solicitors professional indemnity …...solicitors regulation authority registration number: date...

Date

Established:

Solicitors Regulation Authority

Registration Number:

Date Established Date of Succession

Website:

If yes, please refer to Section 10 below.

Name of Practice

1. NAME AND ADDRESS

If yes, please provide details on a separate sheet. If there is no resident Partner/Member/Director at any of these offices,

please identify the office concerned and explain how the office is supervised.

2. PRIOR PRACTICES

Principal Contact:

Email Address:

Firm name including Trustee and/or Nominee

Companies:

DX Number:

Telephone Number:

Fax Number:

Principal Address:

Postcode:

Have any of the listed practices reported any circumstances or claims in the last eight years?

Please list the names of all prior practices of which this practice is a successor practice

(please see definitions at the back) in the last 10 years. If necessary, list further details on a

separate sheet.

a)

Do you have any other offices, other than the main office listed above for which you are

seeking cover? a)

Is your practice an LLP or company registered at Companies House or are you seeking to

incorporate within the next 12 months?b)

b)

SOLICITORS PROFESSIONAL INDEMNITY INSURANCE - 2017 PROPOSAL FORM

Please provide a full answer to every question. The definitions at the end of this form should be read in conjunction with the form. This form must be signed by a Principal/Member/Director of the practice.

Notice concerning Disclosure – An important purpose of this form is to help ensure that you comply with the disclosure responsibilities that apply due to The Insurance Act 2015. It is imperative that you disclose all material circumstances and if you are in any doubt as to whether something is a material circumstance it is recommended that you disclose it. More information regarding disclosure requirements can be found towards the end of this form.

Yes No

Yes No

Yes No

1

Title Surname Forename(s)

Date of

Birth

Equity/

Non-

Equity

Full-Time/

Part-Time Date Qualified

Roll

Number

If yes, please provide details on a separate sheet, including proof of run-off cover purchased

If yes, please provide full details including any application form or documentation

5. COMPANY OWNERSHIP / DIRECTORSHIPS

Please provide all information requested for every Principal, Member, Director, assistant and consultant who will be

employed by your practice as at the policy inception.

If any person listed is a Registered Foreign Lawyer or a Registered European Lawyer, please note RFL or REL

alongside solicitor status. Please enclose Curriculum Vitae for every Principal/Member/Director in your practice

who has not held this position in the Firm for at least three years.

Please list additional solicitors on a separate sheet.

Solicitor status (Principal,

Member, Director

consultant/assistant)

If yes, please provide details on a separate sheet.

4. ALTERNATIVE BUSINESS STRUCTURES

3. OTHER MERGERS AND ACQUISITIONS

Is your practice an Alternative Business Structure regulated by the SRA?

If No, is the practice in the process of or considering becoming an Alternative Business Structure

regulated by the SRA within the next 12 months?

Has your practice merged with or acquired any firm that purchased run-off cover prior to the merger

or acquisition where your practice is not a successor practice?

6. SOLICITOR DETAILS

Is the practice or any Principal/Member/Director of the practice, connected financially, or

otherwise, with any other practice, company or business for which it renders professional

services?

a)

On a separate sheet, please provide details of any joint venture or outside board positions

held by anyone listed in question 6 below.b)

Yes No

Yes No

Yes No

Yes No

2


Date of

Birth

Fee

Earner -

Yes/No

Full-Time/

Part-Time Qualification

Regulatory

Body


Date ceased to be

a Principal/

Member/ Director

Equity/

Non-

Equity

Full-Time/

Part-Time Date Qualified

Roll

Number

a) The practice's accounting year end is:

Please provide all information requested for every non-solicitor principal, member or director as at the policy inception.

Role (e.g. HR, IT, Finance,

Barrister, Legal Executive,

Licensed Conveyancer

etc.)

Former Principals

Please provide all information requested for anyone who has previously been a Principal, Member or Director in the practice

since 1st

October 2010 or since inception of the practice, whichever is the later.

If any person listed is a Registered Foreign Lawyer or a Registered European Lawyer, please note RFL or REL

alongside Roll No.

