering each question and remember to check them carefully. Any misleading, inaccurate or incomplete information can lead to your policy being cancelled, or a future claim being reduced or rejected. If the total combined sum assured being applied for, added to any existing cover on the life of the person(s) to be covered, is worth more than 2.5m for life cover or more than 1m for critical illness cover, you will only need to complete section A. One of our underwriters will contact you to request a signed business financial questionnaire and supporting evidence. However, any preliminary information you provide may be helpful, so you may wish to continue answering all or some of the questions from section C onwards, though it is not required. Please note: AIG will not cover overdrafts. If you require personal, family or personal mortgage protection you will need to apply for YourLife Plan (our personal protection range).you will not need to complete these questions if you seek personal financial protection as this question set is for business protection cases only. AIG Business Protection Data Capture Form 1

2 Section A - Reason for this cover Please provide the name of the business seeking cover What is the reason for taking out this cover? Select the relevant option Commercial lending (including key person loan protection) Key person / loss of profits / role replacement protection Shareholder or partnership protection Business buy-to-let protection Investor protection / management buyout or buy-in / venture capital cover A combination of reasons or another reason If the cover you are applying for is to serve several purposes or another not listed, please briefly explain why you are seeking this cover: If the reason for cover is key person, please tell us: If the key person cover you are applying for is to insure your own life for the benefit of your business, please briefly explain how the policy will be set up to make sure the business receives the benefit in the event of a claim. With regards to the person covered, is the amount now being applied for, added to any existing cover on their life, worth more than 750k of life or 500k of critical illness? (Please include other cover already in force with AIG Life Limited (formerly Ageas Protect Limited or Fortis Life Limited) and with any other provider). There are no more questions Please complete the section relevant to your chosen option Commercial lending (including key person loan protection) - Sections B and C Key person / loss of profits / role replacement protection - Sections B and D Shareholder or partnership protection - Sections B and E Business buy-to-let protection - Sections B and F Investor protection / management buyout or buy-in / venture capital cover, or A combination of reasons or another reason - Section B Our underwriters will also ask you to complete a business financial questionnaire. (Financial advisers can download this document from our online system.) AIG Business Protection Data Capture Form 2

3 Section B - Trading figures Do you have trading figures for the last three consecutive years, including accounts created in the last 18 months? Do the trading figures contain any negative amounts? This applies to turnover, gross profit or net profit. Please provide details of the last three years trading figures below. Please enter the most recent accounts first and make sure you clearly indicate any negative figures. If you do not have figures for the last three years, please enter figures for the years that are available. Year Turnover Gross Profit Pre-tax net profit mm/yy mm/yy (most recent year) mm/yy mm/yy (previous year) mm/yy mm/yy (previous year) If trading figures are incomplete and/or there are any negative figures, please explain why. An underwriter may contact you to request copies of the last three years trading accounts and supporting evidence. If there was a drop in the latest year s trading accounts compared to previous years, please explain why. te: we may require copies of the last three years trading accounts and supporting evidence. Please continue to the section of this document relevant to your reasons for purchasing cover. Please note - there are no further online questions if the reason for this cover is: investor protection / management buyout or buy-in / venture capital cover; a combination of reasons; or a reason not listed. One of our underwriters will instead contact you to request you complete a business financial questionnaire. Copies of trading accounts or other supporting evidence may also be required. AIG Business Protection Data Capture Form 3

4 Section C - Commercial lending Does the person covered have any existing commercial loan cover, or is there an intention to take out any further cover for this purpose? Please provide the following details for any covers you already have in place for this purpose: Company Policy number Type of cover (life and/or critical illness) Existing cover 1 Existing cover 2 Existing cover 3 Sum insured Year commenced Will it be cancelled on commencement of this application? End date Any other details, including reason for cover Please provide us with the basic details of any additional cover you intend to take out for this purpose. (Where possible, please include the company or provider of the cover, the type of cover, the sum insured, intended start and end dates and reason for cover.) What is the amount of the loan? If it is for an existing loan, please tell us the amount that is currently owed. If the amount of cover exceeds the loan amount, please tell us why. What is the repayment term of the loan in years? If it is for an existing loan, please tell us the remaining term. If it is a part-year, please round up to the next complete year. If the term of the cover exceeds the term of the loan, please tell us why. AIG Business Protection Data Capture Form 4

5 Who is the lender? Please tell us the rate(s) of interest payable. How many people are applying for cover, or already have cover, to protect this loan? Is it a requirement of the lender that all those applying for cover must have loan protection cover? please answer the question in the following box Please explain why cover has been requested on people who are not required by the lender to have cover. Is this loan protection cover for an existing loan? please answer the question in the following box Is the loan/are the loans in arrears? (ie payments to the lender have been missed and are still owed in addition to the regular payments) AIG Business Protection Data Capture Form 5

