Professional Indemnity Insurance Proposal Form For The Design and Consulting Departments of Contractors
|
|
- Bridget Tyler
- 8 years ago
- Views:
Transcription
1 Professional Indemnity Insurance Proposal Form For The Design and Consulting Departments of Contractors Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the individual, company, partnership, limited liability partnership, organisation or association proposing cover. 2. This proposal must be completed in ink, signed and dated. All questions must be answered to enable a quotation to be given but completion does not bind you or Underwriters to enter into any contract of insurance. If space is insufficient to answer any questions fully, please attach a signed continuation sheet. You should retain a copy of the completed proposal (and of any other supporting information) for future reference. 3. All facts material to the proposed insurance must be disclosed, fully and truthfully to the best of your knowledge and belief. Failure to do so may make the contract of insurance voidable or severely prejudice your rights in the event of a claim. A material fact is one likely to influence Underwriters assessment or acceptance of the proposal; if you are uncertain what may be a material fact, you should consult your broker. 4. You are recommended to request a specimen copy of the proposed policy wording from your insurance broker and to consider carefully the terms, conditions, limitations and exclusions applicable to the cover. 1. General Information 1.1 Name of Practice/Company. 1.2 Address of registered office and/or principal place(s) of business (if different). 1.3 Is cover being sought for any previous or subsidiary practices/companies? If so, please list on a separate signed sheet and provide full details including name, country of registration, address of principal place of business and ownership/relationship with the main practice. 1.4 State the date when the main practice (and any other subsidiary practices/companies requiring cover), began and (where appropriate) ceased business?
2 1.5 Is the Practice financially associated with any other firms? Yes No 1.6 During the past five years, has the name of the Practice been changed or has any other business been purchased or any merger or consolidation taken place? Yes No 2. The Design and Consulting Department Staff Details 2.1 Individual Details. Name of Principals and Senior Members of Staff Qualifications Date Joined Title of Positions Length of time in Position 2.2 Numbers of Staff. Based in the U.K. Overseas Based Principals and Senior Qualified Members as listed Other Technical and Qualified Staff Clerical, Typists, Others TOTALS 2.3 Do you use independent specialist consultants? Yes No 2.4 Do you verify that they carry their own P.I. Insurance Yes No 2.5 Are any persons ever hired from outside agencies on a short-term basis? Yes No Markel Design & Construction Proposal Form Page 2
3 3. Work Undertaken 3.1 Please give an approximate percentage split of the disciplines within your Design and Consulting Department. Architectural % Chemical Engineering % Soil Engineering % Structural Engineering % Nuclear Engineering % Mechanical Engineering % Surveying (i) Land % Electrical Engineering % (ii) Quantity % Planning Supervisor % (iii) Building % Cladding/Roofing % Foundations/Underpinning % Civil Engineering % Heating and Ventilating Engineering % 3.2 Indicate as a percentage of total work the extent of the following activities: (a) HOME BUILDING Design Only Design and Construct Power Plants Refineries and Petro Chemical Installations Manufacturing Plants Industrial Buildings Systems (b) ENGINEERING CONSTRUCTION Design Only Design and Construct Highways Bridges, Tunnels and Dams Railways, Airports, Harbours and Jetties Sewage/Water Schemes (c) INDUSTRIAL Design Only Design and Construct Power Plants Refineries and Petro Chemical Installation Manufacturing Plants Industrial Buildings Systems Markel Design & Construction Proposal Form Page 3
4 (d) AMENITIES Design Only Design and Construct Hospitals and Nursing Homes Schools and Universities Hotels and Recreation Centres 3.3 Do you engage in the manufacture or fabrication of any pre-engineered unit? Yes No 3.4 Add here a statement of the type of work normally carried out, whether consisting of well-established techniques or of the nature of new and original thought developments, processes or designs employed. State whether and what licensing or similar agreements are in force and the degree to which supervision of them is exercised by associates. 