UNDERWRITTEN IN CHUBB CUSTOM INSURANCE COMPANY A. GENERAL INFORMATION

Transcription

1 Chubb Group of Insurance Companies 15 Mountain View Road, Warren, New Jersey RENEWAL APPLICATION BANKERS PROFESSIONAL LIABILITY POLICY UNDERWRITTEN IN CHUBB CUSTOM INSURANCE COMPANY Bankers Professional Liability coverage is written on a claims-made basis. Except as otherwise provided, this Policy will cover only claims first made against the Insured during the Policy Period. Please read the Policy carefully. Defense Cost Provision: Please note that the Defense Cost provision of this Policy stipulates that the Limits of Liability are reduced or exhausted by the Defense Costs. Any Deductible Amount is reduced or exhausted by Defense Costs. A. GENERAL INFORMATION 1. a. Name of Applicant: b. Address of Applicant: (Street Address) (City) (State) (Zip Code) 2. Limits of Liability Desired: a. Each Loss: $ b. Aggregate: $ 3. a. Provide the dates of the last regulatory examinations along with the name of the examining agency for the Applicant and each subsidiary. (If necessary, attach separate sheet). Dates of last examination: Name of Examining Agency: b. Have all recommendations or criticisms of the last examination been complied with as respects the Applicant and subsidiaries? If no, please provide, on a separate sheet, full details. 4. Provide the following information: a. Blanket Bond: Limit: _ Expiration Date: _ Deductible: _ Insurer: b. General Liability Insurance: Limit: _ Expiration Date: _ Deductible: _ Insurer: c. Directors & Officers Liability: Limit: _ Expiration Date: _ Deductible: _ Insurer: _ Form (Ed. 9-97) Page 1 of 18

2 5. Is the Company or any of its Subsidiaries currently offering or planning to offer any of the following services? a. Actuarial Services? b. Real Estate Appraisal Services? If yes, complete Supplemental Part A. c. Data Processing Services? If yes, complete Supplemental Part B. d. Insurance Agent/Agency? e. Investment Advisor/Counselor/Manager? If yes, complete Supplemental Part C. f. Real Estate Agent/Agency Manager? If yes, complete Supplemental Part A. g. Real Estate Investment Trust Advisory Services? h. Security Broker/Dealer? If yes, complete Supplemental Part D. i. Travel Agent/Agency? j. Underwriting of Securities? k. Wire Transfer Services? l. Lending or Leasing Services? If yes, complete Supplemental Part E. m. Trust Department Function? If yes, complete Supplemental Part F. 6. If any of the services listed above have changed as to a material policy or procedure, managerial or organizational change in the past twelve (12) months, please check below and attach an explanation. Check here B. PAST ACTIVITIES 1. Has the Applicant, its Subsidiaries or its Directors and Officers been involved in or have any knowledge of any fact or circumstance which may give rise to a claim under the proposed Policy involving the following: a. Any antitrust, copyright, patent litigation, or Trademark Infringement? b. Any civil or criminal action or administrative proceeding involving a violation of any federal or state security law or regulation? c. Any civil or criminal action or administrative proceeding involving a violation of any federal or state antitrust or Fair Trade Law? d. Any representative actions, class actions, or derivative suits? If yes, to any of the above, please provide, on a separate sheet, full details. 2. Have there been during the last year, or are there now pending, any suits, claim or proceedings against this Applicant or subsidiaries? If yes, please provide, on a separate sheet, full details. Report claims for all Professional Services including all Trust Functions. 3. Have there been during the last year, or are there now pending, any suits, claims or proceedings against any person proposed for this insurance in their capacity as either Director, Officer or employee of this Applicant or its Subsidiaries? If yes, please attach supplemental claim or incident information form(s). C. OTHER INFORMATION Please attach the following Applicant information with this completed APPLICATION: a. Latest two C.P.A. Management Letters and Responses. b. Latest two Annual Reports to Stockholders; including Audited Financial Statements. c. All promotional material distributed in connection with each service you offer. d. Specimen contract applicable to each service offered. e. Any supplemental completed in conformance with Question No. 7. Form (Ed. 9-97) Page 2 of 18

