DIRECTORS AND OFFICERS LIABILITY INSURANCE. Proposal Form
|
|
|
- Cameron Eaton
- 8 years ago
- Views:
Transcription
1 DIRECTORS AND OFFICERS LIABILITY INSURANCE Proposal Form Notes for Directors and Officers Liability Insurance Proposers: The Proposal Form, if accepted, will form the basis of your contract with Insurers and it is, therefore, essential that the questions asked have been understood and answered correctly. If in answering any of the questions in this Proposal Form you find there is insufficient space, please complete on your firm s headed notepaper and attach it to this form. In the event that you require any assistance in completing this Proposal Form, please do not hesitate to contact Lothbury UK Limited. Please provide, in addition to completing this form, the following information to assist Insurers in considering their terms: a) The last two annual Reports and Accounts (for renewals only the latest Report and Accounts is required) b) Any recent interim statements (if applicable) c) Recently formed Companies, who do not have the above documents, should supply: i) Business Plan. ii) Financial Forecast. iii) Management Accounts (if available) d) Any Offer Document/Listing Particulars published in the past 12 months e) Copy of the latest 20-F filing made to the United States regulatory authorities (if applicable) f) Copies of any brochures that the Company issue (new Proposers only). 1. Company name: 2. Registered Address and Head Office (if different): 3. Country of incorporation/registration: 4. Please give the date since when the Company has continuously carried on business: 5. Please provide a full description of the business activities undertaken by the Company: 6. Please state if the Company is: a) Private b) Public c) Listed on any United Kingdom Stock Exchange d) Listed on any foreign Stock Exchanges please specify which
2 e) Listed on the unlisted securities market f) Trading in any other way please specify below 7. How many shareholders does the Company have? 8. Please state the total number of shares issued (divided by classes if applicable): 9. Please state the total number of shares held by Directors and Officers of the Company, both directly and beneficially: 10. Please provide details of all shareholders owning more than 10% of any class of shares issued by the Company: Name: Shareholding: 11. During the past six years: a) Has the name of the parent Company changed? b) Has any acquisition or merger taken place? c) Has any subsidiary Company been sold or ceased trading? d) Has the capital structure of the parent Company changed? 12. Has the Company, or any of its subsidiaries, publicly revealed that it is considering or planning to implement any new acquisitions, tender offers or mergers?
3 13. Is the Company intending a new public offering of securities in the next year? 14. Has there been any change to the list of Directors and Officers since the Company s last annual Report and Accounts? 15. Are there any changes to the list of subsidiary Companies since the Company s last annual Report and Accounts? If Yes, please supply full details, including country of registration and percentage of shares owned. 16. Please give details of any changes in the capital structure of the Company since the last annual Report and Accounts: 17. Are there any contingent liabilities and/or extraordinary items and/or litigation shown within the latest annual Report and Accounts? If Yes, please provide full details, translated into English if necessary. 18. Has the Company changed its external auditors and/or legal advisers in the past three years? If Yes, please provide full details, including the reason for change. 19. Since when has the Company continually paid cash dividends on? a) Common Stock: b) Preferred Stock: 20. What are the gross assets of the Company and its subsidiary Companies in the United States of America and/or Canada?