Date become

Principal/Member/

Director

LEGAL DISCIPLINARY PRACTICES/ALTERNATIVE BUSINESS STRUCTURES - Non-Solicitor Principals

Number of non-solicitor fee earning staff: Part-Time:Full-Time:

20152016

2017

2018*

*If not available please give an estimate

Please provide gross fee income for the last three accounting periods and an estimate of

gross fee income for the next accounting period:b)

Has any one client or group of clients generated 20% or more of your annual gross fee

income in any of the last three years?c)

8. PRACTICE FEES

7. OTHER STAFF

If yes, please provide full details on a separate sheet of the client and the work undertaken.

PLEASE ATTACH COPIES OF AUDITED ACCOUNTS FOR THE LAST TWO COMPLETED YEARS. IF NOT AVAILABLE

PLEASE PROVIDE COPIES OF SIGNED-OFF MANAGEMENT ACCOUNTS

Year Ending UK USA/Canada Elsewhere Total

Number of all other staff (inc. secretarial): Full-Time: Part-Time:

££ £ £

£ £ £ £

£ £ £ £

£ £ £ £

Yes No

3

e)

a)

b)

c)

f)

g)

i)

Insurance Year 2015/16 Current Year 2016-17

Please provide claims information from Participating Insurers or the Assigned Risks Pool for all indemnity years

since 1st

October 2010 (or date of commencement of the practice if later) for your firm and any firm to which you are

a successor practice.

If yes to any of these, please provide full details on a separate sheet and include a copy of all reports issued by the

SRA, LCS, CSS, OSS, LeO, Solicitors Disciplinary Tribunal and/or any other regulatory body.

10. CLAIMS AND CIRCUMSTANCES

Insurance Year 2011/12 Insurance Year 2012/13

Insurance Year 2013/14 Insurance Year 2014/15

If yes, please provide full details on a separate sheet

If yes, please provide full details (on a separate sheet) of all clients domiciled in USA/Canada and the work

undertaken for them, and whether the work is under UK or US law

Has the Practice:

In the last 10 years has any fee earner in the practice or any fee earner previously employed in the practice:

9. PRACTISING CERTIFICATE AND REGULATORY MATTERS

ever been refused a practising certificate?

been granted a conditional practising certificate?

been reprimanded, fined or otherwise sanctioned by the Disciplinary Tribunal?

practised in a firm subject to an investigation or an intervention by the Law Society or SRA?d)

had an award made for inadequate professional service by the Legal Ombudsman, LCS, CCS

or OSS?e)

entered into any regulatory settlement agreement with the SRA?

had a civil or criminal judgment against him/her?

Does the Practice carry out any work for any clients domiciled in the USA/Canada?

Please of respect in given advice legal any of sheet) separate a (on details full provide

foreign law, jurisdictions or contracts not subject to English Law and what experience your

firm has in the different jurisdictions?

f)

Has your practice, or any prior practice, reported any circumstances, incidents or claims to, Participating Insurers or

the Assigned Risk Pool in the:a)

been investigated by any other regulatory body other than the Law Society or SRA (e.g. FSA,

ILEX …)?h)

acted as an intervening agent or taken over an intervened firm?

at any time in the last three years been the subject of a monitoring visit from the Solicitors

Regulation Authorityj)

ever been the subject of any visit from or enquiry by the Forensic Investigation Unit of the Law

Society or SRA or received notice of a proposed visit?k)

If your practice is represented in the USA/Canada do you have; a local office or

representative; anyone holding power of attorney on your behalf; a reciprocal referral

agreement; bank accounts in the USA/Canada; or do you act as trustee for any trust which

has any USA/Canadian operation?

d)

Yes No N/A

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

N/A

4

a)

d)

a)

b)

c)

d)

e)

f)

Expiry Date:

g)

Expiry Date:

h)

Expiry Date:

a)

b)

£

13. COVER REQUIREMENTS

If yes, please provide details on a separate sheet including how the matter was resolved and the procedures /

processes in place to avoid re-occurrence.

Option 1 Option 2 Option 3

If yes to any of the above please provide details on a separate sheet.

12. CURRENT INSURANCE

£

£

Premium (excluding Insurance Premium Tax)

Limit of Indemnity

Excess

Current Broker

Current Insurer

Does your firm currently have Directors & Officers Insurance?

