Proposal FormPlease complete, sign and return together with the attachments to: Lockton Companies LLP St Botolph Building 138 Houndsditch London EC3A 7AG or alternatively via DX to: DX 765 London City

LLP 026 - Jun 12

As part of our FSA compliance requirements, it is necessary to classify your risk as either Small or Large Commercial. Did your Practice in the last financial year have two of the under noted features:

Important note regarding the completion of this proposal form.

1. Disclosure

Any “material fact” must be disclosed to insurers - A “material fact” is any information which may influence the judgement of a prudent insurer in deciding whether to accept the risk and if so, on what terms.

Any “material change” must be disclosed to insurers. - A “material change” is any material fact which arises on renewal or during the currency of the policy that has not previously been disclosed as a material fact. Examples of material changes to material facts include:

• Fraud on the part of any of the Partners and Employees

• A change in the composition of the firm's practice

• Mergers and Acquisitions with other firms

• Conversion to a Limited Liability Partnership

If you are unsure whether a fact or change is material or not, you should disclose it. Failure to provide all “material facts” and/or notify all “material changes” may cause the contract of insurance to be void from inception i.e. your insurers will return the premium and there will be no cover for any claims made under the policy. 2. Presentation

This proposal form must be completed by an authorised individual or principal of the firm.

All questions must be answered.

If there is insufficient space to provide answers, additional information should be provided on the firm's headed paper.

Where available brochures, standard contract conditions, agreements and letters of appointment should be provided.

Failure to present insurers with information in an appropriate manner may adversely influence the ability of insurers to offer terms. 3. Guidance

If in doubt as to the meaning of any question contained within this proposal form or the issues raised in (1)or (2) above, please contact an account executive at Lockton.

FSA risk classification (please complete)

i) Turnover of €12.8m or more? £

ii) Balance sheet of €6.2m or more? £

iii) Average number of staff - 250 or more?

Yes No

LLP 026 - Jun 12

If 'Yes', please confirm both the average number of staff and figures converted at £1 = €

Affinity A division of Lockton Companies LLP Authorised and regulated by the Financial Services Authority A Lloyd's Broker www.lockton.com

ADJUDICATION WORK

Defined as acting as a neutral third party engaged by disputing parties to provide a non-judicial resolution of their dispute which is, subject to the terms of any contract between the disputing parties, binding upon them, but excluding arbitration work. AGENCY ADVOCACY WORK

Defined as all civil advocacy work, including attendance at a Court or Tribunal for the purpose of such advocacy, done on behalf of another insured Practice, but excluding any work done as a solicitor working as an agent or locum tenens in another Practice. ARBITRATION WORK

Defined as any work done in the discharge or the purported discharge of the functions of an arbitrator in relation to an arbitration to which the Arbitration Acts 1950 - 1996 apply. CHILDREN WORK

Defined as applications made in relation to family proceedings as defined by section 8(3) of the Children Act 1989 and including Parts III and V of the Children Act 1989. COMMERCIAL WORK EXCLUDING WORK RELATED TO PUBLIC COMPANIES

This covers all commercial and private company work, including mergers and acquisitions, corporate trusts and taxation (which is not Financial Advice and Services). COMMERCIAL WORK FOR PUBLIC COMPANIES

This covers all work relating to public limited companies, including mergers and acquisitions, corporate trusts and taxation (which is not Financial Advice and Services). CONVEYANCING - COMMERCIAL

Acting on the acquisition, sale or financing of freehold or leasehold property where the client is acting in the course of business. This includes drafting of leases and related documentation. CONVEYANCING - RESIDENTIAL

Acting on the acquisition , sale or financing of freehold or leasehold property where the client is not acting in the course of business DEBT COLLECTION-SMALL

Defined as the collection of judgement debts of not more than £10,000 or debts without dispute as to liability of not more than £10,000, and the collection of rents not exceeding £7,500 per property per annum. EMPLOYMENT WORK (Non-Contentious)

Defined as all non-litigious work that relates to general employment advice to employers and employees including corporate support on transfer of business, employee benefits and drafting of contracts of employment and staff handbooks. ESTATE AGENCY, PROPERTY VALUATION AND PROPERTY MANAGEMENT