4 21. What is the approximate number of employees in the United States of America and/or Canada? 22. Please list any subsidiary Companies in the United States of America and/or Canada that are not wholly owned, stating who owns the majority stock together with the percentage ownership. If none please state None. 23. Does the Company, or any of its subsidiaries, have any stock, shares or debentures in the United States of America and or Canada? If yes was the offer subject to the United States Securities Act of 1933 and/or the Securities Exchange Act of 1934 and/or any amendments thereof? 24. Are any stocks or shares traded in the form of ADR s? If Yes, please advise: a) Whether they are sponsored or un-sponsored? b) The percentage traded as a total of issued share capital: c) The number of ADR shareholders: d) Does the Company, or any of its subsidiaries, have any debt instruments or commercial paper in the United States of America and/or Canada? 25. Has the Company made a 20-F filing to the United States regulatory authorities? If Yes, please provide a copy of the latest filing. 26. Does the Company, or any Director and/or Officer of the Company, have Directors and Officers Liability Insurance? If Yes, please supply the following details: a) Insurer b) Limit of Indemnity c) Renewal Date d) Retroactive Date or Prior and Pending Date
5 27. Has any claim, whether covered by similar insurance or not, been made against any past or present Director or Officer of the Company, or its subsidiaries, or in their capacity as a Director or Officer for any other Company? 28. Is any Director or Officer, after full enquiry, aware of any act, circumstance or incident that could give rise to a claim? 29. Has any application for similar insurance ever been declined, cancelled or renewal refused, or has any insurance been subject to special conditions? 30. Limit of Indemnity required (including any alternative): a) b) c) DECLARATION I declare that the statements and particulars in this proposal are true and that no material facts have been misstated or suppressed after enquiry. I agree that this proposal, together with any other information supplied shall form the basis of any Contract of Insurance effected thereon. I undertake to inform Insurers of any material alteration of those facts occurring before completion of the Contract of Insurance. I further declare that I am duly authorised by the Directors and Officers to act as their agent in respect of all matters of any nature or kind relating to or affecting the proposal and the policy. Signed of Chairman or Chief Executive Officer: Name of Signatory (please print): Date: Please remember to keep a copy of this Proposal for your records.
Directors and Officers Liability Insurance Proposal Form
- 1 - Directors and Officers Liability Insurance Proposal Form Please answer all questions leaving no blank spaces. If you have insufficient space to complete any of your answers, please continue on your
DIRECTORS & OFFICERS LIABILITY INSURANCE PROPOSAL FORM
BDB (UK) Limited 40 Lime Street, London EC3M 7AW DIRECTORS & OFFICERS LIABILITY INSURANCE PROPOSAL FORM 1 GUIDANCE NOTES This proposal must be completed in ink by a Partner or Director of the Proposer.
D irectors & O fficers Liability Insurance
Proposal for D irectors & O fficers Liability Insurance PROFESSIONAL RISKS 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Tel: +44 (0) 20 7623 4957 Fax: +44 (0) 20 7623 4958-1- PROFESSIONAL RISKS
DIRECTORS AND OFFICERS LIABILITY INSURANCE AND COMPANY REIMBURSEMENT PROPOSAL FORM
DIRECTORS AND OFFICERS LIABILITY INSURANCE AND COMPANY REIMBURSEMENT PROPOSAL FORM Please Note: This is a proposal form for a policy relating to claims made against the Insured during the period of the
DIRECTORS AND OFFICERS LIABILITY INSURANCE PROPOSAL FORM
DIRECTORS AND OFFICERS LIABILITY INSURANCE PROPOSAL FORM Please use block letters and tick boxes as appropriate. 1 a) Name of Company, Registered Office and Country of Registration (referred to throughout
Financial Institutions Directors and Officers Liability Insurance Proposal Form
Financial Institutions Directors and Officers Liability Insurance Proposal Form The following documents must be submitted with this proposal form: ( ( ( (d) (e) The annual report and financial statements
DIRECTOR S & OFFICER S LIABILITY INSURANCE PROPOSAL FORM SHIELD
DIRECTOR S & OFFICER S LIABILITY INSURANCE PROPOSAL FORM SHIELD The following documents must be submitted with this proposal form: ( ( ( (d) (e) The annual report and financial statements of the company
UK Directors & Officers Liability Insurance Proposal Form (for companies whose turnover exceeds 50 million per annum)
UK Directors & Officers Liability Insurance (for companies whose turnover exceeds 50 million per annum) Direct access to our team of specialist underwriters Dedicated focus on D&O with the support of the
