CONTRACTUAL LIABILITY TAKAFUL ENGINEERING CONTRACTORS PROPOSAL FORM

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Warren Freeman
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1 Jubilee General Insurance Company Limited - Window Takaful Operations 3rd Floor, Jubilee Insurance House, I.I. Chundrigar Road, P.O. Box 4795, Karachi UAN: , Tel: (021) , Fax: (021) info.takaful@jubileegeneral.com.pk Website: CONTRACTUAL LIABILITY TAKAFUL ENGINEERING CONTRACTORS PROPOSAL FORM This proposal must be completed by a Partner or Principal of the Practice. All Questions must be answered to enable a quotation to be given. Completing and signing this Proposal does not bind the Proposers or Takaful Operator to complete a Contract of Takaful. If there is insufficient space to answer questions, use an additional sheet and attach it to this form indicating the question to which the answer refers. (Please indicate section number) 1. a) Please state the name and address(es): Name of Practice, together with partner responsible for each office: Address(es) Phone No. Partner(s) in Charge b) Profession of Practice c) Name(s) of former Practice(s) for whom takaful is required : 2. Please state: a) of commencement of current Practice: b) of commencement and cessation of former practice(s) : c) Reason for cessation of former Practice(s) : 3. Please state names of all Partners/ Principals/ Owners of the Practice named above: Page 1 of 7

pk Website: www.jubileegeneral.com.pk CONTRACTUAL LIABILITY TAKAFUL ENGINEERING CONTRACTORS PROPOSAL FORM This proposal must be completed by a Partner or Principal of the Practice.

2 Name(s) Partner/Principal at this Practice Qualifications Qualified 4. If sole Partner/Principal, please answer the following: Is this a part-time occupation? YES / NO If YES please provide brief details of present full time occupation. In either case please complete the Supplementary Questionnaire (Q. 20) 5. Please state names in full of Partners / Principals who have left, retired or died and for whom coverage is required. If none, state none. Name Qualifications How long as Partner / Principal 6. Please state the numbers of: Partners/Principals Qualified staff Draughtsmen Trainee staff, Typists Others 7. State for the whole practice: a) Gross fees received for each of the last five financial years. Account year ending: Month (Please state)... Financial year end Home Contracts PKR PKR PKR PKR PKR PKR Overseas Contracts PKR PKR PKR PKR PKR b) Split of gross fees received in the past financial year: HOME CONTRACTS OVERSEAS CONTRACTS Page 2 of 7

Please state names in full of Partners / Principals who have left, retired or died and for whom coverage is required. If none, state none. Name Qualifications How long as Partner / Principal 6.

3 i) Consulting engineering a) Civil PKR PKR b) Structure PKR PKR c) Soil & foundation PKR PKR d) Mechanical PKR PKR e) procurement PKR PKR a. materials b. machinery/plant c. consumables ii) Architectural electrical PKR PKR a) heating work PKR PKR iii) Town planning/ quantity surveying PKR PKR iv) structural surveys/ inspection reports/ valuations PKR PKR v) Fees paid to independent specialist consultants, please specify PKR PKR vi) other work please specify PKR PKR TOTAL GROSS FEES PKR PKR c) ESTIMATED GROSS FEES FOR CURRENT FINANCIAL YEAR PKR PKR 8. State the approximate amount of gross fees received for each of the last five financial years which relates to contracts where Latent Defects/Decennial Takaful was arranged in respect of the contract. Financial year end: Home Contracts PKR PKR PKR PKR PKR Overseas Contracts PKR PKR PKR PKR PKR 9. a) Please give approximate % applicable to these specified projects as a % of the total work carried out in the past 12 months: Contents % Contents % Bridges/flyovers/tunnels/dams/mines/refineries Chemicals/petro chemicals/oil Harbours/jetties/sea defences Nuclear/Atomic Projects Marine surveyors Sewage/ water schemes Bulk handling equipment/hoppers/silos Hospital/universities/schools Mechanical plant/equipment Factories Fertilizer/Ammonia/Urea Plant Housing b) Please give approximate % applicable to these specified projects as a % of the total work carried out in the past 12 months: Page 3 of 7

independent specialist consultants, please specify PKR PKR vi) other work please specify PKR PKR TOTAL GROSS FEES PKR PKR c) ESTIMATED GROSS FEES FOR CURRENT FINANCIAL YEAR PKR PKR 8.