This covers property management, valuations and real estate agency carried out by the practice but does not include any separate business providing these services that is outside the regulation of the Solicitors Regulation Authority. FINANCIAL ADVICE AND SERVICES REGULATED BY THE SRA

This covers all financial advice and services provided to private individuals, unincorporated bodies and companies where such work is regulated by the SRA as a designated professional body under The Financial Services and Markets Act 2000. This does not include Commercial Work for Public Companies. FINANCIAL ADVICE AND SERVICES WHERE YOUR PRACTICE HAS OPTED INTO REGULATION BY THE FINANCIAL SERVICES AUTHORITY

This covers financial advice and services provided to private individuals, unincorporated bodies and companies where such work is directly regulated by the Financial Services Authority under the Financial Services and Markets Act 2000. This does not include Commercial Work for Public Companies. IMMIGRATION WORK

Defined as advice and assistance on U.K. immigration and nationality law, including preparation for and representation before Immigration Adjudicators, Special Adjudicators, and any Tribunals or Courts of Justice up to but not including the Divisional Court, the Court of Justice of the European Union, the Commission on Human Rights of the Council of Europe or the European Court of Human Rights. LANDLORD/TENANT (Non-Contentious)

Dealing with the exercise of contractual rights under lease whether acting for a Landlord or a Tenant, Drafting leases, Letting agreements and contracts and advising on the same, General advice on housing rights e.g. to council or housing association tenants or advising housing associations or local authorities on the terms of leases/contracts including rights of enfranchisement, Landlord and Tenant Act 1954 claims, Rent reviews, Rights to manage, Possession and dilapidations. Does not include the creation/drafting of contractual rights.

Definitions

LANDLORD/TENANT (Contentious)

Suing tenants/lessees for loss/damage to property, repairs etc ( or defending them), Recovery of rent, Litigation of rent reviews, Rent tribunals, Proceedings under the Landlord & Tenant Act 1954 and similar applications under the Leasehold Reform Act, Claims against local Authority for housing repairs, Disputes over the terms of a lease/contract. LECTURING AND RELATED ACTIVITY WORK

Defined as work involving the preparation for, and the presentation of, lectures, seminars, training and tuition whether for the purposes of professional skills training, continuing education or otherwise, including the provision of written material for publication. MEDIATION WORK

Defined as acting as a neutral third party engaged by disputing parties to assist them to resolve their dispute by negotiated agreement without resort to adjudication. MENTAL HEALTH TRIBUNAL WORK

Defined as representation of patients detained under the Mental Health Act 1983 at hearings of the Mental Health Tribunal. OFFICES AND APPOINTMENTS As Clerks to City Livery Companies, Dean and Chapters, Drainage Boards, Local Councils, Charities or School Governing Bodies; Diocesan Registrars, Archdeacon's Registrars or Provincial Registrars of the provinces of the Church of England in respect of work covered by an Ecclesiastical Fees Order; Company Secretaries, provided that any such offices and appointments are undertaken in the course of private legal practice. (This does not include appointment as an officer or director of a company) . OVERSEAS WORK Gross fees derived from work done overseas and/or work done in UK but relating to instructions received from and/or fees paid by clients overseas. PARLIAMENTARY AGENCY

Defined as all work done in the promotion of or opposition to primary or subordinate legislation. PRINCIPAL

A reference to Principal covers a sole practitioner, a partner in a partnership, a member of a Limited Liability Partnership and a director of a limited company. RELEVANT RECOGNISED BODY

Relevant Recognised Body means a Recognised Body other than: (a) an unlimited company, or an overseas company whose members' liability for the company's debts is not limited by its constitution or by the law of its country of incorporation; or (b) a nominee company only, holding assets for clients of another practice; and (i) it can act only as an agent for the other practice; and (ii) all the individuals who are principals of the recognised body are also principals of the other practice; and (iii) any fee or other income arising out of the recognised body accrues to the benefit of the other practice. SUB-PRIME

Sub-prime and B-paper, B-tier, non prime, near -prime, special finance, second chance lending is an industry term used to describe a mortgage granted to a borrower considered sub-prime. That is, a person with a less than perfect credit report. Also Fringe Lenders: are lenders who offer loans to customers at higher than normal income to loan ratios but with punitive terms. SUCCESSOR PRACTICE