3 The undersigned persons declare that to the best of their knowledge the statements set forth herein in all sections of the Application and in any attachments to this Application are true and correct, and that every reasonable effort has been made to obtain sufficient information from all persons proposed for this insurance to facilitate the proper and accurate completion of this APPLICATION. The undersigned further agree that, if between the date of APPLICATION and the effective date of this Policy (1) any material change in the condition of the Applicant is discovered or (2) there is any material change in the answers to the questions contained herein, either of which would render this APPLICATION inaccurate or incomplete, notice of such change will be reported in writing to the Insurer immediately, and, if necessary, any outstanding quotation may be modified or withdrawn. The signing of this APPLICATION does not bind the undersigned on behalf of the Applicant to purchase the insurance, but it is agreed by the Applicant and all persons proposed for this insurance that the particulars and statements contained in this APPLICATION and the attachments and materials submitted with this APPLICATION (which shall be retained on file by the Company and shall be deemed attached to the Policy, if insurance is provided, as if physically attached thereto) are true and correct and will be the basis of the Policy and will be considered as incorporated in and constituting a part of the Policy. It is further agreed by the Applicant, and all persons proposed for this insurance, that such particulars and statements are material to the decision to provide this insurance and that any Policy will be issued in reliance upon the truth of such particulars and statements. PLEASE TE: ONLY DULY APPOINTED AGENTS OF THE COMPANY AND LICENSED BROKERS ARE AUTHORIZED TO SOLICIT APPLICATIONS FOR COVERAGE. AGENTS AND BROKERS ARE T AUTHORIZED TO BIND COVER- AGE. COVERAGE SHALL BE PROVIDED UNLESS THE COMPANY ACCEPTS THE APPLICATION AND BINDS THE COVERAGE. False Information: Any person who, knowingly and with intent to defraud any insurance company or other person, files an Application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. False Information (Florida Only) Any person who, knowingly and with intent to inure, defraud, or deceive any insurer, files a statement of claim or an Application containing any false, incomplete, or misleading information is guilty of a felony of the third degree. False Information (Louisiana Only) Any person who, knowingly and with intent to deceive any insurance company or other person, files an Application for insurance containing any false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. False Information (New York Only) Any person who, knowingly and with intent to defraud any insurance company or other person, files an Application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation. False Information (Pennsylvania Only) Any person who, knowingly and with intent to defraud any insurance company or other person, files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Company Signature of Chief Executive Officer (or other Senior Officer if the Chief Executive Officer is also the Chairman, Board of Directors) Signature of Chairman, Board of Directors Date A policy cannot be issued unless the RENEWAL APPLICATION is properly signed and dated by the Chief Executive Officer (or other Senior Officer if the Chief Executive Officer is also the Chairman, Board of Directors) and the Chairman, Board of Directors. Note: This RENEWAL APPLICATION and all exhibits shall be treated in strictest confidence. Form (Ed. 9-97) Page 3 of 18

4 RENEWAL SUPPLEMENTAL APPLICATION PART A BANKERS PROFESSIONAL LIABILITY POLICY 1. Name of Applicant: A. REAL ESTATE BROKER/APPRAISAL 2. Please indicate the functions performed and volume/income information: a. Are all activities in-house only? If no, please complete the balance of Supplemental #1. b. Broker or Agent: If yes, please provide the following information for the last year. Number of Properties Sold Total Market Value Total Commissions Commercial Residential Other TOTALS c. Number of employees who are licensed as brokers/agents: d. Real Estate Appraiser: If yes, please provide the following for the last year: Number of Appraisals Fee Income Commercial Residential Other TOTALS e. Number of employees acting as real estate appraisers: f. Are all real estate appraisers required to obtain professional certification and belong to professional associations for appraisers? If yes, please provide, on a separate sheet, full details indicating the certifications and professional associations. If yes, indicate the certifications and professional associations: Form (Ed. 9-97) Page 4 of 18

5 g. Real Estate Manager: If yes, please provide the following: Number of Properties Managed Estimated Revenue Total Management Fees Commercial Residential Other TOTALS h. Do sales contracts and/or property management contracts provide indemnity and/or limitations as to the Applicant s liability? If no, please provide, on a separate sheet, policies and procedures. i. Does the Applicant require a hazardous materials or waste survey before accepting appointment as manager of properties? If no, please provide, on a separate sheet, policies and procedures. j. Does the Applicant have policies and procedures for its management of properties? If yes, are there specific guidelines regarding the maintenance of insurance on managed properties? Signature Date Form (Ed. 9-97) Page 5 of 18