3.5 Have you ever failed to complete a project? Yes No (If Yes, please explain reason and type of project etc.) 4. Fees and Contracts 4.1 Please give details of turnover. Past Financial Year Year ending../../.. Current Financial Year Year ending../../.. Home Overseas Home Overseas (a) Turnover where the practice designs and constructs from their own design and provides full technical supervision (b) Fees of those departments where the practice provides: (i) Design and Technical Services where no construction is involved by the practice (ii) Planning Supervisor Services as defined by the Construction (Design and Management) Regulations (a) Turnover where practice constructs from designs accepted on behalf of the practice by independent, qualified and insured consultants. (b) Turnover where Practice constructs from design and technical supervision accepted on behalf of the Practice by independent, qualified and insured consultants. (c) Other turnover not mentioned above. Please provide brief details below. TOTAL TURNOVER FOR WHOLE PRACTICE Markel Design & Construction Proposal Form Page 4
5 4.2 Please give details of the five largest contracts commenced during the last five years where the Design and Consulting Department has been involved. Date Started Name and Type of Project Services Performed Total Contract Value Estimated Date of Completion 4.3 Please give details of any major new operations being undertaken during the next twelve months. 5. Business Associations and Qualifications 5.1 Is the work of all Associated and/or subsidiary companies design departments/sections checked by Head Office? Yes No (If No, please provide full details) 5.2 (a) Is the Practice or any principal a member of a consortium or joint venture? Yes No (b) Has the Practice or any principal previously been a member of a consortium or joint venture? Yes No If the answer to 5.2 (a) and/or (b) is "Yes", special arrangements must be made with the Insurers. Please provide the relevant dates and the names of the other members and their respective capacities in the consortium or joint venture on a separate letterheaded sheet, together with copies of any contracts or agreements. 5.3 Has the Practice a Quality Assurance System in place? Yes No (If Yes, please provide a copy of your certificate) 5.4 Has the Practice or any partner, principal or director or any other company or organisation related to the Practice ever provided services in connection with the identification of asbestos, chemicals or other hazardous materials? Yes No 5.5 Have those persons in the Design and Consulting Department providing planning supervisor services, as defined in the Construction (Design and Management) Regulations 1994, passed a relevant professional body s training course? Yes No Markel Design & Construction Proposal Form Page 5
6 6. Previous Insurance 6.1 If the Practice is currently insured or has been insured in the past 12 months, please state: (a) Name of insurers (b) Indemnity limit (c) Excess (d) Expiry date of present policy (e) Numbers of years the Practice has been continually insured (f) Retroactive date of current P.I. policy 6.2 Has any Proposal for similar insurance made on behalf of the Practice, any predecessors in business, or present partners, ever been declined or has any such insurance ever been cancelled or renewal refused? Yes No 7. Claims Decalaration 7.1 (a) Please provide full details of all claims involving the Practice or its predecessors in business in the past ten years. (b) Please provide full details of all claims involving any partners, principals, directors, officers or employees of the Practice (whilst at the Practice or in a previous practice) in the past ten years. (c) For 7.1 (a) and (b) above please provide details of the type of allegation, the court or agency involved and any determination, judgment, claims payments (including without prejudice or ex gratia payments) and defence costs for each claim. 7.2 After enquiry, are the Practice, any of its partners, principals, directors or officers aware of any circumstances, allegations or incidents which they have reason to suppose could give rise to a claim against the Practice or any of its partners, principals, directors, officers or employees? Yes No (If Yes, please provide full details on a separate letterheaded sheet.) NOTE:Any claims reported or which should have been reported under 7.1 and/or 7.2 above will be excluded from cover under the policy. Markel Design & Construction Proposal Form Page 6
7 8. Other Material Facts After enquiry, is the Practice, any of its partners, principals, directors or officers aware of any other material facts? Yes No A material fact is one likely to influence assessment of this risk, the premium charged or the terms and conditions imposed by Insurers. If your proposal is a renewal, it should include any change in facts previously advised to Insurers. If you are in any doubt as to whether a fact would be considered material, you should disclose it. All the information requested in this proposal is material. Failure to disclose a material fact could prejudice your rights to recover in the event of a claim or allow Insurers to avoid the policy. Please contact your broker if you require any guidance. 