SOLICITORS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM 2017

Transcription

1 SOLICITORS PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

2 Important Notes This Proposal Form should be completed and signed by a Partner, Director or Principal of the Firm. It is your duty to disclose all material facts to Insurers. The duty of disclosure under Irish law is a duty to pass on to the Insurers all material information relating to the risk under consideration. Material in this context refers to all information which prudent Insurers (not necessarily the Insurers in question) would wish to take into account when considering whether or not to accept the risk, upon what terms and at what price. Material information does not necessarily increase the risk. The duty of disclosure continues up until the Insurance has been concluded and resurrects in the event of any amendment to the risk during the policy period or extension/renewal. It may also be that the terms of the policy include specific ongoing disclosure conditions or warranties which effectively extend the duty of disclosure post inception of the policy. In completing a proposal or claim form or any other material document relating to an insurance policy and in providing information to or for Insurers, the accuracy and completeness of all answers, statements and/or information is the policyholder s own responsibility and it is of paramount importance that all relevant information is provided and that it is accurate. Should you so require, you may request that we assist you by providing examples of the types of matters which ought to be disclosed as being material or arguably material, in general terms or specific to your risk from the knowledge we gain from working with you to understand your risk. In the event of a breach of the duty of disclosure, the Insurers have the right to avoid the Insurance from its commencement. Under such circumstances, the Insurers would be entitled to seek recovery of any claims already paid by them under the Insurance, although at the same time the Insurers would generally be obliged to return paid premium (in the absence of dishonest conduct). The completion and signature of this Proposal Form does not bind the Proposer or Underwriters to complete a Contract of Insurance. A copy of this completed Proposal Form should be retained for your own records. When completed, please return to the Solicitors Professional Indemnity Team at one of the two below addresses: Friends First House, Cherrywood Business Park, Loughlinstown, Dublin 18 Tel: solicitors@jlt.ie or Building 5200 Cork Airport Business Park Cork Tel: solicitors@jlt.ie Ray O Higgins ACII, Director T: +353 (0) M: +353 (0) E: rohiggins@jlt.ie Marcus Carey BSc. CIP, MDI, Account Manager T: +353 (0) M: +353 (0) E: mcarey@jlt.ie David Loughrey MDI. CIP, Account Executive T: +353 (0) E: dloughrey@jlt.ie John Murphy CIP, Regional Director, T: +353 (0) M: +353 (0) E: jmurphy@jlt.ie Insurers hereby deem the questions asked in the Proposal Form to be their own and sufficient for underwriting purposes. Insurers may request additional information if applicable. 2

3 1 General Information Name of Policyholder Principal Address Law Society Firm Number Firm Telephone Number Firm Address Date of establishment and date of change of status if applicable Contact Person 2 Solicitors & Fee Earners Number of all persons working in your firm: Partners / Principals Other Solicitors / Consultants Support Staff Other Fee Earners Please give details for all fee earners: (If space provided is insufficient, please use separate sheet) Solicitors Roll Number Name Date of Admission How long with you? Other Fee Earners Name Qualifications How long with you? 3

4 3 Fee Income Fee Income Year ending (dd/mm/yyyy) Total ESTIMATED current financial year LAST COMPLETED financial year Financial year before last Financial year but two Financial year but three Financial year but four 4 Business Activities Please provide a percentage breakdown of the fee income for the last accounting period into the following categories: Type of Work 4 Percentage Acting as arbitrator, adjudicator or mediator % Commercial conveyancing % Commercial/corporate work excluding public listed companies % Commercial /corporate work for public listed companies % Criminal law % Debt collection (judgement debts over 10,000) % Defendant litigious work for insurers % Employment % Family (excluding children) % Financial advice and services % Immigration % Intellectual property rights (excluding patent registration) % Landlord and tenant % Litigation and arbitration (other) % Mergers and acquisitions % Patent % Personal injury defendant % Personal injury litigant % Personal insolvency % Residential conveyancing (PPR) % Tax % Wills, trust and probate % Other non-litigious % Other low risk work* % Other work (please state nature and percentage of work below):% Total (must equal 100%) 100% *Other low risk work includes debt collection under 10,000, children, mental health tribunal, welfare, administrating oaths and taking affidavits, lecturing and related activity, expert witness and planning % %