6 RENEWAL SUPPLEMENTAL APPLICATION PART B BANKERS PROFESSIONAL LIABILITY POLICY 1. Name of Applicant: B. EDP SERVICES 2. Indicate the types of business services provided, and the annual income from each type: Type Yes/No Annual Fees a. Accounting b. Payroll c. Accounts Pay/Rec. d. Cost/Gen. Acct. e. Management Reporting f. Other (Please provide, on a separate sheet, full details) TOTAL FEES 3. Indicate the types of data services provided and percentage of data processing revenue derived from each: Type Yes/No % of Processing Revenue a. Check Processing b. Data Storage c. Data Entry d. Data Collection e. Data Processing f. Other (Please provide, on a separate sheet, full details) 4. Does the Applicant have a comprehensive disaster recovery plan? If yes, indicate the name of the offsite center: If no, please provide, on a separate sheet, full details describing the procedures in place for disaster recovery. 5. Does the Applicant have a specialized EDP audit staff? If yes, are they required to obtain the Certified Information Systems Auditor designation? 6. Do clients have contractual responsibility for determining the accuracy of results? 7. Is this service rendered under a contract? If yes: (a) are all contracts approved by counsel? (b) do all contracts provide indemnity and/or limitations to the Applicants liability? If no, please provide, on a separate sheet, full details describing how the Applicant protects itself from liabilities. Signature Date Form (Ed. 9-97) Page 6 of 18

7 RENEWAL SUPPLEMENTAL APPLICATION PART C BANKERS PROFESSIONAL LIABILITY POLICY 1. Name of Applicant: C. INVESTMENT MANAGER 2. Exclusive of your trust department, indicate the number of customers or accounts for which investment advice is provided by the Applicant: a. What is the total value of the assets for which Investment advice is provided? b. What is the value of the largest account? c. What are the total fees earned by this service? 3. Are services provided for: a. Individuals b. Corporations c. Charitable Institutions d. Applicant s or an affiliates Trust Department e. Other 4. Are there established criteria for identifying individual customers for whom investment advisory services will be provided (e.g., income level, net worth)? 5. Do customers complete a questionnaire or other written document which clearly identifies and states the customer s investment objectives? 6. Does the Applicant recommend investment areas other than commonly traded securities? If yes, please provide, on a separate sheet, full details describing the specialty area, state its percentage of total investment assets, objectives of investment, and geographic locations if applicable. 7. Is this service rendered under a contract? If yes: (a) are all contracts approved by counsel? (b) do all contracts provide indemnity and/or limitations to the Applicants liability? If no, please provide, on a separate sheet, full details describing how the Applicant establishes customer expectations for service. 8. Please provide, on a separate sheet, full details describing professional qualifications of individuals involved in the provision of this service. 9. Who is the Compliance Officer charged with monitoring your investment management function? Signature Date Form (Ed. 9-97) Page 7 of 18

8 RENEWAL SUPPLEMENTAL APPLICATION PART D BANKERS PROFESSIONAL LIABILITY POLICY 1. Name of Applicant: D. SECURITIES BROKER/DEALER 2. Average daily trading volume: 3. Does the Applicant s Brokerage Department offer margin account? 4. State percentage of volume of margin account transactions? 5. What percentage of accounts are: Individual Corporate Institutional Others 6. a. Give number of complaints received in the past three years: b. How many were unresolved after 60 days? 7. State percent of revenues which are derived from the following: a. Listed Stocks b. Unlisted Stock c. Bonds d. Unregistered Stocks and bonds e. Commercial Paper f. Options Contracts g. Commodity Futures h. International Securities (non-domestic stock exchange) i. Mutual Funds j. Limited Partnerships k. Direct Private Placements l. Market Making/Specialist m. Underwriting n. Other (please specify) 8. a. Does the Brokerage Department clear its own trades? If no, indicate the name of the broker or clearing agent used: b. Is the selection reviewed annually? c. Is there a hold harmless clause in the contract with the broker or clearing agent to protect the Applicant for improperly executed trades? 9. a. Do clients sign a written brokerage contract with the Applicant s Brokerage Department? b. Does the contract contain an arbitration agreement? Form (Ed. 9-97) Page 8 of 18