9. Insurance Requirements 9.1 What is the Limit of Indemnity required? 9.2 What is the amount of excess that the Practice would be prepared to carry in respect of each and every claim? (a) 5,000 (b) 10,000 (c) 25,000 or more 10. Data Protection Act 1998 Consent to use of information Insurers will use the information provided herein to manage the insurance policy, including underwriting and claims handling. This may include disclosing it to other insurers, regulatory authorities or to Insurer s agents providing services on their behalf. In order to detect and prevent fraud, Insurers may at any time: (a) share information about the Practice, its partners, principals, directors and/or officers with other organisations and public bodies including the Police; (b) check and/or file the Practice s and/or its partners, principals directors and/or officers details with fraud prevention agencies and databases, and if Insurers suspect fraud, Insurers will record this. Insurers and other organisations may also search theses agencies and databases to: (i) (ii) (iii) Help make decisions about the provision and administration of insurance, credit and related services for the Practice, its partners, principals, directors and officers; Trace debtors or beneficiaries, recover debt, prevent fraud and to manage the Practice s accounts and insurance policies; Check identities to prevent money laundering. (c) undertake credit searches and additional fraud searches. Insurers can supply on request further details of the databases that they access or contribute to. Markel Design & Construction Proposal Form Page 7
8 Data Protection Act 1998 Consent to use of information Underwrites will use the information provided herein to manage the insurance policy, including underwriting and claims handling. This may include disclosing it to other insurers, regulatory authorities or to Underwriter s agents providing services on their behalf. In order to detect and prevent fraud Underwriters may at any time: a. Share information about the Proposer and/or its partners, principals, directors, officers and/or employees with other organisations and public bodies including the Police; b. Check and/or file the Proposer s and/or its partner s, principals, directors and/or officers details with fraud prevention agencies and databases and if Underwriters suspect fraud, Underwrites will record this. Underwriters and other organisations may also search these agencies and databases to: i. Help make decisions about the provision and administration of insurance, credit and related services for the Proposer, its partners, principals, directors and officers; ii. iii. Trace debtors or beneficiaries, recover debt, prevent fraud and to manage the Proposer s accounts and insurance policies; Check identities to prevent money laundering; c. Undertake credit searches and additional fraud searches. Underwriters can supply on request further details of the databases that they access or contribute to. Declaration I hereby confirm that I am duly authorised and do give consent to the use of information as set out in Section 10 above. I hereby also declare that I am authorised to complete this proposal on behalf of the Practice and that the statements and particulars in this proposal are true and complete and no material facts have been mis-stated or suppressed. I undertake to inform Insurers of any material alteration or addition to these statements or particulars which occurs before the commencement of the period of insurance. It is hereby acknowledged and agreed that the terms, conditions, limitations and exclusions of the policy may be subject to alteration at any time prior to the commencement of the period of insurance should, any such material alterations or additions arise. Signing of this proposal does not bind Insurers to offer, nor the applicant to accept, insurance, but it is acknowledged and agreed that this proposal (together with all documents accompanying it and any other information supplied by the Practice or the partners, principals, directors and officers to Insurers in connection with the policy) shall be the basis and form part of any such contract. Signed Name Capacity Date This proposal should be completed and signed by a partner, principal or director of the Practice on behalf of all parties seeking insurance. Markel Design & Construction Proposal Form Page 8
