PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR RICS MEMBERS

Transcription

1 PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR RICS MEMBERS

2 CONTENTS 1. ADVICE ON COMPLETING THE PROPOSAL FORM 2. PROPOSAL FORM 3. CONSTRUCTION QUESTIONNAIRE 4. SURVEY AND VALUATION QUESTIONNAIRE 5. OTHER INSURANCE REQUIREMENTS CONTACT US Your completed proposal form can either be ed or posted to us using the contact details below. Please retain a copy for your own records. Please do not hesitate to contact us if you have any questions. Howden Insurance Brokers Limited 71 Fenchurch Street London EC3M 4BS [email protected] Howden Insurance Brokers Limited 71 Fenchurch Street, London, EC3M 4BS, United Kingdom. A subsidiary of Howden Broking Group Limited, part of the Hyperion Insurance Group. Howden Insurance Brokers Limited is regulated by the Financial Conduct Authority: firm reference number Registered in England and Wales under company registration number Registered office 16 Eastcheap, London, EC3M 1BD. 2 P a g e

3 1. ADVICE ON COMPLETING THE PROPOSAL FORM To allow us sufficient time to negotiate with Insurers, please ensure you return this proposal form as soon as possible. Wherever the word Principal appears herein, this is deemed to read Partner(s), Director(s), Member(s) or Principal(s). Many businesses either fail to allow sufficient time to complete the proposal form and/or provide inaccurate information. Insurers regard the proposal form as a reflection of the quality of the business seeking insurance; a poorly completed, untidy form can reflect badly on your business and will not assist us in securing terms General instructions relating to completion of the form Please ensure this Proposal Form is completed by a Principal of the business. A response to all questions must be entered. Where a question is not relevant to your business, please respond N/A. Where the Proposal Form is completed by just one Principal, we often find that disagreements arise regarding the responses provided. It is imperative that full consultation within the business has taken place, prior to submission of this form. If you are completing this Proposal Form electronically, the boxes will expand accordingly. If you are completing this Proposal Form by hand, it should be completed in black ink and preferably in block capitals. If you have completed the Form electronically, please print and sign it before returning it to us, either electronically or by post. A number of questions request YES or NO answers. Please place an x in the appropriate box or underline the appropriate response. If there is insufficient space to answer any questions please provide full details on your headed paper. Please ensure that any additional information is signed, dated and makes clear reference to the question(s) on the Proposal Form, to which it refers. If a supplement is attached to this proposal form, please tick here. Depending upon the qualifications and/or experience of the Principal(s), Insurers reserve the right to request a Curriculum Vitae and details of any circumstances or claims pertaining, in the past 5 years, irrespective of whether they were employed by the business at the time. Completion of this proposal form does not automatically bind the Principal, the Firm or Insurers to effect a contract of insurance. Wherever the word Employee appears herein, this is deemed to read Any person who is or has been under a contract of service for or on behalf of the Firm. If you have any questions about completing this Form please contact us A copy of this proposal should be retained for your own records. 1.2 Providing additional information The proposal form is the basis of the contract of insurance which may ultimately ensue and the information contained herein forms the basis of disclosure to Insurers. Failure to disclose something which could be considered material may render the insurance contract voidable. This form confines itself to dealing with essential issues such as income and claims. If you feel there is additional information that is relevant to Insurers appraisal of your business, but is not requested by this form, this should be set out on your headed paper and attached to this proposal form. Additional information, where not requested by the proposal form, could include: Corporate brochure(s); Organisation chart(s); An overview of risk management; CV s of the Principal(s); A description of any services provided in the past 6 years which are no longer provided and/or any new services the business intends to provide in the future; An overview of the client base; Terms of Engagement, particularly if they restrict your liability. 3 P a g e