DIRECTORS AND OFFICERS LIABILITY INSURANCE PROPOSAL FORM
DIRECTORS AND OFFICERS LIABILITY INSURANCE PROPOSAL FORM In completing the Proposal Form please ensure that questions are answered fully and accurately and where necessary schedules giving further explanation
Director s & Officer s Liability & Company Reimbursement Insurance
Director s & Officer s Liability & Company Reimbursement Insurance Proposal Form Abu Dhabi National Insurance Company PJSC (ADNIC) is a Public Joint Stock Company incorporated in the United Arab Emirates
How To Get Insurance On A Company Policy In Australia
Proposal Form: Directors and Officers Insurance Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Directors & Officers Insurance
Proposal Form for Directors & Officers Liability Insurance
Proposal Form for Directors & Officers Liability Insurance Guidance Notes and Important Notices These TICES apply to this Proposal and any attached Addenda 1. The answers to this form preferably should
Directors & Officers Liability Insurance for Financial Institutions
Directors & Officers Liability Insurance for Financial Institutions PROPOsAl FORm Please answer all questions. If you have insufficient space to complete an answer, attach a separate signed and dated sheet
PROPOSAL FORM FOR DIRECTORS AND OFFICERS LIABILITY INSURANCE
PROPOSAL FORM FOR DIRECTORS AND OFFICERS LIABILITY INSURANCE PLEASE NOTE 1. This is a proposal form for a policy relating to claims made against the Directors and/or Officers of the Company shown in answer
Directors and Officers Liability Insurance
Directors and Officers Liability Insurance New Zealand Proposal form Completing the Proposal form 1. This application must be completed in full including all required attachments. 2. If more space is needed
CorporateGuard - Employment Practice Liability Proposal
CorporateGuard - Employment Practice Liability Proposal Chartis Insurance UK Limited 1. Proposer Details 1. Name of Company 2. Address of Head Office 3. Country of Registration 4. (a) How long has the
For Directors and Officers Professional Indemnity Insurance
Questionnaire & Application Pack For Directors and Officers Professional Indemnity Insurance This pack contains the following documents:- Our FSA Keyfacts document explaining who we are. Our FSA Demands
PROPOSAL FORM DIRECTORS & OFFICERS LIABILITY INSURANCE
PROPOSAL FORM DIRECTORS & OFFICERS LIABILITY INSURANCE Important tice: 1. This proposal must be completed in ink by a director of the firm or company. All questions must be answered to enable a quotation
Directors & Officers Liability
LIABILITY Directors & Officers Liability Proposal Lumley, a business division of IAG New Zealand Limited, Lumley Centre, 88 Shortland Street, PO Box 2426, Auckland 1140, New Zealand Tel 09 308 1100 www.lumley.co.nz
How To Write A Professional Indemnity Insurance Plan
PROFESSIONAL INDEMNITY INSURANCE MISCELLANEOUS PROPOSAL FORM GUIDANCE TES This proposal must be completed in ink by a Partner or Director of the Proposer. Please use your headed notepaper to provide full
PROFESSIONAL INDEMNITY INSURANCE
BDB (UK) Limited 40 Lime Street, London EC3M 7AW PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS PROPOSAL FORM 1 GUIDANCE NOTES This proposal must be completed in ink by a Partner or Director of the Proposer.
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM Please answer all questions fully and if you have a brochure or any other information concerning your business please attach to this proposal. 1. Name of
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM Please answer all questions fully and if you have a brochure or any other information concerning your business please attach to this proposal. 1. Name of
100,000 250,000 500,000 1,000,000 2,000,000 Other Please Specify:
Intersure Insurance Brokers Limited Prospect House, 63 rth Street, Sudbury, Suffolk CO10 1RE Telephone: 01787 313133 Fax: 01787 313656 e-mail:enquiries@intersure.net www.intersureinsurance.com PROPOSAL
MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM
MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material fact
PROPOSAL FORM FOR MANAGEMENT LIABILITY AND COMPANY REIMBURSEMENT INSURANCE
PROPOSAL FORM FOR MANAGEMENT LIABILITY AND COMPANY REIMBURSEMENT INSURANCE Pursuant to Paragraph 4(1) of Schedule 9 of the Financial Services Act 2013, if you are applying for this Insurance for a purpose
IMPORTANT NOTICE REGARDING COMPLETION OF THIS MANAGEMENT CONSULTANTS PROPOSAL FORM
IMPORTANT NOTICE REGARDING COMPLETION OF THIS MANAGEMENT CONSULTANTS PROPOSAL FORM 1. Disclosure - Any material fact must be disclosed to Insurers. - A material fact is any information which may alter
Proposal Form: Management Liability Insurance
Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING TO COMPLETE THIS PROPOSAL FORM. Your Management Liability Insurance Policy is issued on a CLAIMS MADE basis.