The definition of Successor Practice in the SRA's Minimum Terms is complicated. You may be a Successor Practice even though you did not intend to take on the liabilities of another Practice when taking it over or merging with it and even if you specifically agreed that those liabilities would remain elsewhere. Whenever a Practice ceases “being carried on as a discreet business,” there is potential for the successor Practice clause to take effect. You may become a Successor by holding out your Practice “expressly or by implication” as being the successor of or by incorporating the other Practice(s), by taking on the majority of the principals in the other Practice as principals in your Practice, by taking on at least one such principal as a principal when the majority have not become principals in another Practice, by taking a sole practitioner or Recognised Body into your Practice as a principal, or by taking on a sole practitioner as an employee after 31st August 2000. If your Practice has done any of these things, at any time or is planning to do so, you may be a Successor Practice and should provide full details. TOWN AND COUNTRY PLANNING

Includes compulsory purchase, listed buildings and conservation areas work. UK WORK Gross fees derived from work done in the UK for clients based in the UK including overseas contracts involving occasional trips abroad.

Affinity A division of Lockton Companies LLP Authorised and regulated by the Financial Services Authority A Lloyd's Broker www.lockton.comLLP 026 - Jun 12

Additional information should be provided on separate sheets (ideally on your headed notepaper), clearly identifiable as forming part of the proposal form.

The Practice

Please provide details of all names under which you practice and any other entities for which you are seeking cover:

a) The Firm:

Main office Solicitors Regulation Authority registration number:

Establishment Date:

b) Other entities including trustee and/or nominee companies and/or incorporated principals for which you are seeking cover.

1.

c) Trading styles

2. Prior Practices a) Please provide details of any Prior Practice(s) and/or individual principal(s) where you are deemed to be the “Successor Practice” in the last 15 years.

No of solicitors who joined the practiceDate of successionDate EstablishedName of Practice(s)

Yes Nob) Since 01/10/2010, have you merged with or acquired any firm that purchased run off cover prior to the merger or acquisition, with the result that you are NOT a successor practice. If 'YES', please provide full details

Yes Noc) In the last 6 years, has the practice acquired, as a Partner, Employee or Consultant, anyone who was previously a Sole Practitioner? If 'YES', please provide further information.

Is your Practice an incorporated practice/limited liability partnership or a company registered at Companies House?

Firm Structure3.

Yes No

c) Are any of your trustee or nominee companies a “Relevant Recognised Body”? Yes No

b) Is your Practice considering or intending to incorporate or convert to a limited liability partnership during the next 12 months?

Yes No

a)

Is your practice considering or intending to convert to an Alternative Business Structure within the next 12 months? If 'YES', please provide details including copy of application.

d) Yes No

Addresses4.

Post Code:County:

Fax No:Website:

Email:Primary Contact:

Tel No:Email:

City:

Principal Address:a)

b) Yes NoDo you have any other branch offices (including overseas offices) for which you are seeking cover?

If 'YES', please advise of the number of branch offices and attach a list of these offices giving full address(es). If there is no resident principal at any of these offices, please identify the office concerned and explain how the office is supervised.

No of Offices

Principals/Staff Please provide details of the number of principals and staff.

5.

Principals (including salaried partners held out as principals).a)

TOTAL

How many people (a-d) are employed in your principal office? e)

All other staff (including secretarial and excluding domestic, cleaning and catering staff). (Please state if none)d)

Non solicitor fee earning staff (including fee earning trainees and legal executives). (Please state if none)c)

Assistant solicitors (including qualified consultants).b)

Yes NoDo any principals or other fee earners also work for any other law firms or business?