9 c. If the operation is a discount brokerage, does the contract or other literature given to clients clearly define the bank s responsibility and specifically indicate that no investment advice is to be given? 10. Does the Applicant have an economic forecasting department? If yes, please provide, on a separate sheet, full details describing the qualifications of its principal managers and/or officers: 11. What was the total fee income generated from these activities during the year? 12. Please provide, on a separate sheet, full details describing the types of financial and economic advisory projects performed for commercial clients. 13. Are services rendered for commercial clients? If yes: (a) are all contracts approved by counsel? (b) do all contracts provide indemnity and/or limitations to the Applicants liability? If no, please provide, on a separate sheet, full details describing how the Applicant protects itself from liabilities. 14. What percentage of your broker/dealer revenue is derived from your activities as a discount broker? 15. Who is the Compliance Officer charged with the responsibility of monitoring your Broker/Dealer function? Signature Date Form (Ed. 9-97) Page 9 of 18

10 RENEWAL SUPPLEMENTAL APPLICATION PART E BANKERS PROFESSIONAL LIABILITY POLICY 1. Name of Applicant: E. LENDING OR LEASING SERVICES 2. Please attach a copy of the most recent itemized summary describing the type and volume of loans and leases as presented to your Board of Directors. 3. Is there a formal lending policy (adopted by the Board of Directors) addressing all types of loans and leases in which you participate? If no, please describe as attachment #1. 4. Does your formal lending policy describe minimum documentation standards for each type of loan or lease in which you participate? If no, please describe as attachment #2. 5. Who is responsible for ascertaining that documentation standards established by your formal lending policy are met? 6. Who is the Compliance Officer charged with the responsibility of monitoring your lending function? 7. To whom and with what frequency does your Compliance Officer provide formal findings? 8. What is your current CRA rating? If multiple ratings, please specify: 9. a. When was your last Fair Lending exam? b. Please provide, on a separate sheet, full details describing what violation(s) were cited (i.e. violation of the Fair Housing Act? Violation of the Equal Credit Opportunity Act. Violation of the Home Mortgage Disclosure Act?) 10. Does an application completed by the loan Applicant accompany all requests for loans? If no, under what circumstances is an application not required? 11. Are all loan declinations notified to the loan or lease Applicant as to reason(s) for the declination? If no, please describe exceptions: Form (Ed. 9-97) Page 10 of 18

11 12. Are formal commitment letters provided to all approved loans, leases and/or approved lines of credit? If no, please describe exceptions: 13. How are lines of credit documented (in writing) to the borrower as to criteria the borrower must meet before future funding of the credit will be extended? 14. Have all Internal Audit and Compliance exceptions within the lending and leasing functions been corrected? If no, please provide, on a separate sheet, full details. 15. Do you ever become involved in the management of business of any borrower either directly or indirectly? If yes, please provide full details on a separate sheet. 16. Have all regulatory criticisms from your last Safety and Soundness exam been addressed and corrected to the satisfaction of your regulator(s)? If no, please provide full details on a separate sheet. Signature Date Form (Ed. 9-97) Page 11 of 18

12 RENEWAL SUPPLEMENTAL APPLICATION PART F BANKERS PROFESSIONAL LIABILITY POLICY Name of Applicant: Section I - Asset Distribution F. TRUST DEPARTMENT FUNCTIONS 1. With respect to all accounts in the Trust Department, please provide the following (include consolidated information for the Applicant and all subsidiaries): Market Value Advisory / No. of of Assets Managed / Non- Accounts (in Thousands) Discretionary Discretionary Custodial Individual Accounts Trusts, Estates (excluding ERISA) $ % % % ERISA Accounts: HR-10 and IRA Plans $ % % % Non-ERISA Pension Plans $ % % % Other Institutional $ % % % Other $ % % % TOTAL $ % % % Corporate Trust: Trustee under Bond Indenture $ % % % Fiscal Agent $ % % % Sinking Fund Agent $ % % % Escrow Agent $ % % % Transfer Agent $ % % % Registrar $ % % % Dividend Disbursing Agent $ % % % All Other $ % % % TOTAL $ % % % Mutual Funds: Custodian $ % % % Transfer Agent $ % % % Registrar $ % % % Dividend Disbursing Agent $ % % % All Other $ % % % TOTAL $ % % % Form (Ed. 9-97) Page 12 of 18