MANAGEMENT CONSULTANTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE
HCC International Walsingham House, 35 Seething Lane London EC3N 4AH, United Kingdom main +44 (0)20 7702 4700 facsimile +44 (0)20 7626 4820 MANAGEMENT CONSULTANTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE
Accountants Application Form
Accountants Application Form Application Form IMPORTANT: In this application: You / Your refers to all firms to be insured under this arrangement, including any predecessor or previous business for which
Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form
Directors & Officers Liability and Corporate Reimbursement Insurance Proposal Form Answer all questions. Blanks and/or dashes, or answers known to underwriters/brokers or N/A are not acceptable and will
PROPOSAL FORM FOR DIRECTORS AND OFFICERS LIABILITY INSURANCE
PROPOSAL FORM FOR DIRECTORS AND OFFICERS LIABILITY INSURANCE NOTICE: PLEASE READ CAREFULLY. THIS IS A PROPOSAL FOR A CLAIMS-MADE AND REPORTED POLICY. THE POLICY FOR WHICH THIS PROPOSAL IS MADE IS LIMITED
Professional Indemnity Insurance for Insurance Brokers and Intermediaries
Professional Indemnity Insurance for Insurance Brokers and Intermediaries Proposal Form Important tice 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the individual,
Proposal Form. BusinessGuard Specified Professions Professional Liability Insurance
BusinessGuard Specified Professions Professional Liability Insurance An Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL
THIS APPLICATION IS FOR A CLAIMS MADE POLICY
PEMBROKE SYNDICATE 4000 ACTUARIES ERRORS AND OMISSIONS INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS MADE POLICY ALL QUESTIONS MUST BE ANSWERED COMPLETELY. DO NOT LEAVE ANY SPACE BLANK. INDICATE
IMPORTANT NOTICE REGARDING COMPLETION OF THIS ACCOUNTANTS PROPOSAL FORM
IMPORTANT NOTICE REGARDING COMPLETION OF THIS ACCOUNTANTS PROPOSAL FORM 1. Disclosure - Any material fact must be disclosed to Insurers. - A material fact is any information which may alter the judgment
Accountants Professional Indemnity Insurance
Accountants Professional Indemnity Insurance Instructions Please provide a full answer to every question. A Partner/Director/Principal must sign and date this form and any separate sheets on behalf of
Proposal Form. BusinessGuard Accountants Professional Liability Insurance
BusinessGuard Accountants Professional Liability Insurance Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited on a claims-made and notified basis. This means
INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM
INFORMATION TECHNOLOGY PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material
Accountants Proposal Form
Accountants Proposal Form Proposal Form IMPORTANT: In this proposal: You / Your refers to all firms to be insured under this arrangement, including any predecessor or previous business for which cover
PROPOSAL FORM FOR CHUBB PRO PROFESSIONAL INDEMNITY INSURANCE
PROPOSAL FORM FOR CHUBB PRO PROFESSIONAL INDEMNITY INSURANCE Completing the Proposal Form * Please answer all questions in full leaving no blank spaces. * If you have insufficient space to complete any
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be answered to enable
PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS
PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE ACCOUNTANTS ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE This proposal form must be completed in ink by a Partner, Principal or Director of the Firm or Company.