If 'YES', please provide details on a separate sheet of headed paper

f)

For each individual who will be employed by your practice as at the inception date of the policy, their name, title, date of birth, status (e.g. principal, assistant, consultant), Law Society roll number, Number of years practising since admission in England & Wales (excluding career breaks), whether they are full time or part time (less than 20 hours per week), if they participate in any other business and if appropriate, whether they are a Registered Foreign Lawyer or a Registered European Lawyer.

i)

If you are a new Practice, please provide CV's for each principal, a business plan and a cash flow statement.iii)

For each principal who is not a solicitor, their name, title, date of birth, role (e.g. HR/IT/FD, barrister, legal executive, licensed conveyancer etc), whether they are full time or part time, which regulatory body they belong to and if they are a fee earner.

ii)

Please provide a list of every principal, assistant and consultant in Appendix 1 with the following information:g)

Has any principal, solicitor, employee or consultant during the last 10 years ever:h)

been refused a practising certificate?

iv) practised in a Practice that has been subject to an investigation or intervention by any regulatory department of the Law Society or Solicitors Regulation Authority including the Office for the Supervision of Solicitors (OSS), the Consumer Complaints Service (CCS), the Legal Complaints Service (LCS) or the Legal Ombudsman (LeO)?

iii) been fined or reprimanded or otherwise sanctioned or been the subject of a costs or penalty order by the Solicitors' Disciplinary Tribunal?

ii) been granted a conditional practising certificate?

i)

v)

had an award for inadequate professional service made against him or her by the OSS/CCS/LCS/LeO or entered into any regulatory settlement agreement with the SRA?

vii)had a civil or criminal judgement (other than minor traffic offences) against him or her? vi)

been investigated by any other regulatory body other than the Law Society or SRA (e.g. FSA, Council of Licensed Conveyancers or ILEX)?

Has any principal or fee earner in the last ten years been declared bankrupt whether voluntarily or involuntarily

viii)

If 'YES', to any of the above, please provide details on a separate sheet of headed notepaper and include a copy of all reports issued by the SDT, LeO former LCS, OSS or CCS and/or any other regulatory body.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Monitoring visits and investigations of the practice6.

Has the practice been the subject of a monitoring visit from the Law Society/SRA in the past 3 years?a)

Has the practice been the subject of any visit or enquiry from the Forensic Investigation Unit or SRA in the past 3 years or has notice of any proposed visit or enquiry been given?

If you have answered 'YES', to any of the above questions, please provide full details on a separate sheet and include all reports, action lists and relevant correspondence issued by the PSU, SRA, LeO, former LCS, CCS or OSS, Forensic Investigation Unit, Disciplinary Tribunal and/or other regulatory body.

b)

Annual Accounts a) For the last three accounting periods, please provide the following information from your annual accounts

7.

Prior to last completed year 2

Prior to last completed year 1Last completed year

Net Worth of the Firm (Total Assets less Total Liabilities)

Total Principal/Partner drawings or Director/Member remuneration

Net Profit (Loss) after tax and before drawings

b) Please confirm the total fees outstanding to your practice as at the date of this application.

d) What is the total estimate of unbilled work in progress as at the date of this application? Please provide a copy of the annual accounts for the practice for the last two complete financial years

%c) What percentage of this amount was billed more than 90 days ago?

Yes No

Yes No

Fee Income Please provide details of your fee income as follows:

8.

Annual Gross Fee for accounting year end (dd/mm/yyyy):

Projected for this year

Previous year 3

Previous year 2

Previous year 1

Last completed year

£ £ £ £ £

£ £ £ £ £

£ £ £ £ £In the United Kingdom (excluding b & c below)

c) In the United Kingdom and/or elsewhere but relating to instructions received from and/or fees paid by clients overseas (excluding b & d)

b) In the UK or elsewhere for fees paid by persons, companies, firms or organisations having a billing address in the USA and its territories and possessions and Canada (please state if none)

a)

£ £ £ £ £

£ £ £ £ £

£ £ £ £ £

£ £ £ £ £

£ £ £ £ £

e)

d) Overseas offices (state countries involved)

Total of a), b), c) and d) above

If you have any declared overseas fees in question 8b) and c), please provide details of the client and the type of work undertaken on a separate sheet of headed notepaper.

f)

Do you practise from an office outside England and Wales. If 'YES', please also complete the “Supplementary Overseas Office Questionnaire”.

g)

Does any one client, group of clients or referral source generate 20% or more of your annual fees?i)

If 'YES', please confirm under which jurisdictional law the work is undertaken and state gross fees for the last accounting period together with full details of these activities on a separate sheet of headed notepaper

Do you give foreign law advice? h)

If 'YES', please provide full details of the client(s) or referrers, fees earned/percentage of fees generated and the work undertaken on a separate sheet of headed notepaper.