Does your firm currently have Employers Liability Insurance?

Does your firm currently have Cyber and/or Crime Insurance?

Are you or has any solicitor referred to above been in the Assigned Risks Pool?

Have you ever failed to pay either your premium (including run-off premium) and/or any

excess?b)

Have any circumstances, or claims reported by you or any prior practice in the past arisen as

a result of the fraud or dishonesty of any Principal/Member/Director or employee of the

practice?

b)

After making full enquiry of all Principals/Members/Directors and employees in your practice,

are you aware of any circumstances, incidents or claims that have not been reported to your

current or prior insurers (including any letters of complaint about your service or dispute as to

outstanding fees)?

c)

After making full enquiry of all Principals/Members/Directors and employees in your practice,

are you aware of any circumstances, incidents or claims that have been notified to your

current or prior insurers but have not been accepted by insurers as a valid or effective

notification?

d)



PLEASE NOTE THAT YOU HAVE AN OBLIGATION UNDER YOUR CURRENT PROFESSIONAL INDEMNITY POLICY TO

NOTIFY ALL CIRCUMSTANCES AND CLAIMS AS SOON AS PRACTICABLY POSSIBLE. ALL SUCH NOTIFICATIONS

OF WHICH YOU ARE AWARE THAT HAVE NOT BEEN REPORTED TO YOUR PREVIOUS INSURERS MUST BE

DECLARED.

11. PREVIOUS INSURANCE

Limit of Indemnity

Excess

Have you ever failed to pay or defaulted on a repayment where the premium was financed?c)

Have you or any prior practice ever been refused professional indemnity insurance?

Are you or has any solicitor referred to above been or is currently the subject of an IVA or

other arrangement?e)

Are you or has any solicitor referred to above been convicted of (or charged but not yet tried

for) any criminal offence Involving fraud or dishonesty?f)

Yes No

Yes No

Yes No

Yes No

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

Yes No

Yes No

Yes No

5

Last

Completed

Financial

Year

Previous

Financial

Year 1

Previous

Financial

Year 2

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

% % %

Lecturing and related activities and expert witness work

14. AREA OF PRACTICE

Acting as an arbitrator, adjudicator or mediator

Agency Advocacy

Administering oaths, taking affidavits and notary public

Children, Mental Health Tribunal and Welfare

Commercial/Corporate (excluding work related to public companies)

Conveyancing - Commercial

Conveyancing - Residential

Criminal Law

Debt Collection

Defendant litigious work for insurers, including defendant personal injury work

Employment - Contentious

Employment - Non-Contentious

Financial advice and services regulated by the Solicitors Regulation Authority (please complete FCA Questionnaire)

Immigration

Landlord & Tenant

Commercial Litigation

Litigious work other than included in any other category. Please specify

Probate and Estate Administration

Property Management, valuations and real estate agency

Town & Country Planning

Wills, trusts and tax planning

Intellectual Property including Patent, Trademark and Copyright

TOTAL MUST EQUAL 100%

Corporate/Commercial work, including public companies

Matrimonial/Family

Non-Litigious work other than included in any other category. Please specify

Offices and Appointments

Parliamentary Agency

Personal Injury (Claimant)

Please provide the percentage of Gross Fees allocated to each Area of Practice during the last financial year and the

two prior years. Please round up to the nearest whole percentage.a)

6

• What percentage is re-mortgage work?

Financial advice and services where your practice has opted into regulation by the FCA (please complete FCA Questionnaire)

g)

j)

15. PERSONAL INJURY WORK

b)

% % %

Small Claims: Fast Track: Multi Track:

If yes, please provide details on a separate sheet




If yes, please request a Financial Services Questionnaire from us.

If yes, please request a Financial Services Questionnaire from us.

If yes, how many personal injury cases (from claims companies) have you undertaken

in the last six years?

In the last 3 years, has the firm undertaken any Personal Injury work?

If no, please continue to Section 16

Has the practice or prior practice within the last 20 years ever sold or provided advice in

connection with financial services products (including mortgage endowment policies)?d)

Has your practice or any prior practice undertaken work in relation to selling or advising on

any mortgage endowment policies in 1990 or any subsequent years?