4 1.3 Claims and circumstances Whilst every question on the proposal form is important and constitutes material information upon which Insurers rely, Insurers will be particularly concerned with the history of claims and/or circumstances. Details of all claims and circumstances notified to previous insurers must be declared on the proposal form, accompanied by a brief description which should include: Overview of the job/instruction being undertaken Date the work, to which the allegation relates, was undertaken Policy year in which the notification was made to Insurers Alleged wrong doing The Firm s own view on the matter Insurers view on the matter (clearly differentiated from the above) Details of any amounts: Paid by Insurers Reserved by Insurers Legal fees incurred by insurers In order to ensure that all notifiable matters are declared, the recommended practice would be for each Principal and all senior members of staff to sign a declaration to the effect that he/she has investigated the areas for which he/she is responsible and can confirm that there are no claims or circumstances other than those (if any) contained in the proposal form. After completion of the proposal form and prior to the expiry of the firm s current insurance, a check should be undertaken within the Business to ensure that there are no claims or circumstances of which anyone is aware other than those already notified in the proposal form. If any new matters are discovered, these should be immediately notified to Howden if we are your current Broker. If we are not your current Broker, then you should notify your current Broker/Insurers and Howden. Such notifications should reach your current Broker/Insurers and Howden prior to the expiry date of the firm s current insurance. 1.4 Disclosure of material facts or information When seeking a quotation, taking out or renewing an insurance contract it is essential that you disclose to prospective Insurers any material facts or information (including any material circumstances or change in circumstances) which might influence the judgement of Insurers in setting the premium and/or the terms and conditions of the insurance contract or in determining whether they will accept the risk. This duty of disclosure continues throughout the Policy period. The statement made in this proposal form (including any supporting information) will form the representation to Insurers and as such will be the basis of the insurance contract. Failure to disclose material information may render the insurance contract voidable from inception, at the option of Insurers and enable them to repudiate liability thereunder. If you have any doubt as to what constitutes a material fact or circumstance, please contact us. Date Protection Act Any information provided on this form, which may include sensitive data (e.g. medical history, criminal convictions, age), will be processed by Howden Insurance Brokers Limited in compliance with the Data Protection Act 1998 and will only be used for the purposes of providing insurance cover and handling claims arising. In the course of our duty as insurance brokers we may be required to provide such data to limited third parties including Insurers and/or circumstance required by law. 4 P a g e

5 PROFESSIONAL INDEMNITY INSURANCE RICS MEMBERS PROPOSAL FORM SECTION 1 GENERAL DETAILS 1.1 Name and address of Firm (including any subsidiaries for whom cover is required). Establishment date(s) 1.2 Name of all predecessors of the Firm for which cover is required. Date of establishment Date of closure 1.3 Contact details (Name and position of person responsible for completing this form) Title Forename Surname Position within firm Telephone number address for correspondence relating to this Insurance 1.4 Principal address and postcode (if applicable) of all other offices. 5 P a g e

6 SECTION 2 - PRINCIPALS, CONSULTANTS AND EMPLOYEES 2.1 Please complete the table below giving details of your Firm s Principals (If insufficient space is allowed below please submit additional information as an attachment) Title Forename Surname MRICS/FRICS or Other Date Qualification obtained 2.2 Please complete the table below for all consultants who you wish to be indemnified under your policy Title Forename Surname MRICS/FRICS or Other Date Qualification obtained 2.3 Please state the total number of: Principals RICS qualified staff (excluding principals) Other technical staff Administrative and all other staff Total 6 P a g e

7 SECTION 2 - PRINCIPALS, CONSULTANTS AND EMPLOYEES continued 2.4 Please provide a list of all employees and consultants who are members of RICS Valuer Registration scheme and supply a copy of your organisation s VRS registration form as an attachment to this form. Name VRS membership number 7 P a g e

8 SECTION 3 - FEE INCOME 3.1 Please state for the whole Firm the total annual gross fees received in each of the last three completed financial years. Please state the applicable year where required. (The figures should exclude disbursements but include fees paid to sub-consultants) Year: Year: Year: UK USA/Canada Elsewhere excluding USA/Canada Total 3.2 Please state estimated annual gross fee income for the next full financial year 3.3 Does your Firm have or has it had offices outside of the UK? YES NO 3.4 Does your Firm enter into contracts outside of the jurisdiction of the UK courts? YES NO 3.5 If, in response to question 3.1 you have stated that fees derive from Elsewhere or if you have answered YES to question 3.4 please provide further information in the table below: Country Start / finish date of contract Jurisdiction under contract Professional services provided 8 P a g e