9 NOTICE TO THE PROPOSER The Insurers The Insurers will be either Markel International Insurance Company Limited or Markel Syndicate 3000 at Lloyd s, together with any other subscribing insurer(s). Prior to any placement being concluded, the Proposer will be advised which insurer(s) is/are to write this contract of insurance. The Law of the Insurance Contract The parties to this proposed insurance are free to choose the law applicable to the insurance contract. Unless specifically agreed otherwise with Insurers, the proposed contract will be governed by English law. Procedure for queries or complaints Below are two complaints notices. If you are insured with Markel Syndicate 3000 at Lloyd s, please follow the procedure set out in (1) below. If you are insured with Markel International Insurance Company Ltd, please follow the procedure set out in (2). 1. Markel Syndicate 3000 at Lloyd s If at any time you have any questions or concerns regarding this Policy or the handling of a claim, you should in the first instance refer to your insurance broker or intermediary, if applicable. If your problem cannot be resolved in this way, please write to the Claims Manager, Professional Liability Division, Markel International Limited, The Markel Building, 49 Leadenhall Street, London, EC3A 2EA. We will then advise you of Markel s internal complaints handling procedure. If you are still unable to resolve the situation and wish to make a complaint, you can do so at any time by referring the matter to the Complaints Department at Lloyd s. Their address is Complaints Department, Lloyd s, One Lime Street, London, EC3M 7HA; Tel: ; Fax: ; Lloyds-Regulatory-complaints@Lloyds.com Complaints that cannot be resolved by our internal complaints handling procedure or by the Complaints Department at Lloyd s may be referred to the Financial Ombudsman Service. Further details will be provided at the appropriate stage of the complaints process. These complaints procedures do not affect your right to have recourse to legal action or to any other remedy available to you. 2. Markel International Insurance Company Ltd. If at any time you have any questions or concerns regarding this Policy or the handling of a claim, you should in the first instance refer to your insurance broker or intermediary, if applicable. If your problem cannot be resolved in this way, please write to the Claims Manager, Professional Liability Division, Markel International Limited, The Markel Building, 49 Leadenhall Street, London, EC3A 2EA. We will then advise you of Markel s internal complaints handling procedure. Complaints that cannot be resolved by our internal complaints handling procedure may be referred to the Financial Ombudsman Service. Further details will be provided at the appropriate stage of the complaints process. These complaints procedures do not affect your right to have recourse to legal action or to any other remedy available to you. Markel Design & Construction Proposal Form Page 9
10 About Us Markel International Limited is the London based subsidiary for the international operations of Markel Corporation and is one of the UK s leading specialist insurance companies. The company has developed its expertise through understanding and catering for niche markets. In each of these markets Markel aims to provide quality products and excellent customer service thereby establishing the Markel brand as a market leader. The company operates in the UK through two commercial entities: Markel International Insurance Company Limited, its London based insurance company and Markel Syndicate 3000, its 100 per cent owned Lloyd s syndicate. In both of these business environments Markel International offers a wide range of products, with its considerable underwriting expertise organised around the following product lines: Marine & Energy, Non-Marine Property, Specialty, Professional Liability and Retail. For more details about our products, please visit our website at The Markel Building, 49 Leadenhall Street, London EC3A 2EA Tel: Markel +44 Design (0)20 & 7953 Construction 6000 Fax: Proposal +44 Form (0) Page 10
Prefect Professional Liability Insurance for Educational Establishments
PROPOSAL FORM Prefect Professional Liability Insurance for Educational Establishments Important tice 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the individual,
More informationLiability 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,
More informationProfessional Indemnity Insurance for Miscellaneous Professions Proposal Form
Professional Indemnity Insurance for Miscellaneous Professions Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you / your means the individual, company,
More informationDirectors 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,
More informationProfessional 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,
More informationPROFESSIONAL INDEMNITY INSURANCE SINGLE PROJECT PROPOSAL FORM
PROFESSIONAL INDEMNITY INSURANCE SINGLE PROJECT PROPOSAL FORM IMPORTANT NOTICE This proposal form must be completed in ink by the Individual or a Partner, Principal or Director of the Firm or Company.
More informationFIFA 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
More informationHOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM DESIGN & CONSTRUCTION INDUSTRY
HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM DESIGN & CONSTRUCTION INDUSTRY PLEASE READ THE FOLLOWING BEFORE COMPLETING THIS PROPOSAL FORM: ALL QUESTIONS SHOULD BE COMPLETED IN INK.