Yes No

Yes No

Yes No

Division of work Definitions of types of work are given at the front of this form. Please provide approximate percentages for the fee income generated by the Practice in the annual accounting periods specified and derived from each of the following work categories:

a)

Your Work9.

For accounting year end (dd/mm/yyyy):

Previous year 2

Previous year 1

Last completed year

Approximate % rounded to the nearest whole %. If none, state NONE

Acting as Arbitrator /Adjudicator or Mediator

Wills and tax planning

TOTAL

All other non-contentious work *

All other contentious work *

Trusts

Town & country planning

Probate and estate administration

Personal injury - defendant

Personal injury - claimant **

Parliamentary agency

Offices & appointments

Oaths and affidavits and notary public

Matrimonial/Family

Marine litigation

Landlord/tenant (Contentious)

Landlord/tenant (Non-contentious)

Intellectual property including patent, trademark and copyright *

Immigration

Financial advice and services regulated by the Financial Services Authority

Financial advice and services regulated by the Solicitors Regulation Authority

Expert witness/lecturing work

Estate agency, property valuation and property management

Employment (Contentious)

Employment (Non-contentious)

Defendant litigation (insurers)

Debt collection (large)

Debt collection (small)

Criminal

Conveyancing - residential***

Conveyancing - commercial***

Commercial litigation

Commercial/Corporate work for public companies

Commercial/Corporate work (excluding work related to public companies)

Children work, mental health tribunal and welfare

Agency advocacy

* Please provide full details on a separate sheet of headed notepaper. ** Please complete Personal Injury Questionnaire if you have generated income in this practice area *** Please complete Conveyancing Questionnaire if you have generated income in this practice area

Taxb)

Implementation of schemes devised by othersi)

%Devising tax mitigation schemes yourself ii)

Yes NoDo you undertake tax planning advice other than inheritance tax?

If `Yes', please state what percentage is for:

%

Specialisationc)

Do you specialise by way of undertaking work for any specific type of business activity or for any specific type of group of clients?

ii) Has your Practice or any Prior Practice ever provided management services or investment advice to any entertainment clients or sporting professionals?

i)

If 'YES', please explain on a separate sheet of headed notepaper.

Yes NoIn any of the last 6 years has your practice generated gross fees from any conveyancing work including remortgages (residential and/or commercial)?

Conveyancingd)

In the last 6 years, has your Practice or any Prior Practice ever accepted instructions for any class actions or other group litigation, where you have acted for the:

Class Actionf)

i)

Claimant?ii)

Defendant?

If 'YES', please explain on a separate sheet of headed notepaper

In respect of commercial work, please provide gross fee income for the last accounting periodCommercialg)

Gross Fees public companiesGross Fees non-public companiesArea

Year EndedFees EarnedPublic on Non-Public company, Please state. Contract ValueArea of Work

Mergers & Aquisitions

General Commercial

Regulation/Compliance

Insolvency

Tax

Pension schemes

Project Financing

Debit Issuance/securitisation

Please list the five largest matters over the last three years and fees earned in each case.

Other

Yes No

Yes No

Yes No

Yes No

iii) Have you ever acted on behalf of any company or client in relation to any Collective Investment Schemes? Yes No

In the last 3 years have you dealt with any matrimonial settlements above £1,000,000 or regular annual payments above £100,000?If 'YES', please explain on a separate sheet of headed notepaper.

Matrimonial Worke)

Yes No

If 'YES', please complete the Supplementary Conveyancing Questionnaire.

Claims Please attach a copy of the confirmed claims summaries from all qualifying insurers or the Assigned Risks Pool for the Practice and any Prior Practices for the period since 1st September 2002.

Please also complete the following questions:

10.