9 SECTION 3 - FEE INCOME continued 3.6 If any of the fees declared in question 3.1 are paid by your Firm to any independent and/or sub-consultants (other than those declared in response to question 2.2) please provide the following information: Name of Firm/Individual Professional Discipline Fees paid (Last Financial Year) 3.7 Do you require the sub-consultants listed above to carry Professional Indemnity Insurance for a limit not less than the amount of cover requested by this proposal? YES NO Note: If this is not a requirement and you would like them to be indemnified under your policy for work done on behalf of your Firm, special arrangements must be made with insurers. In such cases further information on the consultant will be required. 9 P a g e

10 SECTION 3 - FEE INCOME continued 3.8 Please provide a split of gross fees for the last 2 years: Last completed financial year Previous completed financial year SECTOR/ACTIVITY % of fee income % of fee income RESIDENTIAL Estate agency Lettings Property management Development appraisals Landlord and tenant advisory Home condition surveys (no valuation) Mortgage valuations Valuations for homebuyers reports 1) For Clients 2) For Lending Institutions Valuations for non-lending purposes Auctioneering COMMERCIAL Estate agency Lettings Property management Development appraisals * (please provide a full description of work undertaken in this area, below) Landlord and tenant advisory Investment & portfolio consultancy* (please provide a full description of work undertaken in this area, below) Structural surveying (No Valuation) Mortgage valuations Valuations for non-lending purposes Machinery and equipment valuations Facilities management Auctioneering 10 P a g e

11 CONSTRUCTION Design Contract administration Project management: Contracts < than 20m in size Contracts > than 20m in size Project co-ordination: Contracts < than 20m in size Contracts > than 20m in size Cost estimation/qs Contracts < than 20m in size Contracts > than 20m in size CDM Building surveying Planning applications RURAL Estate agency Lettings Estate/property management Landlord & tenant advisory Investment & portfolio consultancy Mortgage valuations Valuations for non lending purposes Valuations of land only Agricultural valuations (EU quotas excluding land and property) Valuations of machinery and equipment Auctioneering Sporting rights Last completed financial year Previous completed financial year 11 P a g e

12 SECTION 3 - FEE INCOME continued MISCELLANEOUS LPA receivership Rating Rent reviews Fine art auctioneering *(please provide a full description of the services provided in the box below) Asbestos & hazardous materials surveys Energy performance certificates Land Surveying Setting out Compulsory purchase Financial Services Intro Only Financial Services Non Intro Expert witness Other (please specify) TOTALS Note: If fees have been declared for valuation work or construction related work you will need to complete Sections 4 and/or 5 of this form. 3.9 Are you, for purposes of the Financial Services and Markets Act 2000, an Appointed Representative of any principal? YES NO If YES, please provide the name of your Principle(s) 12 P a g e

13 SECTION 4 - JOINT VENTURES 4.1 Is your Firm or any Partner a member of a consortium or joint venture or engaged with any other firm or person in a Single Project Partnership? YES NO 4.2 Has the Firm or any Partner previously been a member of a consortium or joint venture or engaged with any other firm or person in a Single Project Partnership? YES NO (If the answer to either of the above is YES please provide the names of other members/partners and their capacities in the consortium/joint venture) Note: Special arrangements must be made with underwriters if coverage is required for work done whilst as a member of a consortium or joint venture. In such cases a copy of the consortium agreement will be required. SECTION 5 - INTERNAL CONTROL PROCEDURES 5.1 Explain the due diligence process you complete before taking on instructions from a new client 5.2 Does your Firm insist on satisfactory written references from former employers for the three years immediately preceding the engagement of any employee responsible for money, accounts or goods? YES NO 5.3 Will any Director, Partner or Employee be authorised to sign cheques on their sole signature in respect of the Firm s or Clients accounts? YES NO If YES please state name, position and limit 13 P a g e

