management liability proposal form 2014

8
Who can use this proposal form This proposal form is only for: n UK registered Private Limited companies with an annual turnover of up to £50m. n UK registered Charities, clubs or associations with an annual income of up to £2m. If your organisation is larger than this, or is a listed company, please use our extended proposal form. This product is NOT suitable for: n law firms, or other companies in the legal sector n professional football or rugby clubs n financial services companies that are directly regulated by the Financial Conduct Authority n sole traders, partnerships or limited liability partnerships. Checking the form Before completing this form, please check that you have the latest version. You can do this by speaking to your nearest AXA Trading Centre or by logging on to the AXA website through iMarket (www.imarket.co.uk). Please check all the details you have provided are full and true. Please make sure that you include all relevant information: this is information that could affect our decision to give you insurance or affect the terms we give you. If you are not sure if something is important or relevant you should tell us. These details will form the basis of the insurance contract between us. If you fail to give full and true answers, your policy may not protect you in the event of a claim. Please read the Data Protection notice at the end of this proposal form carefully. Please keep a record of all information given to us (including copies of letters or emails), and a copy of this proposal form as it is part of your insurance policy. Copies of documents If you need a copy of this proposal form, please contact us. We can supply copies up to 3 months after receiving the form. Please also contact your insurance adviser if you would like a copy of the policy wording. Law applicable to the policy You and we can choose the law which applies to this policy. We propose that the Law of England and Wales apply. Unless we and you agree otherwise, the Law of England and Wales will apply to this policy. AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. This can be checked on the FCA’s register by visiting the FCA’s website at www.fca.org.uk/register or by contacting them on 0800 111 6768. Management Liability Policy Standard proposal form (with premiums) 1 of 8 January 2014 edition

Upload: amb-insurance

Post on 22-Mar-2016

212 views

Category:

Documents


0 download

DESCRIPTION

Management Liability Proposal Form 2014

TRANSCRIPT

Who can use this proposal form

This proposal form is only for:

n UK registered Private Limited companies with an annual turnover of up to £50m.

n UK registered Charities, clubs or associations with an annual income of up to £2m.

If your organisation is larger than this, or is a listed company, please use our extended proposal form.

This product is NOT suitable for:

n law firms, or other companies in the legal sector

n professional football or rugby clubs

n financial services companies that are directly regulated by the Financial Conduct Authority

n sole traders, partnerships or limited liability partnerships.

Checking the form

Before completing this form, please check that you have the latest version. You can do this by speaking to your nearest AXA Trading Centre or by logging on to the AXA website through iMarket (www.imarket.co.uk).

Please check all the details you have provided are full and true. Please make sure that you include all relevant information: this is information that could affect our decision to give you insurance or affect the terms we give you. If you are not sure if something is important or relevant you should tell us. These details will form the basis of the insurance contract between us.

If you fail to give full and true answers, your policy may not protect you in the event of a claim.

Please read the Data Protection notice at the end of this proposal form carefully.

Please keep a record of all information given to us (including copies of letters or emails), and a copy of this proposal form as it is part of your insurance policy.

Copies of documents

If you need a copy of this proposal form, please contact us. We can supply copies up to 3 months after receiving the form. Please also contact your insurance adviser if you would like a copy of the policy wording.

Law applicable to the policy

You and we can choose the law which applies to this policy. We propose that the Law of England and Wales apply. Unless we and you agree otherwise, the Law of England and Wales will apply to this policy.

AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. This can be checked on the FCA’s register by visiting the FCA’s website at www.fca.org.uk/register or by contacting them on 0800 111 6768.

Management Liability PolicyStandard proposal form (with premiums)

1 of 8

January 2014 edition

35291_ACLD0675XA_BRO_A4.indd 1 14/01/2014 10:02

2 of 8 January 2014 edition

1 Your details

Your business

1.1 Type of company or organisation

Charity

Club

Association

Private Limited company – please tick your business sector

Construction

Education/social

Leisure

Manufacturing

Motor trade

Professional services

Property owners or managers

Retail or wholesale

Transport

Other – please give details

1.2 Registered name

1.3 Registered address

Postcode

Your cover

1.4 Turnover or income in the last 12 calendar months

£

1.5 When would you like the cover to start?

Your cover will only start when AXA accepts your proposal.