Has your practice or any prior practice ever advised on any Home Income Plans or Equity

Release Plans?f)

Does your practice carry out any work for which no fees are charged?

Has your practice or any Prior Practice carried out any work in connection with any tax

planning or tax mitigating/avoidance schemes?h)

Has your practice or any Prior Practice carried out any work in connection with the recovery of

Payment Protection Insurance (PPI) monies, bank charges or Card Security Product fees?

Last Completed

Financial YearSmall Claims: Fast Track: Multi Track:

Previous Financial Year

1Small Claims: Fast Track: Multi Track:


2

b)Has your practice or any prior practice ever provided management services or investment

advice to any entertainment clients or sporting professionals?

Has your practice or any prior practice ever accepted instructions for any class actions or

other group litigation? c)

i)

Has your practice or any Prior Practice carried out any work in connection with Stamp Duty

Land Tax mitigation or avoidance schemes?

Has your practice or any prior practice ever accepted referrals from personal injury claims

companies and/or their agents?a)

Please provide the following details in respect of the last three years:

e)




Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

7

c)

d)

h)

i)

%

%

Last completed

Financial Year

Previous Financial

Year 1

Previous Financial

Year 2

Pre April 2013:

Post April 2013:

£££

%

If yes, please provide full details including names


What percentage of personal injury claims have been rejected by the practice in the last 12

months? f)

In the last 6 years have you been part of any referral network, claims management or

promotional group?

Please provide the names of all ATE insurance providers you have dealt with in the last six years:

What changes has the firm made or is intending to make in response to the Jackson reforms?

Please advise the current number of cases of:

What percentage of claimant personal injury claims have been funded by unions?e)

What was the average size of personal injury settlement for:

How many open claimant personal injury cases does your firm currently have?

All other Personal Injury (RTA, employers’ public liability etc.):

Occupational Disease:

Clinical Negligence:

%

g)

In the last six years have you vetted any personal injury cases for a third party?

What percentage of current cases have ATE Insurance:

Yes No

Yes No

8

j)

b) Please state the number of fee earners in your firm who undertake or have undertaken conveyancing work

Principal/Partners/Directors Members

Solicitors (excluding

Principal/Partners/Directors/Members)

Non-qualified fee earners

Last Completed

Financial Year

Previous Financial

Year 1


2

Other qualified fee earners (including trainees)

If no, please continue to Section 17


16. CONVEYANCING WORK

Please provide the percentage for each insurer

If yes, please provide full details including copies of all correspondence, reports and recommendations


Have you ever been involved in miner’s compensation or industrial disease claims or actions?n)

In the last three years, has the practice undertaken any residential and/or commercial

conveyancing? a)

If yes, please provide full details including names and percentages

Please list all ATE insurance providers where you have placed more than 20% of your business in any year

Have your files been audited in the last six years or has an audit been proposed by any

underwriters or funders?k)

In the last six years have you ever received any commission or financial incentive from any

insurer?l)

In any of the last six years have you used any particular provider for expert reports in more

than 20% of your cases?m)

Yes No

Yes No

Yes No

Yes No

Yes No

9

c)

d)

e)

f)

Other

Investment /property clubs

Irish lenders

Non CML lenders

Last Completed

Financial Year

Previous Financial

Year 1


2

%

%

%

% % %

%

%

%

%

%

%

%

%

%

%

%

% %

£ £ ££ £ ££ £ £

Please provide the percentage of matters where you have accepted instructions from or work introduced by:

CML lenders

ageskpac/erskbro/Intermediaries

instruction coming from a broker or intermediary)

£ £

% % %

%

Gross Fees

Number of transactions

Percentage of transactions relating to re-mortgage

work

Percentage of transactions relating to Buy to Let

Highest loan value

Highest capital value

Average typical value

Last Completed

Financial Year

%

£

Percentage of transactions relating to re-mortgage

work

Percentage of transactions relating to Buy to Let

Highest loan value

Highest capital value

Average typical value

Last Completed

Financial Year

Previous Financial

Year 1

COMMERCIAL CONVEYANCINGPrevious Financial

Year 1


2

%

%

£

£

£

%

%

£

£

£

£ £Gross Fees

Number of transactions

£

Please provide the following details:


2RESIDENTIAL CONVEYANCING

%

%

£

£

£

Are all clients met in person and what checks are performed to ensure the identity of your client?