If 'YES', to any of the insurance years, please provide the number of claims and circumstances for each year:

Yes NoDuring the last 10 years has your Practice or any Prior Practice reported any circumstances, incidents or claims to The Assigned Risks Pool or to any Qualifying Insurers?

a)

2011/122002/3

No of claims & circumstances

2003/4 2004/5 2005/6 2006/7 2007/8 2008/9 2009/10 20010/11

NoYesof any claim(s) having been made in the last 5 years against any Principal whilst in a former Practice?i)

Are you aware, after full enquiry:b)

If 'YES', please provide full details on a separate sheet of headed notepaper giving your opinion on both liability and quantum.

Yes No

If 'YES', please provide details of all incidents including how the matter was resolved and the procedures/processes in place to avoid re-occurrence.

of any circumstances, incidents or claims reported by the Practice or any Prior Practice in the past 6 years as a result of the dishonesty or alleged dishonesty of any Principal or employee of the Practice or any Prior Practice(s)?

ii)

Yes NoHas your Practice or any Prior Practice ever been in the Assigned Risks Pool and/or has any Qualifying Insurer refused to offer your Practice or Prior Practice terms for your Professional Indemnity Insurance?

11. The Assigned Risks Pool and problems with renewal

If 'YES', please explain on a separate sheet of headed notepaper.

Yes NoHave you ever been late in paying or failed to pay either a professional indemnity premium or excess?

Late Payments12.

Changes to the Practice13.

Yes NoSince the completion of last years proposal form have there been any significant changes within the Practice or are you expecting any changes in the next 12 months including any successions or mergers?

a)

Yes NoIs there any other material information including Risk Management procedures within the Practice of which you feel insurers should be aware?

b)

If 'YES', to either question please provide details on a separate sheet of headed paper.

Yes NoIf 'YES', please state name and status.

Do you have a designated person in your practice with responsibility for risk management?

Risk Management14.

a)

Name: Status:

Yes NoAre you aware, after full enquiry of all principals and employees of your Practice, of any claims and/or circumstances and/or shortcomings that you have not notified to your previous and/or current insurers?

c)

If 'YES', please explain on a separate sheet of headed notepaper.

PLEASE NOTE: you are obliged to notify all such matters to your existing insurer by the end of the current indemnity period. Failure to do so may entitle insurers to seek reimbursement from you if there is a claim.

Yes NoAre there any matters notified by your Practice or any Prior Practices to SIF, Qualifying Insurers or The Assigned Risks Pool which have not been accepted as an effective notification?

d)

Do you analyse and/or review your complaints and claims record on a regular basis?

d) Before accepting a new instruction, are all new clients vetted and agreed by a Partner or Department Head?

If 'NO', please provide method of vetting new clients on a separate sheet of headed notepaper.

c) Does each department require a standard risk assessment to be carried out relative to each new instruction?

b)

Do you instruct your staff to ensure that the client is always issued with an engagement letter giving costs and other information as set out in OFR? Yes No

e)

Yes No

Yes No

Yes No

Financial Services Work

Yes No

If 'YES', please complete the “Supplementary Financial Services Questionnaire”.

Since 1990 has your Practice or any Prior Practice ever given financial advice including selling or advising on mortgage endowment policies?

h)

Do you have a formal file closure procedure in all departments?k)

Please give details of any quality standards achieved and the date of first accreditation:l)

Do you have any procedures to ensure compliance with the diary system that records critical dates and time limits?j)

If 'YES', please state how many files are audited, how often and by whom on separate sheet of headed notepaper. If 'NO', please explain how your firm complies with the regulatory requirement to check work quality on a separate sheet of headed notepaper.

Are regular audits undertaken of all Principal, Solicitor and Fee Earner files?i)

If 'NO', please detail what conflict checking procedures are in use on a separate sheet of headed notepaper.

Do you have a formal conflicts search procedure in place when opening new files?h)

LEXCEL

Others (please specify)

Investors in People ISO9000/01/02

CQS

Do you have enhanced due diligence procedures including how you establish identity, if you do not meet the client prior to any property transaction?

m)

If 'YES', are these services always carried out by a principal/solicitor other than the principal connected with the client? If 'NO', please provide full details on a separate sheet of your headed notepaper.

Does the practice provide professional services for any client in which any principal holds a partnership/ directorship or has any other financial interest?

r)

If 'NO', please provide details of who is entitled to authorise payment, on a separate sheet of headed notepaper.