14 SECTION 5 - INTERNAL CONTROL PROCEDURES continued 5.4 Is cash in hand, petty cash, counterfoils and bank statements checked independently of the employee responsible? a) At least monthly? YES NO b) Additionally, without warning, at least every six months YES NO 5.5. a) Has your Firm suffered any loss during the past ten years through the fraud or dishonesty of any Director, Partner or Employee? YES NO b) Has your Firm or any current or former Director, Partner or Employee ever been the subject of an investigation or disciplinary proceedings by the Royal Institution of Chartered Surveyors? YES NO If the answer to a) or b) is YES please provide full details and outline the steps taken to prevent recurrence. 5.6 Has the firm been the subject of an RICS monitoring visit? If YES, please provide details of when and subsequent findings below. YES NO 5.7 Is a diary system used to ensure deadlines are met and critical dates are not missed? YES NO 5.8 Is work undertaken by staff regularly reviewed by a principal or qualified manager? YES NO 5.9 Are working papers including records of all contracts, letters of engagement, client meetings and telephone calls retained for at least six years? YES NO 5.10 Is a formal review of working procedures undertaken at least annually? YES NO 5.11 Are written procedures or checklists used for professional/technical services provided? YES NO 5.12 Are all offices under the day to day control and supervision of a principal and are arrangements in place for the office supervision in the event of a principal s absence? YES NO 5.13 Are contracts or terms of engagement, including any changes, evidenced in writing stating the work to be undertaken and the extent of the firm s responsibility? YES NO 5.14 Is a principal responsible for allocating all new instructions/contracts? YES NO 14 P a g e

15 5.15 Who / which member(s) of staff has authority to change the Standard Terms of Engagement? INTERNAL CONTROL PROCEDURES IN RESPECT OF PROPERTY MANAGEMENT 5.16 Are deposit cheques always required? YES NO 5.17 Is it made clear as to who is responsible for issuing notices? YES NO 5.18 Are procedures in place for obtaining references for prospective tenants? YES NO SECTION 6 - CURRENT AND FUTURE INSURANCE ARRANGEMENTS 6.1 If the Firm currently has Professional Indemnity Insurance please provide the following details. (This information is not required where the policy is currently arranged by Howden) Name of Insurer(s) Name of Brokers Limit of Indemnity Excess(es) Retroactive date Policy Expiry date Premium 6.2 Limit of indemnity required for new policy year 6.3 Excess required for new policy year 6.4 Do you have any other specific requirements with regard to your Professional Indemnity Insurance renewal? 15 P a g e

16 SECTION 7 PREVIOUS APPLICATIONS FOR INSURANCE Has an Insurer ever: a) Declined to insure this Firm or any Partner? YES NO b) Imposed special terms? YES NO c) Cancelled or voided insurance? YES NO If any answer is YES please give full details 16 P a g e

17 SECTION 8 CLAIMS 8.1 Please list, in respect of the Firm, its current Partners/Directors, retired Partners/Directors and/or Predecessors of the Firm, for the last 10 years: a) all claims made against any of them and b) all circumstances or events disclosed to Insurers If none please tick this box NONE Date of claim Details Amount claimed Amount paid Claimant s costs if known Defence costs (if known) Other comments

18 SECTION 8 CLAIMS CONTINUED 8.2 Are any of the Partners/Directors AFTER ENQUIRY with all staff and consultants aware of any circumstances or events, which may give rise to a claim against the Firm or its Predecessors? YES NO If YES please give full details DISCLOSURE It is essential that when you are seeking a quotation, taking out or renewing an insurance, that you disclose all material facts to Insurers. A material fact is one that is likely to influence the judgement of an Insurer in fixing the premium or in determining whether to accept the risk. If your proposal is a renewal it should include any changes in facts previously advised to insurers. If you have any doubt about facts considered material you should disclose them. Failure to disclose could prejudice your rights to indemnity in the event of a claim or cause Insurers to void your policy. DECLARATION Please read the declaration carefully and sign where required I/We declare that the statements made and particulars given in the Proposal are true and I/We have not mis-stated or suppressed any material fact. I/We undertake to inform Insurers of any material alteration to these facts occurring before completion of the contract of insurance. Signature of Partner/Director Name of Partner/Director Date