More informationProfessional Indemnity Insurance for Architects & Engineers Proposal Form
Professional Indemnity Insurance for Architects & Engineers Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which 'proposer' or 'you/your' means the individual, company,
More informationEmployment Practices Liability Insurance Proposal Form
Employment Practices Liability 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,
More informationProfessional Indemnity Insurance for Insurance Brokers & Intermediaries Proposal Form
Professional Indemnity Insurance for Insurance Brokers & Intermediaries Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which 'proposer' or 'you/your' means the individual,
More informationProfessional Indemnity Insurance for Security Companies Proposal Form
Professional Indemnity Insurance for Security Companies Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which 'proposer' or 'you/your' means the individual, company,
More informationProfessional 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'
More informationDesign & Construct Professional Indemnity Insurance Proposal Form
Your Professional Indemnity Specialists www.brian-thornhill.co.uk Design & Construct Professional Indemnity Insurance Proposal Form Please complete this form in BLOCK CAPITALS IMPORTANT INFORMATION This
More informationIMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM
Consulting Engineers Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically
More informationIntellectual Property Litigation Insurance Proposal Form
PROPOSAL FORM Intellectual Property Litigation Insurance Proposal Form Important tice 1. This proposal must be completed in black ink by a partner, principal or director of the firm or company. All questions
More informationProfessional Liability Insurance for Educational Establishments Proposal Form
Professional Liability Insurance for Educational Establishments Proposal Form Important Notice 1. This is a proposal for a contract of insurance, in which 'proposer' or 'you/your' means the individual,
More informationEngineers Professional Liability Proposal Form
Proposer Details Name of insured Firm(s) (including predecessors) Principal Address line one Principal Address line two City and postcode Telephone number Website Date Firm Established Please provide details
More informationDESIGN AND CONSTRUCT PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE
Monometer House, Rectory Grove Leigh on Sea, Essex, SS9 2HN Office: 01702 713 636 Fax: 01702 713 691 DESIGN AND CONSTRUCT PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE IMPORTANT TICE This proposal must
More informationPROFESSIONAL INDEMNITY PROPOSAL FORM
PROFESSIONAL INDEMNITY PROPOSAL FORM For the Design and Consulting Department of Electrical and Mechanical Services Contractors Please answer all questions. It is appreciated that for some Proposers, certain
More informationPLEASE COMPLETE AND RETURN TO: Sutton Specialist Risks Ltd, 31 Great George Street, Bristol, BS1 5QD APPLICATION FORM
DESIGN & CONSTRUCT AND MISCELLANEOUS PROFESSIONAL LIABILITY PLEASE COMPLETE AND RETURN TO: Sutton Specialist Risks Ltd, 31 Great George Street, Bristol, BS1 5QD APPLICATION FORM Please answer ALL questions
More informationCONSULTING ENGINEERS PROFESSIONAL INDEMNITY PROPOSAL FORM
CONSULTING ENGINEERS PROFESSIONAL INDEMNITY PROPOSAL FORM Please read the following questions carefully and answer them all providing additional information where required. Should you require more space
More informationProfessional Indemnity Insurance for Professional Risks of building and engineering contractors Proposal Form
Professional Indemnity Insurance for Professional Risks of building and engineering contractors Proposal Form Professional Indemnity Insurance for Construction Industry Professionals Proposal Form Please
More informationMARKETFORM : SYNDICATE 2468 PROPOSAL FORM FOR DESIGN CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE
MARKETFORM : SYNDICATE 2468 BROKER / INSURANCE AGENT PROPOSAL FORM FOR DESIGN CONSULTANTS PROFESSIONAL INDEMNITY INSURANCE PLEASE READ THESE GUIDANCE NOTES BEFORE COMPLETING THE PROPOSAL FORM. WHERE FURTHER
More informationDesign and Construct. Professional Indemnity Insurance proposal form
Design and Construct Professional Indemnity Insurance proposal form Please complete all the questions in this proposal form in black ink, continuing your answers on page 7 where there is insufficient space.