Do all cheques and/or electronic fund transfers for more than £25,000 require two written confirmations (signatures or authorisation) including at least one principal?

q)

If 'NO', please advise who is authorised to give undertakings on a separate sheet of headed notepaper.

Are all undertakings made with documented agreement by a senior executive or principal of the practice?p)If 'YES', please detail procedures on a separate sheet.

Do you have procedures in place to ensure professional undertakings are effectively discharged?o)

Do you have procedures in place to ensure that the price recorded by the Land Registry and in any documents is the true net price of the property (e.g. excluding the value of any incentives, discounts or allowances)?

n)

Please bear in mind that, the minimum cover required is £2million for a partnership or £3million for LLP's and companies registered at Companies House including any “Relevant Recognised Body”

16. Your professional indemnity requirements

Total cover requireda)

Self-insured excess requiredb)

£

or £or ££

or £or £

Yes NoDoes your practice outsource any legal, secretarial or other work? If 'Yes', please provide full detailss)

Yes No

If you currently hold a professional indemnity insurance policy with Lockton please do not complete question 15 c)

Please advise of the following (where applicable):c)

Primary insurancei) £

£Excess layer insuranceii)

iii) Fee payable to broker (if applicable) £

Current InsurerLimit of IndemnityPremium

d) Please confirm your firm maintains Employers Liability insurance

If 'Yes', please confirm renewal date.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Do you have a system for monitoring live cases where either fees have not been charged for more than three months or are overdue for payment NoYes

f)

Does the firm limit its liability in Engagement letters? Yes No

If `Yes', what proportion of cases achieve a liability cap?

g)

15. Only answer this question if you have less than 5 principals in your practice: Please provide details of all individuals in the practice who are authorised to make payments from the client account.

APPENDIX 1

Year of Admission (England &

Wales)

Full/Part timeD.O.BTitle Full Name Roll No

Equity Partner/Partner/

Assistant/Consultant

STAFF DETAILS

Assistant Solicitors

5g.

No of Partners/DirectorsNon Solicitor fee earning staff

All other staff (including secretarial)

Please provide all information requested for every Principal, Fee Earner and Consultant who will be employed by your Practice as at the inception date of the Policy. If anyone is a Registered Foreign Lawyer or a Registered European Lawyer, please note RFL or REL alongside solicitor status. If you are a newly established Practice, please enclose a CV for every Principal in the Practice.

APPENDIX 2Additional space if required

PLEASE SIGN THE DECLARATION ON THE NEXT PAGE

Data Protection

By signing this proposal form you consent to Lockton Companies LLP using the information we may hold about you for the purpose of providing insurance and handling claims, if any, and to process sensitive personal data about you where this is necessary (for example criminal convictions). This may mean we have to give some details to third parties involved in providing insurance cover. These may include insurance carriers, third-party claims adjusters, fraud detection and prevention services, reinsurance companies and insurance regulatory authorities. In the course of performing our obligation to you, this information may be disclosed to agents and service providers appointed by us and insurers (which includes their re-insurers, legal advisers, loss adjustors or agents). Where such sensitive personal information relates to anyone other than you, you must obtain the explicit consent of the person to whom the information relates both to the disclosure of such information to us and its use by us as set out above. The information provided will be treated in confidence and, where appropriate, in compliance with the relevant Data Protection legislation. You have the right to apply for a copy of your information (for which we may charge a small fee) and to have any inaccuracies corrected.

From time to time, we may disclose personal information (other than sensitive personal data) to other Lockton Companies. We or they may use that information to advise you of our services which may be of interest to you.

If you would prefer not to receive information, please tick this box

I/We declare that the above statements and particulars are true, full enquiry having been made, and I/We have not omitted, suppressed or mis-stated any material facts which may be relevant to insurer's consideration of this proposal form and undertake to inform the Insurer of any change to any material fact that occurs prior to the point at which the insurance contract has been agreed.

I/We understand that the information I/We provide will be used in deciding the price charged by the Insurer for the risk and whether the Insurer will accept the application and the terms of any policy provided.

I/We hereby consent to the use and disclosure of information including personal data for the purposes of and as set out in the above paragraph entitled “Data Protection”.