Proposal Form. BusinessGuard Insurance Brokers Professional Liability Insurance
BusinessGuard Insurance Brokers Professional Liability Insurance BusinessGuard Insurance Brokers Professional Liability Insurance This policy is issued by AIG Australia Limited on a claims-made and notified
Management Liability Insurance. Proposal Form
Management Liability Insurance Proposal Form KEYSTONE MANAGEMENT LIABILITY INSURANCE PROPOSAL FORM This Proposal form is for designed for: UK registered Private Limited companies with an annual turnover
How To Write A Proposal Form For Insurance (Uk) Ltd
PROPOSAL FORM FOR IT CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE Precision Underwriting (UK) Limited, 3 rd Floor, 14 Cullum Street, London, EC3M 7JJ. T: +44 (0) 20 7398 0800 F: +44 (0) 20 7398 0801 E:
RECRUITMENT SERVICES ADDENDUM PROFESSIONAL INDEMNITY, PUBLIC & PRODUCTS LIABILITY & DIRECTORS & OFFICERS /EMPLOYMENT PRACTICES LIABILITY INSURANCE
RECRUITMENT SERVICES ADDENDUM PROFESSIONAL INDEMNITY, PUBLIC & PRODUCTS LIABILITY & DIRECTORS & OFFICERS /EMPLOYMENT PRACTICES LIABILITY INSURANCE IMPORTANT NOTICE: This Addendum and any further details
Investment Structures Insurance Solutions (ISIS)
Investment Structures Insurance Solutions (ISIS) Directors and Officers Liability Entities Securities Professional Liability Crime Proposal form Instructions to applicant Completing the Proposal Form Please
ACE Insurance Limited ELITE II PROFESSIONAL INDEMNITY INSURANCE POLICY
ELITE II PROFESSIONAL INDEMNITY INSURANCE POLICY Renewal Proposal Form - Miscellaneous ABN 23 001 642 020 AFSL 239687 Page 1 of 8 ACE ELITE II PROFESSIONAL INDEMNITY INSURANCE RENEWAL PROPOSAL FORM Miscellaneous
Security Consultants. Professional Indemnity. Proposal Form
Thompson Heath & Bond Limited 107 Leadenhall Street London EC3A 4AF Tel: +44 (0) 20 7469 0100 Fax: +44 (0) 20 7621 0661 www.thbgroup.com Lloyd s Broker Security Consultants Professional Indemnity Proposal
Directors and Officers Liability and Company Reimbursement Insurance Proposal Form
Directors and Officers Liability and Company Reimbursement Insurance Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which 'proposer' or 'you/your' means the individual,
THIS APPLICATION IS FOR A CLAIMS MADE POLICY
PEMBROKE SYNDICATE 4000 MISCELLANEOUS ERRORS & OMISSIONS INSURANCE APPLICATION THIS APPLICATION IS FOR A CLAIMS MADE POLICY ALL QUESTIONS MUST BE ANSWERED COMPLETELY. DO NOT LEAVE ANY SPACE BLANK. INDICATE
Professional Indemnity Insurance for Motor Traders Financial Product Sales. Proposal Form
Professional Indemnity Insurance for Motor Traders Financial Product Sales Proposal Form Professional Indemnity Insurance for Motor Traders Financial Product Sales Proposal Form Please read the following
QBE PROFESSIONAL LIABILITY. Directors & Officers Liability INSURANCE PROPOSAL PROPOSAL
QBE PROFESSIONAL LIABILITY Directors & Officers Liability INSURANCE PROPOSAL PROPOSAL Directors & Officers Liability tice to the Proposed Insured This notice must be read before you complete the proposal
INDEPENDENT FINANCIAL ADVISORS PROFESSIONAL INDEMNITY PROPOSAL FORM
INDEPENDENT FINANCIAL ADVISORS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers.