6 Section D - Key person cover Does the person covered have any existing key person cover, or is there an intention to take out any further cover for this purpose? Please provide the following details for any covers you already have in place for this purpose: Company Policy number Type of cover (life and/or critical illness) Existing cover 1 Existing cover 2 Existing cover 3 Sum insured Year commenced Will it be cancelled on commencement of this application? End date Any other details, including reason for cover Please provide us with the basic details of any additional cover you intend to take out for this purpose. (Where possible, please include the company or provider of the cover, the type of cover, the sum insured, intended start and end dates and reason for cover.) If the term you have selected for this application is more than 10 years, please briefly explain why. (Key person cover is usually required by a business for a short period of time.) Why is this person being covered by the business? Please select your answer. To protect profitability and/or sales generated by this person To finance their replacement with someone holding special skills and knowledge A combination of the above Another reason (Please explain how the amount of cover has been calculated and why the person covered is key to the business.) AIG Business Protection Data Capture Form 6

7 Please provide details of the last three years salary for the person covered. Please enter the most recent year first. Include any yearly dividends that form part of the salary package. If there are any missing years, enter as 0. Year Salary (including yearly dividends) mm/yy mm/yy (this year) mm/yy mm/yy (last year) mm/yy mm/yy (previous year) How many people in the business are covered or intend to be covered with key person cover? Please state the percentage of the net profit that is attributable to the person to be covered. We will only ask for this information if the amount of life cover you are now applying for is over 1,500,000, or if you intend to cover a total of four or more key people in the business. % How many employees are there in the business? AIG Business Protection Data Capture Form 7

8 Section E - Share purchase protection Does the person covered have any existing share or partnership protection, or is there an intention to take out any further cover for this purpose? Please provide the following details for any covers you already have in place for this purpose: Company Policy number Type of cover (life and/or critical illness) Existing cover 1 Existing cover 2 Existing cover 3 Sum insured Year commenced Will it be cancelled on commencement of this application? End date Any other details, including reason for cover Please provide us with the basic details of any additional cover you intend to take out for this purpose. (Where possible, please include the company or provider of the cover, the type of cover, the sum insured, intended start and end dates and reason for cover.) Will there be a buy-sell agreement in place when this cover commences? If no, please explain below why there is no buy-sell agreement Does the business agreement specifically detail the need for critical illness cover and, if applied for, Total and Permanent Disability? (You only need to answer this question if this application includes critical illness cover.) AIG Business Protection Data Capture Form 8

9 What is the value of the business? Please explain how the value of the business has been calculated. (We will only request this information if your valuation of the business is greater than our profit calculation.) What percentage of the business is held by the person covered? % If the sum assured exceeds the value of the shareholding percentage, please explain why. Does the total value of the shareholder or partnership cover for all the shareholders or partners exceed the stated value of the business? This includes existing, applied for and cover that is planned. If yes, please explain why in the box below. AIG Business Protection Data Capture Form 9

10 Section F - Property development Does the person covered have any existing loan cover for the properties, or is there an intention to take out any further cover for this purpose? Please provide the following details for any covers you already have in place for this purpose: Company Policy number Type of cover (life and/or critical illness) Existing cover 1 Existing cover 2 Existing cover 3 Sum insured Year commenced Will it be cancelled on commencement of this application? End date Any other details, including reason for cover Please provide us with the basic details of any additional cover you intend to take out for this purpose. (Where possible, please include the company or provider of the cover, the type of cover, the sum insured, intended start and end dates and reason for cover.) What is the total amount of the outstanding mortgage or mortgages to be protected by this cover? Please give the amount owed currently if the mortgage is in place. If the sum assured exceeds the mortgage amount owed, please explain why. Who is the lender? Please tell us the rate(s) of interest payable. Questions continue on next page. AIG Business Protection Data Capture Form 10

11 How many mortgages will be in place when this cover commences? Please provide details for each mortgage that will be in place. Mortgage 1 Is the mortgage already in place? Mortgage 2 Is the mortgage already in place? Mortgage 3 Is the mortgage already in place? Mortgage 4 Is the mortgage already in place? Mortgage 5 Is the mortgage already in place? Mortgage 6 Is the mortgage already in place? Is this cover to protect an existing mortgage? please answer the question in the following box Is the mortgage or are the mortgages payments or interest in arrears? AIG Life Limited. Telephone Registered in England and Wales. Number Registered address: The AIG Building, 58 Fenchurch Street, London EC3M 4AB. AIG Life Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. The registration number is EDCO