I/We hereby consent to receive by email details on other products and services including newsletters where Lockton consider that the information maybe relevant and useful to us.

I/We agree to prevent and detect fraud, the insurers/underwriters may at anytime:

§ Share information about you with other organisations including the police

§ Undertake credit searches

§ Check and/or share your details with fraud prevention and detection agencies.

Proposer's Declaration

Print Name:

Date:

On Behalf of :

Signature:

(an authorised individual/principal)

Please note, if you wish to submit your form via email, an indication of terms and conditions may be provided on the basis of this proposal questionnaire. An original signature is required before a contract of insurance can be made. Encrypted signatures are not acceptable.

Signing this form does not bind the Practice to complete the insurance. We recommend that you keep a record of all information supplied to us, including copies of letters and this proposal form, for the purpose of entering into this contract.

Print Name:

Date:

On Behalf of :

Signature:

(an authorised individual/principal)

CHECKLIST Have you attached the following:

Have you signed and dated the Proposal Form?

A list of all branch offices (if applicable)?4b)

Details of who carries out professional services for clients in which they hold a partnership/ directorship or has any other financial interest

14r)Details of authorisation procedures for client monies14q)

Details of who is authorised to give undertakings if not by a senior executive or principal of the practice14p)

Details of procedures to ensure undertakings are discharged14o)

Details of procedures for checking work quality14i)

Details of conflict checking procedures (if applicable)14h)

Details of any other material information of which you feel insurers should be aware (if applicable) 13b)

Details of any significant changes to the Practice since completion of last year's proposal form or expected in the next 12 months (if applicable)

13a)

Details of your firm's history in the Assigned Risks Pool and/or Qualifying Insurers refusal to offer your Practice or prior practice terms for your Professional Indemnity Insurance

11)

Details of any claims or circumstances not already notified (if applicable) 10c)

Details of any circumstances, incidents or claims reported by the Practice or any Prior Practice in the past 5 years as a result of the dishonesty of any partner, principal or employee of the Practice or any Prior Practice(s) how each matter was resolved and the procedures/processes in place to avoid re-occurrence (if applicable)

10bii)

Your opinion on both liability and quantum regarding incidents or claims against any member/principal whilst in a former Practice during the last 5 years (if applicable)

10bi)

Your opinion on both liability and quantum regarding incidents or claims to The Assigned Risks Pool or to any Qualifying Insurers during the last 10 years (if applicable)

10a)

Claims summary sheet(s) for your Practice and any Prior Practice(s) in respect of claims notified since 1st September 2002

10)A signed and dated “Supplementary Financial Services Questionnaire” (if applicable) 9h)

Details of any class actions or other group litigation9f)

A signed and dated “Supplementary Conveyancing Questionnaire (if applicable)9d)

Details of management services or investment advice to any entertainment clients or sporting professionals9cii)

Details of other non-contentious work (if applicable)

Details of other contentious work (if applicable)

A signed and dated “Supplementary Personal Injury questionnaire (if applicable)

Details of intellectual property work including patent, trademark and copyright work (if applicable)9a)

If one client or group of clients generates 20% or more of your annual fees, details of this work (if applicable)

8i)

Details of foreign law advice (if applicable)8h)

A signed and dated “Supplementary Overseas Office Questionnaire” (if applicable)8g)

Details of the client and the type of work undertaken for overseas fees8f)

Copies of all reports and relevant correspondence issued by the PSU, SRA, LeO, former LCS, CCS or OSS, Forensic Investigation Unit, Displinary Tribunal and/or other regulatory body

6)

Copies of all reports issued by the SDT, LeO former LCS, OSS, CCS, and/or any other regulatory body (if applicable)?

5h)

If a new practice, CV's for each principal, a business plan and a cash flow statement?

A list of all principals, assistants and consultants together with details?5g)N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

N/A NoYes

Yes No

Yes No

Details of specialisation9ci) N/A NoYes

Details of Collective Investment Schemes9ciii) N/A NoYes

Details of matrimonial work9e) N/A NoYes

Details of client vetting (if applicable)14d) N/A NoYes

Details of any outsourced work (if applicable)14s) N/A NoYes