19 CONSTRUCTION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED FEES FOR CONSTRUCTION RELATED WORK IN SECTION 3 1. Please state the 5 largest contracts awarded to the Firm where construction completed within the last 6 years Start date Approximate completion date Description of contract Total contract value Fee Extent of service provided 2. Please state the 5 largest contracts awarded to the Firm where construction is ongoing or expected to start within the next 12 months Start date Anticipated completion date Description of contract Total contract value Fee Extent of service to be provided

20 CONSTRUCTION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED FEES FOR CONSTRUCTION RELATED WORK IN SECTION 3 continued 3. Are all projects on track to be completed on time and within budget? YES NO If NO please provide details below END OF SECTION

21 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION 3 1. Please advise the geographical spread of your survey/valuations in the last three years Scotland % East Anglia % North West England % South West England % North East England % London/South East England % Midlands % Northern Ireland % Wales % Others please specify below % 2. Do you undertake valuations further than a 25 mile radius from your office? YES NO If YES please provide details 3. Please state the average fee earned for a mortgage valuation in the last financial year Residential Commercial Average fee 21 P a g e

22 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION 3 4. Please provide a breakdown of your survey and valuation fee income by the purpose for which the work is undertaken along with the number of jobs undertaken per annum. Residential Commercial Purpose of Survey/Valuation Percentage No. Percentage No. Mortgage valuation reports Homebuyers Reports Full Building Surveys including Valuations Full Building Surveys excluding Valuations Asset Valuation for Balance Sheet Purposes Probate / Divorce Valuations Insurance reinstatement valuations Development valuations Other (specify) 5. In relation to mortgage valuation reports, please provide the details of the top 5 (in accordance with number of instructions received) lenders/banks/financial institutions over the last three years Name Of Lender Type of Bank (e.g. High Street, Private, Middle Eastern, Bridging) Number of instructions received % of total secured lending valuation work by number of instructions 22 P a g e

23 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION 3 6. Please provide details of any mortgage valuation work undertaken within the last 36-months in respect of: Valuations undertaken for No. of Reports Types of Properties Name of Lenders i) Buy-to-let properties ii) iii) iv) Property investment clubs New build for developers Sub-prime products / lenders v) Bridging Loan providers 7. If YES to 6V) are you still undertaking work for Bridging Loan providers? YES NO 8. Please give details of the five highest residential mortgage valuations undertaken in the last six years Location and description of property valued Date of valuation Value of property Purpose of valuation Lender (if applicable) 23 P a g e

24 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION 3 9. Please give details of the five highest residential valuations (for non-lending purposes) undertaken in the last six years Location and description of property valued Date of valuation Value of property Purpose of valuation 24 P a g e

25 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION Please give details of the five highest commercial (to include development sites) valuations for lending undertaken in the last six years Location and description of property valued Date of valuation Value of property Purpose of valuation Lender 11. Please give details of the five highest commercial (to include development sites) for non-lending purposes undertaken in the last six years Location and description of property valued Date of valuation Value of property Purpose of valuation 25 P a g e

26 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION Please give details of the five highest portfolio valuations for lending purposes undertaken in the past six years Description Number of properties Date of valuation Total value Did the sale complete after your valuation? Has the property subsequently been sold/re-mortgaged? Lender

27 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION Please give details of the five highest portfolio valuations for non-lending purposes undertaken in the past six years Description Number of properties Date of valuation Total value Purpose of valuation 27 P a g e

28 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION Please provide details of how comparables are used to support valuations and in what medium they are retained on file (for example: print-outs from databases, included within templates from site notes, or, hand written note) 15. How do you collect data whilst on site, paper, tablet, photographs etc.? 16. When instructed to provide a valuation of a single unit within a block of flats or other multiple dwelling(s), please provide details of how you use comparables to support the report? Please explain the process you adopt in the event that comparables aren t available or those available are provided by the Developer?. 17. Do you limit the number of valuations your firm undertakes in any new residential development? YES NO If YES, please provide details below 18. What approach do you take if your valuation is more than 5% away from the latest sold house price data available for the property?