More informationProfessional indemnity insurance Design & construct proposal form
Professional indemnity insurance Design & construct proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters
More informationArchitects and Engineers 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
More informationSecurity 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
More informationARCHITECTS PROFESSIONAL INDEMNITY PROPOSAL FORM
ARCHITECTS PROFESSIONAL INDEMNITY PROPOSAL FORM Please read the following questions carefully and answer them all providing additional information where required. Should you require more space please provide
More informationPROFESSIONAL INDEMNITY INSURANCE ARCHITECTS
Form PROFESSIONAL INDEMNITY INSURANCE ARCHITECTS All questions must be answered to enable a quotation to be given. The completion and signature of this proposal form does not bind the Proposer(s) or the
More informationArchitects. 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 Architects Professional Indemnity Proposal Form THB
More informationCONSULTING ENGINEERS 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 CONSULTING ENGINEERS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE
More informationProfessional Indemnity for Engineers Proposal Form
Professional Indemnity for Engineers Proposal Form 4767 03/06 Your business activity 1. Name of all companies/firms to be insured: Name Date established 2. Address of main location: Postcode: 3. Please
More informationEngineers, Architects, Surveyors And Relation Professions Professional Indemnity Proposal Form
Engineers, Architects, Surveyors And Relation Professions Professional Indemnity Proposal Form Once completed, please sign and return together with any additional sheets and attachments to: Prime Underwriting
More informationMarketing & Media 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 Marketing & Media Consultants Professional Indemnity
More informationArchitects and Engineers Professional Liability Proposal Form
AIG Insurance Hong Kong Limited Architects and Engineers Professional Liability Proposal Form I. Applicant Details Name of Insured: Address(es): Web Site Address: Establishment Date: II. Business Activities
More informationProfessional Indemnity Insurance Design and Construct Industry Proposal Form
Professional Indemnity Insurance Design and Construct Industry Proposal Form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block
More informationProfessional Indemnity Insurance Proposal Form for Architects
QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Architects IMPORTANT INFORMATION Duty of Disclosure When completing any insurance proposal form
More informationINFORMATION 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
More informationUIB UK PROFESSIONAL INDEMNITY
l It is very important that you disclose fully and accurately all material facts. If you require more space please continue on your headed paper, then sign and attach to this form. Material facts are those
More informationSECTION 1 ABOUT THE PROPOSER (Please write in block capitals or cross the appropriate boxes as required)
Proposal Form Professional Indemnity Insurance MISCELLANEOUS PROFESSIONS IMPORTANT NOTICE TO THE PROPOSER Please fully complete this Proposal Form. It is very important that the person completing the Proposal
More informationProfessional Indemnity Insurance Proposal Form for Architects
Professional Indemnity Insurance Proposal Form for Architects Please complete all questions in ink. If there is insufficient space please supply the information on a separate sheet of paper indicating
More informationProfessional Indemnity Select
Allianz Insurance plc Professional Indemnity Select Architects Proposal Form Contents Architects Professional Indemnity Insurance 1 General Information 2 Thank you for choosing Allianz Insurance plc. We
More informationJUA Underwriting Agency Pty Ltd
JUA Underwriting Agency Pty Ltd Engineers & Architects Professional Indemnity Proposal Form Please answer every question fully, incomplete answers will not be accepted, and may result in a delay in terms
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES Howden Insurance Brokers Limited is an official scheme provider of Professional Indemnity for BIBA members Please complete this
More informationBuilding and Engineering Contractors Proposal Form
Building and Engineering Contractors Proposal Form This Proposal form must be completed in ink, signed and dated by a Principal, Partner or Director of the Proposer. All questions must be answered and
More informationInformation 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
More informationCONTRACTUAL 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)
More informationProfessional Indemnity Proposal Form Project Management
Professional Indemnity Proposal Form Project Management GUIDANCE NOTES Completing your proposal form Please complete all questions in full using the Additional Information section or separate sheets where
More informationManagement 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 Management Consultants Professional Indemnity Proposal
More informationEngineers, Architects, Surveyors and Relation Professions
Application Form Professional Indemnity Insurance Send quotation requests to: Email: distribution@breezeuw.com.au Phone: 1300 556 826 Engineers, Architects, Surveyors and Relation Professions IMPORTANT
More informationUIB UK PROFESSIONAL INDEMNITY