Are you a member of the Conveyancing Quality Scheme (CQS)?

Does your firm comply with the Law Society Practice Note on Mortgage Fraud (dated 31st

July 2014)?g)

Yes No

Yes No

10

i)

k)

(i)

(ii)

(iii)

Have you made a block notification to your current insurer or any other previous insurer of all

claims and circumstances that have arisen out of requests for your conveyancing files by a

particular lender or in respect of a particular fee earner?

l)

In the last 12 months where acting for the purchaser in residential conveyancing transactions, how many of your clients

have purchased:m)

(i) A First Title Home Owners Protection Policy?

(ii) Any other known or unknown risk legal indemnity policy?

If yes, how many files?

If no, please provide reasons for not doing so

If no, please provide details

If yes, please provide details

Have you reviewed all the files that have been subject of file requests?

Has notification of all these requests been reported to your insurer?

Has any potential notification(s) been declined or rights been reserved by your insurer?

Has the firm undertaken any Wills and Probate work in the last 3 years?

If yes, do you use Certainty - the National Will Register – to register the wills you have created?

17. WILLS AND PROBATE

What

?kwor conveyancing ekunderta

who staff and embers/MDirectors/Partners to fraud mortgage identifying on provided been has or is training h)

In the last six years, has the firm been suspended or removed from any lender panel?

Have you received any requests for conveyancing files or information from conveyancing files

by lenders or a lender's representative?j)

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

11

a)

c)

*If not available please give an estimate

Does your firm have currently have an overdraft facility or facilities?

Does your firm currently have any loans or other borrowings from a bank or other third party

including for the funding of litigation?b)

Please provide the following information for the last 3 Financial Years

Do you expect there to be any significant change to or in your practice in the coming year?

Net Worth of the Practice

(Total Assets less Total Liabilities)

2017* 2016 2015

20. SIGNIFICANT CHANGE

Net Profit/Loss after tax and before drawings

Total Partner/Principal drawings or Member/Director

remuneration


21. MATERIAL INFORMATION


Is there any other material information that may be relevant to this form?

19. FINANCIAL COMMITMENTS

If yes, please provide details. Including total limits and amounts owing at the date this application is dated.

If yes, please provide details. Including name of lenders, purpose of the loans, amount of the loans and amounts owing at the

date this application is dated

Operating Expenses (Excluding Partner/Principal

Salary and Drawings)

If yes, please provide details. Include areas of practice, client management process with regards to the scope of the retainer

18. UNBUNDLING LEGAL ADVICE

Do you currently provide or intend to provide “unbundled legal advice” sometimes referred to as 'a la

carte' legal services?

£

£

£

£

£

£

£

£ £

£

£

£

Yes No

Yes No

Yes No

Yes No

Yes No

12

a)

Status:

Status:

Status:

b)

d)

Please provide the name and status of the person responsible for risk management in your practice.

What Compliance Software does the practice utilise to carry out the duties of the COLP/COFA?

Does the practice always obtain satisfactory written references when engaging new

Principals, Members or Directors and employees, including procedures for verifying

qualifications, previous experience, previous claims and/or circumstances?

c)

With regard to Cyber/Crime

Are all employees who are responsible for authorising and executing payments or funds

transfer requests provided with anti-fraud training?e)

(iv)

Has the firm taken steps to implement the recommendations contained in the Law Society's

Fraud Guidance as issued in February 2016 including any subsequent updates?(i)

Name:

22. RISK MANAGEMENT

Name:

Have all employees involved in handling or transferring client or the Firm's monies been made

aware of the need to confirm and validate the recipient's financial details by way of telephone

call to the client on a previously verified number?

(ii)

To the best of your knowledge and belief, is your Firm's security software, including anti-virus,

anti-spam and firewall software sufficient and regularly reviewed and updated to identify and

remove malware and is all software kept up to date and regularly 'patched'?