13 2. For each Common Trust Fund that the Applicant sponsors, provide the following: Most Recent Most Recent Name Fund Objective Market Value Assets Book Value Assets $ $ _ $ $ _ $ $ _ $ $ _ $ $ TOTAL $ $ 3. Trust Accounts: a. Asset value of Largest Managed/Discretionary account: $ b. Asset value of Largest Non-Discretionary account: $ c. Asset value of Largest Custodial account: $ Section II - Securities Processing and Investments 1. a. Please provide, on a separate sheet, full details describing or name the trust accounting system(s) in use (if different systems are in use at different subsidiaries, so indicate): b. Provide the installation date(s) of the current trust accounting system(s): c. Does the Applicant plan to install a new trust accounting system in the next 18 months? 2. Does the Applicant perform management or advisory functions with respect to: Total Value of Assets a. Closely-held Businesses? $ b. Farms and Ranches? $ c. Other Real Estate? $ d. Mergers, Acquisitions, or Takeovers? $ e. Oil, Gas, or Other Mineral Leases? $ f. Timber Interests? $ If yes, please provide, on a separate sheet, the policies and procedures which govern each activity. 3. Does the Applicant s investment division recommend or provide any of the following specialty investments: a. Below Investment Grade Bonds? b. Cattle Trusts or Ventures? c. Commodity or Other Futures? d. Precious Metals? e. Mortgages, Mortgage Pools, or Other Mortgage-Backed Securities? f. Oil/Gas Leases or Investments? g. Covered Call Options? h. Option Contracts or Futures? i. General or Limited Partnerships? j. Real Estate? k. Foreign Securities (Domestic Exchange)? l. International Securities (Non-Domestic Stock Exchange)? m. Over-the-Counter Securities? n. Restricted Securities? If yes, please provide, on a separate sheet, the policies and procedures which govern each specific investment area. Form (Ed. 9-97) Page 13 of 18

14 4. Does the Applicant have an approved list of securities in which assets held by the Trust Department may be invested? 5. a. Does the Applicant enter into any Repurchase/Reverse Repurchase Agreements, securities lending agreements, and/or other similar type of transactions that involve the assets of any trust, investment management, or custodial account? b. If yes, does the Trust Department obtain the clients written authorization to enter into these transactions? c. If the answer to (5.a.) is yes, please attach the following: (1) The Applicant s polices for approval of transactions. (2) Procedures for approving Broker/Dealers and other institutions. (3) A list of dollar amounts outstanding and the name(s) of the Broker/Dealer(s) or other institution(s). (4) The procedures used to monitor and account for collateral in these transactions. 6. a. Do the Applicant s commercial departments underwrite or participate in the underwriting of debt securities? b. Does the Trust Department serve as trustee for any debt securities underwritten by the Applicant s commercial departments? If yes, please provide the following: (1) Number of issues: (2) Total amount of debt outstanding: $ c. Does the Applicant serve as trustee for any debt underwritten by other institutions and issued by any: (1) governmental or quasi-governmental entity? (2) Private or public corporation? If yes is indicated in response to either of these questions, complete the following section: Form (Ed. 9-97) Page 14 of 18

15 Governmental or Quasi-Governmental Entity Private or Public Corporation Number of issues: Total amount of debt outstanding: $ $ Number of issues rated by Moody s or Standard & Poor s: Number of issues in default: Amount of debt outstanding for issues in default: $ $ Number of issues supported by a letter of credit, credit line, or some other form of credit support: If this support is provided by Applicant or an affiliate, please indicate: Total number of issues: Total amount of debt outstanding: $ $ Number of issues backed by municipal bond or financial guaranty insurance: Number of issues backed by federally guaranteed mortgages: N/A Number of multi-family housing issues backed by municipal bond insurance: N/A d. Does the Applicant have a special unit to administer accounts where it is acting as trustee for debt securities? If yes, provide an organization chart of the unit. e. Does the Applicant have a special team to handle defaults or troubled accounts? If yes, please provide, on a separate sheet, full details describing the organization of the team and its procedures. f. Please provide, on a separate sheet, full details describing the procedures followed to monitor the call provisions for any debt or equity security for which the Applicant acts as trustee or registrar. Form (Ed. 9-97) Page 15 of 18