D D M M Y Y

1.6 Please tick if you only need a quote

Quote only

Management Liability Policy: standard proposal form

35291_ACLD0675XA_BRO_A4.indd 2 14/01/2014 10:02

3 of 8January 2014 edition

2 General questions

If you tick a highlighted box for any of the questions in section 2, please provide full details at the end of the section.

2.1 Have you been trading for at least 12 months?

Yes No

2.2 Have you made any redundancies in the last 6 months, or do you plan to make any redundancies in the next 12 months?

Yes No

2.3 Is your organisation regulated by the Financial Conduct Authority?

Yes No

2.4 Do you use external Human Resources consultants or legal advisors to review all employment terminations?

Yes No

2.5 Do you communicate written employment and grievance policies to all new and existing employees?

Yes No

2.6 Are all duties segregated so that dual controls exist on signing cheques above £2,500 and issuing instructions for disbursement of assets or funds?

Yes No

2.7 Do you have any assets in the United States of America (USA), or does your turnover or income include any turnover or income from the USA?

Yes No

2.8 In the last 5 years, have there been any claims or investigations made against you, or against any directors, trustees, officers or employees, that this policy might have covered if it had been in force?

Yes No

2.9 After full enquiry, are you or any of your directors, trustees, officers, or employees aware of any fact or circumstance that may lead to a claim under the proposed policy?Before answering this question, you must ask all directors, trustees, officers and employees for full information.

Yes No

2.10 Have you previously held Directors’ & officers’ or Trustees’ liability cover?

Yes – when did your previous cover first start?

D D M M Y Y

No

If your organisation is a Private Limited company, please answer question 2.11, then go to Section 3

2.11 Did you make a profit (that is, a net profit after tax) in the last 12 months?

Yes No

Management Liability Policy: standard proposal form

35291_ACLD0675XA_BRO_A4.indd 3 14/01/2014 10:02

4 of 8 January 2014 edition

2 General questions continued

If your organisation is a charity, club or association, please answer questions 2.12 to 2.14, then go to Section 3

2.12 Have you made a surplus (that is, your income was greater than your expenditure) in at least one of the last three years?

Yes No

2.13 Do you have a positive net worth? (That is, your total assets are worth more than your liabilities)

Yes No

2.14 Do you provide any of the following services?

Management or supervision of children or vulnerable adults

Yes No

Certification, examination or regulation of your members

Yes No

Financial or legal advice for a fee

Yes No

If you have ticked any of the highlighted boxes, please provide full details here. If you need more room, please attach additional sheets, adding your company name to each.

If you have attached any additional sheets, please write your company name on each sheet, and fill in the number of additional sheets here.

additional sheets

Management Liability Policy: standard proposal form

35291_ACLD0675XA_BRO_A4.indd 4 14/01/2014 10:02

5 of 8January 2014 edition

3 Limits of cover, premiums and excesses

Please note: if you have ticked a highlighted box and given extra information for any of the questions in Section 2, we will need to consider the information you have given us before we can confirm your premiums and excess levels. This means that your premiums and excesses may be different from those shown below. Our terms of cover may also be different.

Please fill in this section to show the cover you need, and we will confirm your premium as soon as we have reviewed the extra information you provided.

Limits of cover for private limited companies

The limit of cover will apply separately to each section of cover. The policy sections are: Directors’ and officers’ liability; Employment practices liability; and Company legal liability.

3.1 Please tick the limit of cover you require for your company

Limit per section Annual turnoverany one claim

Up to £1,000,001 £2,500,001 £10,000,001 £25,000,001 including costs £1million to £2.5million to £10million to £25million to £50million

£250,000 £400 £550 £800 £1,000 £1,150

£500,000 £600 £750 £1,000 £1,200 £1,350

£1,000,000 £800 £1,000 £1,300 £1,450 £1,600

£2,000,000 £1,000 £1,300 £1,700 £1,900 £2,050

£5,000,000 £2,000 £2,500 £3,400 £4,000 £4,750

The premiums shown above do not include Insurance Premium Tax, which we will add at the current rate. Your insurance adviser will be able to confirm the current rate of Insurance Premium Tax.

Limits of cover for charities, clubs and associations

The limit of cover will apply separately to each section of cover. The policy sections are: Trustees’ liability; Employment practices liability; and Charities, clubs and associations legal liability.