(iii)

If you have answered 'No' to questions (i), (ii) or (iii) above, please provide full details below

If None, please state “None”

Name:

Please provide the name and status of the person nominated as the COFA

Please provide the name and status of the person nominated as the COLP

Does your firm accept responsibility or liability for malicious or fraudulent emails purportedly

coming from your firm? i.e. it should remain the client's responsibility to ensure that any

emails coming from your firm are genuine before replying on anything contained within them.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

13

f)

(i)

(ii)

(iii)

(iv)

(v)

g)

(i)

(ii)

(v)

h)

(i)

(ii)

(iii)

social engineering

phishing

masquerading

other fraud schemes

internal and external frauds and scams

When a payment or fund transfer request is made, are the following checks always made and documented?

Written or verbal confirmation from the client that the payment is genuine and correct?

Do your account controls:

If a request is received to alter the payee details held by the firm (including account information, invoice changes,

telephone numbers, contact information or location), what additional checks are in place to verify the request?

Does your training cover:

Confirmation of the reason for the payment?

Confirmation of the authenticity of the payment?

(iii)All payee names and addresses match those held on your company's records, which have

been validated by the client?

(iv)All account numbers, names and sort codes match those held on your company's records,

which have been validated by the client?

i)

Which Legal Services Commission Quality Marks or other quality standards, e.g. LEXCEL, Investors In People, Law

Society Conveyancing Quality Scheme is your practice currently accredited with? Please specify and give the date of

accreditation.

j)

If you have answered no to any of the above, please explain how you manage these risks

If you have answered no to any of the above, please provide full details of how your processes differ:

set limits for each authority holder?

require dual sign-off above a prescribed amount?

ensure separation between the individual instructing payment and the authoriser?

If you have answered no to any of the above, please provide full details of how your processes differ:

(vi)A direct call to the client using the telephone number provided before the payment or funds

transfer instruction was received?

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

14

k)

l)

n)

o)

p)

q)

(i)

(ii)

(iii)

(iv)

r)

Do you have the required procedures in place throughout your firm for:

If necessary, list further details on a separate sheet.

Do you have written work instructions or checklists for the services provided?

Do you have a time recording system?

If you have an e-mail capability do you have an e-mail/internet user policy in place and

enforced?m)

Please outline the steps taken to review work undertaken by staff and describe how they are supervised.

Are all relevant telephone conversations the subject of a note on the file?

If necessary, list further details on a separate sheet.

Please describe the diary system in operation (including back-up procedures).

Client retainer letter?

Vetting clients including checking for conflicts of interest?

Carrying out Money Laundering checks?

Registering claims and complaints?

Please confirm that all fee earners and employees are kept up to date with relevant changes

in legislation and other legal developments which could affect the work and services they

carry out.

Yes No

Yes No

Yes No N/A

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

15

(i)

(ii)

(iv)

(v)

CHECKLIST:

Please provide a claims print issued by Participating Insurers or Assigned Risks Pool for the last 6 years for your

Practice and any Prior Practice(iii)

Has a Principal/Partner/Member/Director signed and dated the form and answered all questions?

Please provide a copy of your letterhead marked "specimen"

Please provide copies of all reports and determinations issued by any Disciplinary Tribunal or any regulatory body

Please provide copies of your last two years statutory/management accounts

Signature

(Principal/Member/Director)Date:

Print Name:

DATA PROTECTION

All personal data collected by PIB Insurance Brokers will be held in accordance with the Data Protection Act 1998. PIB Insurance Brokers will disclose this information to our service providers and agents for administration purposes and for underwriting and claims handling purposes. In addition PIB Insurance Brokers may exchange information with other organisations such as the police, regulatory authorities and professional bodies by whose rules we are bound, through various databases to help us check information provided and to prevent fraud. By returning this form, you consent to the processing of personal data, including sensitive personal data, for these purposes and to PIB Insurance Brokers transferring such information outside the European Economic Area where necessary.When you provide information about another person, you are confirming that they have appointed you to act for them. Such persons will have been made aware of the purposes for the data collection and processing set out above and have consented to such processing. You will receive on their behalf any data protection notices and keep them informed about how their data will be processed and where it may be disclosed.PIB Insurance Brokers may share personal data with other companies with which we establish commercial links so we and they may contact you (by mail, email, telephone or other appropriate means) in order to keep you informed about carefully selected products, services or offers that we believe will be of interest to you. If you do not wish us to do this please tick the box.