4 Contents % Contents % Industrialized systems building Government Departments Restoration Work Local Authorities Reinforced/ Pressed concrete High rise contracts(10 storeys or more) Soil Testing/foundation/piling/underpinning No of stories in highest block completed in last 10 years c) Proportion of work where Practice both designs and supervises construction % N.B. If the Practice has not been in operation for 12 months, please give estimated answers for the above questions Contents Starting Description of Contract (e.g. hotel, factory etc) Total Contract Value Approx Completion State Professional Services Provided a) Please state the 5 largest contracts where construction has commenced during the past 6 years: b) Please give details of contracts where construction is expected in the next 12 months: 11. a) Does the Practice Undertake any work whatsoever where the end product Of such work is carried out outside Home territory? (If YES please give details) Country Starting Description of Contract Total Contract Value Approx Completion State Professional Services Provided Page 4 of 7

If the Practice has not been in operation for 12 months, please gi

5 b) Does the Practice work other than from its Home territory offices? c) Does the Practise enter into contracts where the jurisdiction is other than Home territory courts? (If the answer to b) or c) is YES, full details are required i.e. list the jurisdictions and amount or work there from etc.) Details: 12. a) Is the Practice or any Partner/Principal a member of a consortium or Group Practice or engaged with any other Practice or person in a Single Project Partnership? (If YES give the names of other members/partners and their capacities in the consortium/partnership) Details N.B. Special arrangements must be made with Takaful Operator if coverage is required for work done whilst as a member of a consortium. In such cases a copy of the consortium agreement will be required. b) Does this Practice or any Partner/Principal have any association with, or financial interest in any other Practice, Operator or organisation? If YES give full details of the nature of the association together with the name and business of the other firms. 13. When independent or specialist consultants are required for any commission Have you in the past covered, and will you in the future endeavour to cover, that such consultants are appointed directly by and paid by your Participant? for (N.B. Whenever a Participant requires that you engage or employ consultants, you should ask evidence of professional indemnity takaful from them?) 14. Does the practice hold professional indemnity takaful. If YES state: a. Name of takaful operators: b. Limit of Indemnity : c. Excess : d. of Expiry of Coverage: (If the practice has not been covered from its start, advise no. of years continuously covered to date): 15. Has any insurer/takaful operator ever: a) Declined a proposal or renewal for this Practice or any Partner/Principal? Details Page 5 of 7

a) Is the Practice or any Partner/Principal a member of a consortium or Group Practice or engaged with any other Practice or person in a Single Project Partnership?

6 b. Required an increased contribution or imposed special terms? Details c. Cancelled or voided insurance/takaful? (Attach a separate sheet if necessary.) Details 16. For what limit(s) of indemnity do you require a quotation? Limit: (Please state whether you require the limit to be for the total amount during any one year or for each and every claim) Annual aggregate / Any one claim 17. Do you require coverage for replacing lost or damaged documents? If YES, state cover required and state % of above relating to Computer Systems Records) 18. Have any claims for professional negligence, error or omission (successful or otherwise) been made against the Practice or its present and/or past partners during the past 10 years? If YES, give full details, including amounts) (Attach a separate sheet if necessary) Details 19. Are any of the Partners/Principals, after enquiry, aware of any circumstances which may give rise to claim against this Practice or their predecessors in business or any of the present or former Partners/Principals? (If YES give full details) Details Page 6 of 7

Limit: (Please state whether you require the limit to be for the total amount during any one year or for each and every claim) Annual aggregate / Any one claim 17.

7 20. Supplementary questionnaire for single partner operations only Please answer fully, the following: 1. Your Age : of Birth: / / 2. Please give the full experience and qualifications of any assistants whom you employ: Their length of service in your employ: Details: (Please attach a separate sheet if necessary) 3. What formal arrangements have you made with any other practices to assist you when you are Incapacitated or are unable for any reason to attend your business? If applicable, name practices in above: (Attach a separate sheet if necessary) It is essential that every proposer or participant, when seeking a quotation, taking out or renewing an takaful, reveals to the prospective takaful operators any material fact or information (including any material circumstance) which might influence the judgement of an takaful operator in fixing the contribution or in determining whether he will accept the risk. Failure to do so may render the contract or takaful voidable form inception at the option of the takaful operators and enable them to repudiate liability there under. If you have any doubt as to what constitutes a material fact or circumstance please do not hesitate to seek our advice. DECLARATION I/we declare that the statements and particulars in the Proposal are true and that I/we have not misstated or suppressed any material fact. I/we agree that this Proposal together with any other information supplied by me/us shall form the basis of any Contract of Takaful effected thereon. I/we undertake to inform Takaful Operator of any material alteration to these facts occurring before completion of the Contract of Takaful. d this: day of: 20 Signature of Partner/Principal : Name of Firm/ Operator/ Practice : A copy of this proposal should be retained by you for your own records Page 7 of 7

What formal arrangements have you made with any other practices to assist you when you are Incapacitated or are unable for any reason to attend your business?

CONTRACTUAL LIABILITY INSURANCE ENGINEERING CONTRACTORS PROPOSAL FORM

CONTRACTUAL LIABILITY INSURANCE ENGINEERING CONTRACTORS PROPOSAL FORM Jubilee General Insurance Company Limited (formerly New Jubilee Insurance Company Limited) Jubilee Insurance House, I.I.Chundrigar Road, Karachi 74000 UAN: 111 654 111, Tel: (021) 32416022-26, Fax: (021)