S$30,000,001 to S$50,000,000. Premium Payable plus GST =

Transcription

1 Zuellig Insurance Singapore SNCF Management Liability Insurance Program by Zuellig Insurance Brokers and American Home Assurance, Singapore Branch. Management Liability Insurance Application Form (for Credit Co-operatives only) Statement pursuant to 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 to know, otherwise the policy issued may be void and you may receive nothing from this policy. Proposed Insured Address Nature of Business STEP 1 - Based on the Total Gross Assets of your co-operative - Choose the Limit of Cover required Limit of Indemnity Required - (all figures in S$) For companies with Total Gross Assets of up to S$100,000,000 Total Gross Assets of Your co-operative (including subsidiaries) Limit of Cover Required (Limit of Liability) S$1,000,000 S$3,000,000 S$5,000,000 up to S$5,000,000 S$5,000,001 to S$30,000,000 S$30,000,001 to S$50,000,000 S$50,000,001 to S$80,000,000 Premium Payable plus GST = S$80,000,001 to S$100,000,000 Premium subject to change. If you require a limit of liability above S$5,000,000 or your co-operative has total gross assets above S$100,000,000, please contact Zuellig Insurance Brokers for advice. STEP 2 - Confirm your status I confirm that the co-operative, and any subsidiary thereof: Yes No a. Is registered outside of North America b. Has NO assets, domiciled operations (other than a pure representative office) or securities offerings in North America c. Has NO previous claims or circumstances against the co-operative, its subsidiaries or its directors d. Is NOT a Non-Credit Co-operative as defined by SNCF e. Its latest accounts showed a retained net profit, that assets EXCEED liabilities, and DO NOT have an audit qualification If answered No, an Insolvency Exclusion(including creditors) may be applied subject to receipt and review of the co-ops latest audited financial statements. f. Is an affiliate of SNCF g. Has a Non-Performing Loan (NPL) ratio of not more than 5%. (NPL is defined as total non-performing loans over total loans portfolio) h. Does not have increasing Non-Performing loans for the past 3 years I. Does not have any exposure to structured notes linked to Lehman Brothers or any other type of Structured products j. Does not have have any exposure to Madoff/Stanford/EU Debt Crisis (if your answer is "No" to any of the above, Zuellig Insurance Brokers will advise you of the amended terms and conditions) Page 1 of 2

2 STEP 3 - Underwriting Information required: 1 Latest audited financial statements attached Yes No 2 List of the investment products utilised by the co-op as part of their investment portfolio STEP 4 - Sign the Declaration I/We declare that the statements and particulars in this application are true and that no material facts have been mis-stated or omitted, after enquiry. I agree that if the information supplied in this application changes between the date of this application and the effective dateof the insurance, he/she(undersigned) will, in order for the information to be accurate on the effective date of the insurance, immediately nofity the Insurer of such changes, and the Insurer may withdraw or modify any outstanding quotations and/or authorisations or agreements to bind the insurance. I agree that this application, together with any other information supplied shall be the basis of the contract should a policy be issued, and it will be attached to and become part of the policy. Signed Date Print Name and Title (Authorised Signatory of the Company) Financial Lines, CHARTIS Building, 78 Shenton Way, #07-16, Singapore Tel: Fax: Incorporated in the United States with liability limited Page 2 of 2

3 QUOTATION SLIP TYPE POLICY FORM INSURED PERIOD OF INSURANCE Directors & Officers Liability and Company Reimbursement Insurance American Home Assurance Company CorporateGuard Premier (Non-US Securities) The Singapore National Co-operative Federation Limited (Scheme) 12 Months from Date to Be Advised CONTINUITY DATE Pending Prior Litigation : As at Policy Inception TERRITORY/ JURISDICTION RETROACTIVE COVER INTEREST Worldwide (Excluding USA) Full Retroactive Cover Management Error The Insurer shall cover Payments and/or Defence Costs resulting from a Management Error Claim. LIMIT OF INDEMNITY As presented in Zuellig s presentation on 30 th July 2010 EXTENSIONS/ CONDITIONS Advancement of Defence Costs Automatic Cover for newly acquired or created subsidiaries Amended Definition of Insured to Include Committee Members and Volunteers Discovery Period 12 Months Bilateral (at 50% Additional Premium) Domestic Panel Endorsement Employment Practices Liability Claims (Including Retaliatory Claims) Employees covered where named as a co-defendant with a Director Emergency Defence Costs Full Policy Limit (10% of Policy Limit) Full Severability (Proposal Form and Personal Misconduct Exclusions) Heirs, Spouses, Estate and Legal Representatives Late Reporting Period (60 Days) Legal Representation Cover (Sub-limit: S$250,000 Part of and not in addition to Policy Limit) Non-Accumulation Clause 1

4 Outside Directorship Liability, automatic cover except for the following:- - Entities which are incorporated or domiciled within the United States of America or Canada or any of their territories or possessions; - Entities which have securities listed on a securities exchange or market within the United States of America or Canada or any of their territories or possessions; - Entities which have securities that are legally required to be the subject of any registration statement filed with the United States Securities and Exchange Commission (SEC) - Entities which is subject to an obligation to file reports with the SEC in accordance with Section 13 of the Securities Exchange Act of 1934 (USA); and - Entities which are Financial Institutions Occupational Health & Safety, Corporate Manslaughter Defence Costs Punitive Damages and Aggravated Damages (where insurable by law) Premium Payment Warranty (60 Days) Pollution Defence Costs (Sub-limit: S$250,000 Part of and not in addition to Policy Limit) Pollution Shareholder Derivative Actions (Sub-limit: S$250,000 Part of and not in addition to Policy Limit) Retired Directors coverage upon non-renewal of policy (72 Months) EXCLUSIONS 20% Major Shareholder Exclusion Bodily Injury/Property Damage Exclusion with carveback for employment practices liability claims Conflict of Interest Exclusion Dishonest, Fraudulent or Intentional Breach (subject to final adjudication) ERISA Exclusion Future Securities Offering Exclusion Insured versus Insured Exclusion Intangible Rights Exclusion Intellectual Property Rights Exclusion Pollution Liability Exclusion with carveback for Pollution Defence Costs and Shareholder Pollution Actions Product Liability Exclusion Professional Services Exclusion (Absolute) SEC Exclusion Sarbanes-Oxley Exclusion DEDUCTIBLES Directors and Officers Liability - Nil Company Reimbursement - $5,000 each and every claim (Non-Credit Co-op) - $10,000 each and every claim (Credit Co-op) 2

5 ANNUAL PREMIUM As presented in Zuellig s presentation on 30 th July 2010 SECURITY American Home Assurance Company Subjectivity: i) Receipt and acceptance of a signed and dated Directors and Officers Liability proposal form, prior to binding. ii) There being no material change in the risk between the date of the submitted proposal and the inception of this policy. 3