IMPORTANT DISCLOSURE INFORMATION

As a result of the Insurance Act 2015 (the “Act”), significant changes have been made to the law in relation to commercial insurance. The Act has a significant impact on the operation of your insurance policy, including your disclosure obligations towards insurers, warranties and fraud. The Act also impacts upon the remedies insurers may adopt in the event of your obligations not being complied with.

The Act imposes an obligation on all policyholders to “make a fair presentation of the risk” prior to the policy commencing. A fair presentation is one that discloses, in a manner that is reasonably clear and accessible, every material circumstance which is known or ought to be known by the policyholder’s senior management, or those responsible for arranging insurance, following a reasonable search.

This means that you must disclose anything which would influence the judgement of a prudent insurer in determining whether to take the risk and, if so, on what terms. There is no specific limitation on what constitutes a material circumstance, but it would typically include any factors pertaining to the risk to be insured including prior claims, your financial history, convictions of key personnel and your business activities. You are not obliged to disclose something that reduces the risk to be insured. The obligation extends to all material circumstances that you ought to know as well as those that you actually know, meaning that if the information is readily available to you but you fail to disclose, for example owing to a lack of enquiry, you will have breached your duty to fairly present the risk. Equally, any relevant knowledge we have as your broker must also be presented to insurers and we must therefore make you aware that all information you provide to us must form part of the presentation of the risk, if relevant.

Your knowledge, for the purposes of the Act, includes (but is not limited to) that of all senior management. Senior management includes anyone who has a key role in making decisions on behalf of the business, even if they do not sit on the board or if they do not officially have a management role. Note that you are obliged to undertake a reasonable search i.e. you will need to demonstrate that appropriate enquiries were made to establish material circumstances that were known or ought to be known by senior management and others you rely on, such as advisers, consultants and specialists. What is reasonable will depend upon the nature of your business, the policy you are purchasing and who is best placed to provide the relevant information.

Finally, all information must be provided to insurers in a reasonably clear and accessible manner. This means that information must not be provided in an ambiguous way and the new rules also prevent policyholders from concealing key facts amongst large volumes of less relevant or immaterial information.

If you are in any doubt whether a circumstance is material, you should disclose it.

CONFIRMATION

I/We declare that I/We have read and understood the Important Disclosure Information above. I/We declare on behalf of the firm that the particulars and statements in this proposal and any additional information submitted are true and I/we have not mis-stated or withheld any material circumstances.

I/We understand that failure to inform Insurers of all material circumstances may result in an Insurer applying ‘proportionate remedies’ to any claim which could in certain circumstances result in the contract being invalidated, I/We accept that if I/We am/are in doubt whether any fact may influence the Insurer I/We should disclose it. I/We also understand that I/We have a continuing obligation to disclose all material circumstances up to commencement of and throughout the period of the policy.

I/We accept that all data collected by PIB Insurance Brokers will be held in accordance with the Data Protection Act 1998 and that PIB Insurance Brokers may disclose this information only in order to obtain quotations for my/our practice’s professional indemnity insurance.

PROPOSAL FORM COMPLETION

PIB Insurance Brokers may have assisted you with the completion of this proposal form. You should not rely on any information which may have been populated on your behalf. This application will form part of the ‘fair presentation of risk’ for your insurance cover, it is essential that you check to ensure that the information contained in this form is correct and accurate before signing this declaration. Any errors or inaccuracies in your application may result in the contract of insurance being invalidated.

Signing this form does not bind you to accept any quotation provided by PIB Insurance Brokers.

THIS PROPOSAL FORM MUST BE SIGNED BY A PRINCIPAL/MEMBER/DIRECTOR OF THE FIRM

PIB Insurance Brokers is a trading style of Cooke & Mason Plc. Cooke & Mason Plc is authorised and regulated by the Financial Conduct Authority,

Firm Reference Number 308333.

Cooke & Mason Plc is registered in England and Wales. Company Registration Number 2682789. Registered Office: Rossington’s Business Park, West Carr Road, Retford, Nottinghamshire, DN22 7SW

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