5 5 Conveyancing If in the past five years your fee income includes income from conveyancing, please give a split of THAT fee income figure as follows: PPR conveyancing Commercial conveyancing Number of undertakings that currently remain undischarged Gross Fees Number of transactions Gross Fees Number of transactions PPR conveyancing Commercial conveyancing Estimate for current year (2017) Last complete financial year (2016) Financial year before last (2015) Financial year but two (2014) Financial year but three (2013) Financial year but four (2012) a. Are you aware of any disputes, questions or queries arising from the provision of Commercial Property Undertakings given or accepted by your firm? Yes No b. Have you received correspondence from any bank or financial institution threatening legal action or a report to the Law Society in relation to a delay or non-compliance with any Commercial Property Undertakings given by your firm? Yes No c. In the last 6 years, has more than 10% of your conveyancing turnover derived from single source or referrer? Yes No d. In the last 6 years, has your firm acted for multiple buyers of property in the same development or in the same building? Yes No 6 Claims and circumstances a. Has your firm or any Preceding Practice made any claim or reported any circumstances in the last 6 years? Yes No b. Please provide details of all claims and circumstances, including firms referred to in (a) above, made to insurers for each of the following years of experience, including firm referred to in question 1. NOTE: Do not leave this section blank. If you have no claims, please state No claims. Indemnity Period Name of Participating Insurer / Assigned Risks Pool Number of claims / circumstances Claims / circumstances attached YES / NO

6 c. Please attach to this form your current claims report provided by the above participating insurer(s) or the Assigned Risks Pool. If this is not yet available, please provide claims/circumstances details on a separate sheet. d. Is any Principal or Partner aware, after careful enquiry, of any loss or claim or circumstance which may give rise to a loss being sustained or claim being made against or involving any person or persons to be included in this insurance, their predecessors in practice or any past partners, directors or members, where such has not been previously notified to past or present insurers? Yes No If yes, please provide full details on a separate sheet. 7 Risk Management Have you achieved any risk management or quality standard? Yes No If YES please state: Name of Risk Management / Quality Standard Risk Management / Quality Standard Score 8 Basis Of Cover a. As a minimum we will provide insurance terms to you for a limit of indemnity in the amount of 1,500,000 in respect of any one claim. If you require cover in excess of the minimum 1,500,000 limit of indemnity please state the total amount required: b. Please state your required policy deductible / excess if greater than the minimum 4,500 in respect of each and every claim 6

7 9 Declaration Please read carefully the following statements prior to signing where indicated. The completion of this proposal does not bind the Practice or Insurers to affect a Contract of Insurance, but if a policy is issued, this Proposal Form, together with any other information supplied prior to inception shall form the basis of any Contract of Insurance affected thereon. Any liability of Insurers, under any policy issued, to provide insurance cover over and above the minimum limit of insurance cover required by the Law Society of Ireland will be subject to the terms and conditions specifically applicable to such Excess cover, which terms and conditions may differ from the Minimum Terms and Conditions of Professional Indemnity Insurance for Solicitors in Ireland as specified by the Law Society of Ireland. In particular but without limitation, in the event that the Practice fails to disclose and/or misrepresents circumstances known to it at any time prior to the inception of Excess cover (and not merely at the date that this Proposal Form is signed) which may give rise to a claim, the Insurers reserve the right to take whatever action is deemed appropriate and necessary in accordance with the terms and conditions applicable to the Excess cover. I/We declare that the statements and particulars in this Proposal Form are true and that no material facts have been misstated or suppressed after enquiry. I/We agree that this Proposal Form, together with any other information supplied shall form the basis of any Contract of Insurance affected thereon. I/We undertake to inform the Insurers of any material alteration to those facts occurring before the completion of the Contract of Insurance. Signed: Date: Principal / Partner / Authorised Signatory (This form must be signed by a Principal, Partner or Authorised Signatory) Important Notes Professional Indemnity Insurance is written on a claims made basis that means that claims are dealt with by the insurer on cover when a claim or circumstance is notified, not when the error is made. You should notify us separately and immediately of any claim, or circumstance which you think may lead to a claim. Please ensure that a copy of your up to date claims experience from all previous insurers is attached to this proposal before posting. Please also enclose details of any further information which you would like to be considered by insurers. 7

8 Friends First House Cherrywood Business Park Loughlinstown Dublin 18 Building 5200 Cork Airport Business Park Cork JLT Insurance Brokers Ireland Limited trading as, JLT Financial Services, GIS Ireland, Charity Insurance, Teacherwise, Childcare Insurance, JLT Online, JLT Trade Credit Insurance, JLT Sport is regulated by the Central Bank of Ireland. Directors: Eamonn Bergin, Paul Doherty, Adrian Girling (British), Aidan Gordon, Patrick Howett, Michael Lacey, Dan McCarthy, Raymond O Higgins. Registered Office: Cherrywood Business Park, Loughlinstown, Dublin 18. A member of Jardine Lloyd Thompson Group plc. Registered in Ireland No VAT No W. Private Company Limited by Shares. August