l It is very important that you disclose fully and accurately all material facts. If you require more space please continue on your headed paper, then sign and attach to this form. Material facts are those
More informationW.R. Berkley Insurance Ireland
W.R. Berkley Insurance Ireland ARCHITECTS PROFESSIONAL INDEMNITY PROPOSAL FORM IMPORTANT NOTICE TO THE PROPOSER TO COMPLETION OF THIS PROPOSAL FORM 1) Disclosure - Any material fact must be disclosed to
More informationProfessional Indemnity Insurance. Proposal for PROFESSIONAL RISKS. 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB
Professional Indemnity Insurance Proposal for IT Consultants PROFESSIONAL RISKS 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Tel 020 7623 4957 Fax 020 7623 4958 PROFESSIONAL RISKS Kerry London
More informationProfessional 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
More informationHow To Answer A Question From The Insurance Company
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR HEALTH & SAFETY CONSULTANTS This proposal form must be completed in black ink by a Partner, Principal or Director of the Company. All questions must be
More informationNew ACE Professional Indemnity Insurance Scheme PROPOSAL FORM. for members of the Association for Consultancy and Engineering
New ACE Professional Indemnity Insurance Scheme PROPOSAL FORM for members of the Association for Consultancy and Engineering PLEASE READ THE FOLLOWING BEFORE COMPLETING THE PROPOSAL FORM Please note that
More informationAllianz Professional Indemnity Insurance Construction Projects
Allianz Global Corporate & Specialty Pacific Allianz Professional Indemnity Insurance Construction Projects Proposal Form General Information The General Information set out below is provided for your
More informationHOULDER INSURANCE SERVICES
HOULDER INSURANCE SERVICES PROFESSIONAL INDEMNITY PROPOSAL FORM ENGINEERS PLEASE READ THE FOLLOWING BEFORE COMPLETING THIS PROPOSAL FORM: ALL QUESTIONS SHOULD BE COMPLETED IN INK. WHERE A QUESTION IS NOT
More informationARCHITECTS 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 ARCHITECTS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE IMPORTANT
More informationMISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM
MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM Please Note: This is a proposal form for a policy relating to claims made against the Insured during the period of the policy only CLAIMS MADE. Please
More informationPROFESSIONAL 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
More informationProfessional Indemnity Insurance Proposal Form for Engineers and Construction Professionals
Professional Indemnity Insurance Proposal Form for Engineers and Construction Professionals Answer all questions. Blanks &/or dashes, or answers known to underwriters or brokers or N/A are not acceptable
More informationInsurance Brokers Professional Liability Proposal Form
Insurance Brokers Professional Liability Proposer Details 1. Name of Firm(s) 2. Principal address Postcode Tel No. Website 3. Date Firm Established 4. Please provide details of any subsidiary companies
More informationDICKSON MANCHESTER. Charity and Association Liability Proposal Form. Proposal form for Insurance effected through Dickson Manchester & Co Ltd
DICKSON MANCHESTER Charity and Association Liability Proposal Form Proposal form for Insurance effected through Dickson Manchester & Co Ltd A SUBSIDIARY OF HCC INSURANCE HOLDINGS, INC. Member of the General
More informationMISCELLANEOUS 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
More informationProfessional Indemnity for Architects Proposal Form
Professional Indemnity for Architects Proposal Form 3716 V1 12/03 1. Your Business Title of Practice(s): Profession(s)/Business(es) of Practice of Commencement of Current Practice: of Commencement and
More informationIMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM
Employment & Recruitment Agencies Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink
More informationIMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM
Management Consultants Professional Indemnity Insurance Proposal Form IMPORTANT INFORMATION REGARDING COMPLETION OF THIS FORM Method of Completion This proposal form may be completed in ink or electronically
More informationProfessional Indemnity Insurance for Specialist Consultants/Firms Proposal Form
Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Professional Indemnity Insurance for Specialist Consultants/Firms Proposal Form Please read the following carefully before
More informationAccountants 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
More informationHow To Write A Professional Liability Insurance Proposal
MISCELLANEOUS PROFESSIONAL INDEMNITY PROPOSAL FORM Centry Gothic Please read the following questions carefully and answer them all providing additional information where required. Should you require more
More informationE nvironm ental Consultants
Professional Indemnity Insurance Proposal for E nvironm ental Consultants PROFESSIONAL RISKS 2nd Floor John Stow House 18 Bevis Marks London EC3A 7JB Tel 020 7623 4957 Fax 020 7623 4958-1- PROFESSIONAL
More informationCONTRACTUAL LIABILITY TAKAFUL ENGINEERING CONTRACTORS PROPOSAL FORM
Jubilee General Insurance Company Limited - Window Takaful Operations 3rd Floor, Jubilee Insurance House, I.I. Chundrigar Road, P.O. Box 4795, Karachi-74000. UAN: 111-654-111, Tel: (021) 32402004-09, Fax:
More informationPROFESSIONAL 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
More informationCONSULTING GEOLOGIST PROFESSIONAL INDEMNITY PROPOSAL FORM
Thompson Insurances Corporate and Personal Brokers 16, Upper Grand Canal Street, Dublin 4, Ireland. Tel: + 353 1 481 7700 Fax: + 353 1 6604058 Email info@nti.ie Web Site www.nti.ie CONSULTING GEOLOGIST
More informationMarketform Miscellaneous Professional Indemnity Proposal Form
Marketform Miscellaneous Professional Indemnity Proposal Form IMPORTANT Please read these guidance notes before completing the Proposal Form. Where further information is required please refer to your
More informationMiscellaneous Professional Indemnity Insurance Proposal form
Miscellaneous Professional Indemnity Insurance Proposal form Instructions Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters with
More informationProposal 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
More informationInformation Technology Consultants Proposal Form
Proposal Form This Proposal form must be completed in ink, signed and dated by a Principal, Partner or Director of the Proposer. All questions must be answered and where appropriate not applicable or n/a
More informationMANAGEMENT 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
More informationContractors Choice. Professional Indemnity Supplementary Proposal Form September 2013 Edition
Contractors Choice Professional Indemnity Supplementary Proposal Form September 2013 Edition Proposal for Professional Indemnity Insurance (Building Contractors Design and Construct) This product is only
More informationProfessional Indemnity Insurance Proposal Form Architects and Civil Engineers - Annual Cover
Professional Indemnity Insurance Proposal Form Architects and Civil Engineers - Annual Cover te: This Proposal must be completed in full by a Partner of the Firm. Unless the Proposal is fully completed
More informationINSURANCE BROKER AND INTERMEDIARIES PROFESSIONAL INDEMNITY PROPOSAL FORM
INSURANCE BROKER AND INTERMEDIARIES 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.
More informationProfessional 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
More informationProfessional 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.
More informationHow 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:
More informationARCHITECTS AND ENGINEERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM
ARCHITECTS AND ENGINEERS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM 1. General information 1.1 Name of the proposed : 1.2 Please provide a full description of your activities 1.3 Please provide details
More informationAUCTIONEERS & 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,
More informationProfessional Indemnity Insurance for the Media Industry Advertising, Marketing, Public Relations and Sales Promotions
Professional Indemnity Insurance for the Media Industry Advertising, Marketing, Public Relations and Sales Promotions Proposal Form Professional Indemnity Insurance for the Media Industry Advertising,
More informationProfessional Indemnity Proposal Form Architects
Professional Indemnity Proposal Form Architects GUIDANCE NOTES Completing your proposal form Please complete all questions in full using the Additional Information section or separate sheets where necessary.
More informationMISCELLANEOUS 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
More informationMARINE SURVEYORS 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 MARINE SURVEYORS PROPOSAL FORM PROFESSIONAL INDEMNITY INSURANCE
More informationSecurus Insurance Limited. Proposal Form. Engineers Professional Indemnity
Securus Insurance Limited Proposal Form Engineers Professional Indemnity Securus Insurance Limited Suite 3, Stafford House Strand Road Portmarnock Co Dublin Phone (01) 8464512 Fax (01) 8464522 Email info@securus.ie
More informationPROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES
PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR INSURANCE INTERMEDIARIES - 1 - P a g e CONTENTS 1. ADVICE ON COMPLETING THE PROPOSAL FORM 2. PROPOSAL FORM 3. BINDING AUTHORITY QUESTIONNAIRE 4. OTHER
More informationPlease complete the whole form to the best of your ability, clarifying any areas where necessary and continuing on a separate sheet if required.
Professional Indemnity Proposal Form Insurance Brokers Please complete the whole form to the best of your ability, clarifying any areas where necessary and continuing on a separate sheet if required. A
More informationProposal Form. Construction Industry Consultants Professional Indemnity
Proposal Form Construction Industry Consultants Professional Indemnity Important Notices Please read these notices before completing the Proposal Form. Your Duty of Disclosure Before you enter into a contract
More informationArchitects Professions
Architects Professions 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 cover
More informationArchitects and Engineers Professional Liability Proposal Form
Statement Pursuant to Schedule 9 of the Financial Services Act 2013: The Policyholder is to disclose in this proposal form, fully and faithfully, all the facts which you know or ought to know, which are
More informationProfessional Indemnity Insurance for Insurance Brokers
Professional Indemnity Insurance for Insurance Brokers Proposal Form Please complete, sign and return together with the attachments to: Affinity A division of Lockton Companies LLP The St Botolph Building
More information