Professional Indemnity Insurance Proposal Form for Accountants
QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Accountants IMPORTANT INFORMATION Duty of Disclosure When completing any insurance proposal form
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS PLEASE READ THIS GUIDANCE NOTE BEFORE COMPLETING THE PROPOSAL FORM To help us to provide you with our most competitive quotation, it is important
Liability and Theft Insurance for Pension fund Trustees
PROPOSAL FORM Liability and Theft Insurance for Pension fund Trustees Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the individual, company, partnership,
ACE elite Professional Indemnity Insurance
ACE elite Professional Indemnity Insurance Proposal Form for Lawyers Important tices to the Applicant Your Duty of Disclosure Before you enter into a contract of general insurance with an insurer, you
Professional Liability Insurance Proposal Form
Professional Liability Insurance Proposal Form Details of Proposer 1. a) Firm ame b) Trading ame c) AB d) Contact Person e) Dun and Bradstreet umber f) If you intend to claim an Input Tax Credit for the
THE HARTFORD DIRECTORS, OFFICERS AND ENTITY LIABILITY INSURANCE APPLICATION (FINANCIAL INSTITUTIONS/FINANCIAL SERVICES) NEW YORK
, a stock insurance company, herein called the Insurer THE HARTFORD DIRECTORS, OFFICERS AND ENTITY LIABILITY INSURANCE APPLICATION (FINANCIAL INSTITUTIONS/FINANCIAL SERVICES) NEW YORK NOTICE: THIS IS A
Chubb Insurance Company of Canada
Chubb Insurance Company of Canada APPLICATION Financial Institutions Executive Liability Insurance If coverage is desired for more than one institution, a separate Application must be completed for each.
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR PRIVATE MEDICAL INSURANCE BROKERS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions
4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au FINANCIAL PLANNERS PROFESSIONAL INDEMNITY
Proposal Form. Management Consultants Professional Liability Insurance
Management Consultants Professional Liability Insurance BusinessGuard AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL 381686, Level 12, 717 Bourke Street, Docklands VIC 3008 Important Notice Claims-Made
PROFESSIONAL INDEMNITY INSURANCE
BDB (UK) Limited 40 Lime Street, London EC3M 7AW PROFESSIONAL INDEMNITY INSURANCE INSURANCE CONSULTANTS & FINANCIAL ADVISERS PROPOSAL FORM 1 THIS PROPOSAL MUST BE SIGNED BY A PARTNER OR DIRECTOR OF THE
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR MANAGEMENT COMPANY Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters within the
Insurance Brokers Professional Liability Insurance Proposal Form
Insurance Brokers Professional Liability Insurance Proposal Form AIG Proposal Form American Home Assurance Company AB 67 007 483 267 AFSL o 230903 incorporated with limited liability in the USA is a member
Professional Indemnity Insurance
Professional Indemnity Insurance Proposal Form for Miscellaneous Professional Liability Important tices to the Applicant Your Duty of Disclosure Before you enter into a contract of general insurance with
Professional Indemnity Insurance Proposal Form for Accountants
QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Accountants Short Proposal Form for 1-4 Partner Firms IMPORTANT INFORMATION Duty of Disclosure
SPECIFIED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
P.O. Box 1882 PC 114, Jibroo, Sultanate of Oman Tel. No.+968 24577 677 Fax +968 24577 678 SPECIFIED PROFESSIONS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM SECTION 1 Proposer Details 1. Name(s) of Firm(s)
How To Write A Professional Indemnity Proposal Form For Management Consultants
Professional Indemnity Insurance Management Consultants Proposal Form Towergate Lifestyle Suite 4b, 1 Portland Street, Manchester, M1 3BE Tel: 0844 892 1789 Fax: 0844 892 1796 Email: lifestyle@towergate.co.uk
ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM
ACCOUNTANTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to Insurers. - A material fact
APPLICATION FORM. Professional Indemnity Insurance
APPLICATION FORM Professional Indemnity Insurance Accountants/Auditors Instructions to the applicant. A. Please answer all questions. The information is required to make an underwriting and pricing evaluation.