16 Section III - Fiduciary Activities 1. When the Applicant s succeeds another bank, entity, or person as trustee, is a hold harmless agreement executed in the Applicant s favor? If no, please provide, on a separate sheet, full details describing on a separate sheet, how the Applicant protects itself from liabilities of the predecessor trustee. 2. a. Does the Applicant control 5% or more of the stock of any corporation via its trust functions? If yes, please provide, on a separate sheet, a listing and the percentage held of each corporation. b. Is the Applicant involved in the management or actual operation of any of the above-mentioned corporations? c. Does any Director, Officer or employee of the Applicant act in the capacity of Director or Officer of any of the corporations listed in (a) above? If yes, please provide, on a separate sheet, the names of the corporation, the names of the individuals holding the positions, and the positions held. It is agreed that coverage is not provided under this Policy for the outside positions or corporations listed in conjunction with the above question. Section IV - Business Operations 1. a. If the Applicant is a multi-bank holding company, are trust powers exercised by more than one subsidiary? If yes, please describe on a separate sheet, the policies and procedures the holding company utilizes to coordinate and control trust functions, including Board oversight at the holding company level. b. Please attach an organizational chart. c. Have there been any changes in senior management of the Applicant s Trust Department(s) within the past year? If yes, please provide, on a separate sheet, full details. d. Does the Applicant employ full-time in-house legal counsel who is dedicated solely to providing legal advice to the Applicant s Trust Department? If no, please provide the name(s) and address(es) of the outside law firm acting as trust counsel: e. Before accounts are accepted, does the law firm or internal counsel review: (1) Personal trust documents? (2) Corporate trust documents? If no, please provide, on a separate sheet, the review procedures. Form (Ed. 9-97) Page 16 of 18

17 3. How often are statements and accountings rendered to clients? Please attach a sample statement. 4. Is the Applicant or any of its subsidiaries currently offering or planning to offer any of the following services? a. Estate Planning? b. Actuarial Services? c. Underwriting of Securities? d. Discount Broker Services? e. Data Processing Services? f. Trust Advisory Services to Non-Affiliated Entities? g. Security Broker/Dealer? h. Investment Advisor/Counselor to Non-Trust Clients? i. Real Estate Investment Trust Advisory Services? j. Tax Rebate Calculations for Municipal Bond Issues? 5. Has the Applicant discontinued any trust functions within the past 12 months or does it intend to do so within the next 12 months? If yes, please provide, on a separate sheet, full details. 6. Has the Applicant been involved in any merger, consolidation, or acquisition with any other entity during the last policy period or does it intend to do so within the next 12 months? If yes, please provide on a separate sheet, a description of the details and effects on trust functions. 7. a. Does the Trust Department have its own Compliance Officer? If yes, what percentage of his/her time is spent on the compliance function? If no, please provide, on a separate sheet, how this function is accomplished. % b. To whom and with what frequency does your Compliance Officer provide formal findings? 8. a. State the dates of the most recent internal, external, and regulatory audits of Trust Department and Common Trust Funds: Trust Department Latest Audit Common Trust Funds Latest Audit Internal _ External _ Regulatory _ b. Were any recommendations or criticisms made in the most recent audits in the following categories: Internal? External? Regulatory? If yes regarding any category, please provide, on a separate sheet, a copy of the recommendations or criticisms. Form (Ed. 9-97) Page 17 of 18

18 c. Have all recommendations or criticisms been corrected: Internal? External? Regulatory? If no, please provide, on a separate sheet, full details. 9. Has any carrier refused or cancelled Trust Department Errors and Omissions coverage? 10. a. Please give details of the following insurance carried by the Applicant (if none, so state): Limit Deductible Carrier Term Directors & Officers Liability Fidelity Bond Blanket Trust Policy (For Property and Liability Coverage) Data Processing Errors and Omissions General Liability Other Insurance on Trust Assets Identify b. Have any of the above coverages been cancelled by the Insurer or has any Insurer refused to renew any of those coverages? If yes, please provide, on a separate sheet, full details. 11. As part of this Application, please submit the following with respect to the Applicant (if n/a, please indicate): a. Latest Independent Audit Report of trust functions. b. Latest Annual Report for each Common Trust Fund. c. Latest Internal Audit Report of trust functions and any written response thereto. d. Copy of Applicant s current Trust Department E&O Policy. e. Latest Annual Report of Trust Assets filed with the FDIC, OTS or OCC for each Bank (If a multi bank holding company). Signature Date Form (Ed. 9-97) Page 18 of 18