3.2 Please tick the limit of cover you require for your charity, club or association

Limit per section Annual incomeany one claim

Up to £100,001 £250,001 £500,001 £1,000,001 including costs £100,000 to £250,000 to £500,000 to £1million to £2million

£100,000 £250 £350 £500 £800 £1,000

£250,000 £400 £500 £700 £900 £1,150

£500,000 £500 £700 £1,000 £1,200 £1,350

£1,000,000 £650 £900 £1,200 £1,350 £1,500

£2,000,000 £1,000 £1,200 £1,350 £1,500 £1,700

£5,000,000 £2,000 £2,500 £3,250 £3,500 £4,000

The premiums shown above do not include Insurance Premium Tax, which we will add at the current rate. Your insurance adviser will be able to confirm the current rate of Insurance Premium Tax.

About these premiums

Please note: these premiums only apply if you have not ticked any of the highlighted boxes in Section 2.

These premiums change from time to time. Please check that you are using the latest version of this form.

About these premiums

Please note: these premiums only apply if you have not ticked any of the highlighted boxes in Section 2.

These premiums change from time to time. Please check that you are using the latest version of this form.

Management Liability Policy: standard proposal form

35291_ACLD0675XA_BRO_A4.indd 5 14/01/2014 10:02

6 of 8 January 2014 edition

3 Limits of cover, premiums and excesses continued

Your excesses

section your excess

Directors’ & officers’ or £Nil Trustees’ liability section

Employment practices liability section £3,750 each and every claim including defence costs

This excess shall not apply where the advice of the agreed solicitor has been obtained and followed for any matter that may lead to a claim under the policy.

Company or Charities, £2,500 each and every claim clubs and associations including defence costs legal liability section

Management Liability Policy: standard proposal form

35291_ACLD0675XA_BRO_A4.indd 6 14/01/2014 10:02

7 of 8January 2014 edition

4 Declaration

If you have not given full and true answers to all questions asked on this proposal form, your insurance may not protect you in the event of a claim.

Before signing the declaration, please read the following Data Protection notice

AXA Insurance UK plc is a member of the AXA Group. In order to supply your quote and then to administer your insurance policy, we will hold and use information including sensitive personal data and claims information you provide and may send it in confidence for secure processing to other companies in the AXA Group (or companies acting on our instructions) including those located outside the European economic area.

Please read this declaration carefully and then sign below

n I/We agree that the policy, the policy schedule and this proposal form and any additional information given will be the basis of the contract between me/us and AXA Insurance UK plc.

n I/We understand that all relevant information, which is information that may influence AXA Insurance UK plc in the acceptance of this insurance and the terms provided, has been disclosed and recorded.

n I/We declare that all particulars given in this proposal form whether made by me/us or on my/our behalf are true and complete.

n I/We understand that if full and true answers have not been given or if all relevant information has not been disclosed that this insurance may not protect me/us in the event of a claim.

n I/We will tell you of any change to the details given before the start date of the contract.

Signature of Chairman, Managing Director, Trustee or equivalent

Name

Position in company

Date

D D M M Y Y

AXA Insurance UK plc may occasionally contact you with details of our other products and services. If you do not wish to receive this information from AXA Insurance UK plc, tick this box.

We may provide information supplied by you to selected third parties, who may contact you in relation to the provision of insurance-related services. If you do not wish us to provide your details to third parties, tick this box.

Agent name and address

Management Liability Policy: standard proposal form

35291_ACLD0675XA_BRO_A4.indd 7 14/01/2014 10:02

www.axa.co.uk

ACLD

0675X-

A 01.1

4 (

352

91

)

AXA Insurance UK plc Registered in England and Wales No 78950.

Registered Office: 5 Old Broad Street, London EC2N 1AD. A member of the AXA Group of companies. AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by

the Financial Conduct Authority and the Prudential Regulation Authority. Telephone calls may be monitored or recorded.

Myers Solicitors Limited, trading as Myers & Co, 33-43 Price StStoke-on-Trent, ST6 4EN. Authorised and Regulated by the Solicitors Regulation Authority, Registration Number 482567

AMB Insurance Services Ltd. Financial Services Register number is 303326.Registered Office: Hillcrest House, 2 Woodland Avenue, Wolstanton Newcastle, Staffs, ST5 8AZ. AMB Insurance Services Ltd is authorised and regulated by the Financial Conduct Authority.

35291_ACLD0675XA_BRO_A4.indd 8 14/01/2014 10:02