Professional Liability Insurance for Charities Associations, Societies, Clubs and the like Proposal Form
Professional Liability Insurance for Charities Associations, Societies, Clubs and the like Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which 'proposer' or 'you/your'
PROFESSIONAL LIABILITY INSURANCE FOR CHARITIES, ASSOCIATIONS, SOCIETIES, CLUBS AND THE LIKE
Important notice: PROFESSIONAL LIABILITY INSURANCE FOR CHARITIES, ASSOCIATIONS, SOCIETIES, CLUBS AND THE LIKE 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the
Accountants Professional Liability Insurance Proposal Form
Accountants Professional Liability Insurance Proposal Form AIG Australia Proposal Form American Home Assurance Company AB 67 007 483 267 AFSL o 230903 incorporated with limited liability in the USA, trading
Professional Indemnity Proposal Form Accountants
Professional Indemnity Proposal Form Accountants GUIDANCE NOTES Completing your proposal form Please complete all questions in full using the Additional Information section or separate sheets where necessary.
ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM
Australian Indemnity ACCOUNTANTS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information for
Accountants. Professional Indemnity Proposal Form. Vantage Professional Risks. 41 Eastcheap London EC3M 1DT
Professional Indemnity Proposal Form Accountants Vantage Professional Risks 41 Eastcheap London EC3M 1DT Telephone 020 7655 8020 Email: pi@vantageinsurance.co.uk www.vantageprofessionalrisks.co.uk IMPORTANT
PROPOSAL FORM FOR INTERNATIONAL INVESTMENT MANAGERS PROFESSIONAL INDEMNITY INSURANCE
PROPOSAL FORM FOR INTERNATIONAL INVESTMENT MANAGERS PROFESSIONAL INDEMNITY INSURANCE Prime International (a trading name of Miller Insurance Services LLP) 70 Mark Lane, London EC3R 7NQ Tel: +44 20 7488
Professional Indemnity Insurance for Insurance Intermediaries Proposal Form
Professional Indemnity Insurance for Insurance Intermediaries Proposal Form Professional Indemnity Insurance for Insurance Intermediaries Proposal Form Please read the following carefully before completing
MISCELLANEOUS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE
HCC International Walsingham House, 35 Seething Lane London EC3N 4AH, United Kingdom main +44 (0)20 7702 4700 facsimile +44 (0)20 7626 4820 MISCELLANEOUS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM IMPORTANT FACTS RELATING TO THIS PROPOSAL FORM The Purpose of this Proposal Form is to set out all relevant information for your adviser to submit on your
Professional Indemnity Proposal Form for Accountants & Auditors
Tel: (011) 482 5452 / Cell: 083 626 3846 / Fax: 086 542 0506 2 Loch Avenue, Parktown, Johannesburg, 2193 P.O. Box 31729, Braamfontein, 2017 admin@khanyisabrokers.co.za Professional Indemnity Proposal Form
Management Consultants Professional Liability Proposal Form
Notice:Statement pursuant to Section 25(5) of 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
Professional Indemnity Proposal Form
Professional Indemnity Proposal Form IMPORTANT NOTES This insurance cover is based upon representations given to us by you. Should any particulars have changed or be incorrect you must notify us immediately.