29 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION Do you request the LTV prior to undertaking a valuation? YES NO If NO, in what % of instructions are you aware of the LTV? 20. Do you decline jobs if they are above a certain LTV? YES NO If YES, above what LTV? 21. When instructed to revalue a property for re-mortgage, second mortgage or other further advance, do you always re-inspect the property? YES NO If NO, please provide full details of how you prepare the valuation 22. Do you stipulate the period of time for which a valuation issued to a lender is valid? If YES, please provide details. YES NO 23. Do you seek to impose limitations on your financial liability to lenders and also the period of time within which any claim must be brought? YES NO If YES, please provide full details. 29 P a g e

30 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION Have you been refused admission to, removed or suspended from any lender s panel(s) within the last 36 months? YES NO If YES, please provide full details. 25. Within the last twelve-months have you received any requests for valuation files from any lenders from whom you have received instructions (outside of normal auditing / PVQ requests? YES NO If YES, please provide full details. 26. Do you have any financial or other interest in / referral fee or shared commission arrangement with any third party organisation from whom you receive valuation instructions; specifically, any mortgage broker(s), firm(s) of solicitors, accountants, or, financial advisor(s)? YES NO If YES, please provide full details. 27. Please provide details of how staff undertaking survey and valuation work maintain their qualifications and ensure that their working knowledge is up to date. 28. Do you have any standard contractual disclaimers / terms of engagement when accepting survey / valuation instructions; particularly, in relation to any sub-consultancy appointments with panel management firms for mortgage originators and brokers. YES NO If YES, please attach copies of the relevant documentation. 30 P a g e

31 SURVEY AND VALUATION QUESTIONNAIRE ONLY COMPLETE IF YOU HAVE DECLARED INCOME FROM SURVEYS AND VALUATIONS IN SECTION Please provide details of the training provided to surveyors returning to valuing for lending after longer than a 12 month absence? 30. Please outline in full the working procedures and practices that you operate to ensure the quality and accuracy of surveys and / or valuation files in the following areas. i) The recording of the original instructions from the client and any subsequent amendments. ii) The recording of information collated from visits to the property and any telephone conversations involving instructions from the client or the provision of advice. iii) Processes of audit and check including: by whom these are undertaken; how frequently they are undertaken; and, the number / percentage of files reviewed. iv) Sign-off / referral procedures for larger and unusual properties / valuations including: the internal reporting lines; and, the thresholds applicable. v) Peer review systems including: the frequency and timing of reviews; the scope of reviews; the numbers of files reviewed; and, how these are monitored. END OF SECTION 31 P a g e

32 OTHER INSURANCE REQUIREMENTS It is vital your insurance programme meets the evolving needs of your business. Whilst many organisations keep a close eye on their most expensive, business critical insurances, it is not uncommon for other forms of insurance to be continued with no verification of whether they remain appropriate to business needs. Combining our in-depth knowledge of the professional sectors we serve with the product expertise and global knowledge of the Howden Broking Group enables us to handle the most complex insurance programmes. If you are interested in other forms of insurance please tick the relevant box(s) below and we will arrange for a member of the relevant specialist team to contact you: Employee Benefits Pension Auto Enrolment Group Death in Service Private Medical Insurance Keyman and Shareholder Protection Bespoke Private Client Insurance (Household, Contents, Fine Art, Valuables, Motor, Overseas Property Commercial Insurances Business Travel Expatriate Medical Insurance Directors and Officers Insurance Environmental Liability Insurance Property Insurance Cyber Insurance Intellectual Property and Patent Insurance Political Risk Insurance Block Management Insurance Motor Fleet Business Interruption Transactional Risk Insurance Single Project Insurance Contractors all Risks Other (please specify below) If the person responsible for any of the insurances listed above is that other than the person responsible for buying PII please complete the following: Name: Telephone Number: address: 32 P a g e