Proposal Form. Information Technology Combined Professional and Public & Technology Products Liability. Page 1 of 13
Information Technology Combined Professional and Public & Technology Products Liability Page 1 of 13 Information Technology Combined Professional and Public & Technology Products Liability IMPORTANT NOTICE
UNDERWRITTEN IN FEDERAL INSURANCE COMPANY, TEXAS PACIFIC INDEMNITY COMPANY, OR NORTHWERSTERN PACIFIC INDEMNITY COMPANY
Chubb Group of Insurance Companies 15 Mountain View Road, Warren, New Jersey 07059 APPLICATION FORM FOR EXECUTIVE LIABILITY INSURANCE FINANCIAL INSTITUTIONS AND SUBSIDIARIES UNDERWRITTEN IN FEDERAL INSURANCE
Proposal Form. BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance
BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance BusinessGuard Mortgage/Finance Brokers, Originators, Managers Professional Liability Insurance Important Notice
4. DETAILS OF THE PRINCIPAL(S) OF THE FIRM How Long Practicing as Partner/Director
SURA Professional Risks Level 13 / 141 Walker St North Sydney NSW 2060 P O BOX 1813 North Sydney NSW 2059 Telephone. 02 9930 9500 Facsimile. 02 9930 9501 sura.com.au ACCOUNTANTS PROFESSIONAL INDEMNITY
Information Technology. Professional Indemnity. Proposal Form
Thompson Heath & Bond Limited 107 Leadenhall Street London EC3A 4AF Tel: +44 (0) 20 7469 0100 Fax: +44 (0) 20 7621 0661 www.thbgroup.com Lloyd s Broker Information Technology Professional Indemnity Proposal
DIRECTORS AND OFFICERS LIABILITY INSURANCE INCLUDING CORPORATE INDEMNITY POLICY APPLICATION PROFIT CORPORATIONS
DIRECTORS AND OFFICERS LIABILITY INSURANCE INCLUDING CORPORATE INDEMNITY POLICY APPLICATION PROFIT CORPORATIONS THIS IS AN APPLICATION FOR A CLAIMS MADE POLICY WITH DEFENCE COSTS INCLUDED IN THE LIMIT
PROPOSAL FORM FOR PUBLIC/PRODUCTS LIABILITY INSURANCE FOR SECURITY COMPANIES (NOT CASH IN TRANSIT)
Tel: (011) 482 5452 / Cell: 083 626 3846 / Fax: 086 542 0506 2 Loch Avenue, Parktown, Johannesburg, 2193 P.O. Box 31729, Braamfontein, 2017 admin@khanyisabrokers.co.za PROPOSAL FORM FOR PUBLIC/PRODUCTS
Institute of Mercantile Agents Combined Professional Indemnity and Public Liability Insurance Proposal Form
Institute of Mercantile Agents Combined Professional Indemnity and Public Liability Insurance Proposal Form Important Notice Relating to this Proposal PLEASE READ THE FOLLOWING ADVICE BEFORE PROCEEDING
AUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA
Professional Indemnity Insurance Proposal Form AUCTIONEERS & VALUERS ASSOCIATION OF AUSTRALIA IMPORTANT NOTICE Your Duty of Disclosure Before you enter into a contact of general insurance with any insurer,
Proposal Form. BusinessGuard Recruitment and Personnel Consultants Professional Liability Insurance
Recruitment and Personnel Consultants Professional Liability Insurance An Important Notice Claims-Made and Notified Insurance This policy is issued by AIG Australia Limited (AIG), ABN 93 004 727 753 AFSL
PENSION TRUSTEE LIABILITY INSURANCE NOTE: THIS IS A PROPOSAL FOR A CLAIMS MADE POLICY
HCC Global 5 th Floor, 36-38 Leadenhall Street London EC3A 1AT, United Kingdom main +44 (0)20 7648 1300 facsimile +44 (0)20 7648 1301 PENSION TRUSTEE LIABILITY INSURANCE TE: THIS IS A PROPOSAL FOR A CLAIMS
FIFA Professional Indemnity Insurance Proposal Form
FIFA Professional Indemnity Insurance Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which 'proposer' or 'you/your' means the individual, company, partnership, limited
PROFESSIONAL INDEMNITY PROPOSAL FORM
AAO Pana Insurance Brokers Sdn Bhd 29-1, Dataran Prima Business Centre, Jalan PJU 1/41, 47301 Petaling Jaya Tel : 03-7880 9277 Fax : 03-7880 8689 Web site : www.aaogroup.com PROFESSIONAL INDEMNITY PROPOSAL