Fidelity Guarantee Insurance Proposal

Transcription

1 Allinz Insurne pl Proposl Form Fidelity Gurntee Insurne Proposl Plese use BLOCK LETTERS nd tik oxes where pproprite Client Detils Cover does not tth until this proposl hs een epted y Allinz Insurne pl. Plese supply the following detils. If you do not hve enough room plese use seprte piee of pper. Full Nme of Employer Compny Registrtion. (if pplile) Address Postode Telephone. Yer Estlished Full Business Desription/Ativities Nmes nd Ativities of ll Susidiry Compnies to e inluded Plese nswer ll of the following questions. Importnt: This form should only e ompleted nd signed y senior exeutive, offiil, diretor or prtner uthorised to sign on ehlf of the Proposer. 1 Stte the totl numer of employees nd estimted wgeroll for the finnil yer most onurrent with the period of insurne in the following tegories:.of Employees Estimted Wgeroll Mngers, Diretors nd Exeutives Trvellers, Colletors nd Slesmen Drivers d Other employees hving responsiility (diretly or indiretly) for money, seurities, stok or ounts e All other employees 2 Stte estimted nnul turnover 3 Wht is the totl numer of premises oupied y your employees? 4 Hve you previously pplied for, or re you urrently pplying for Fidelity Gurntee (Theft By Employee) insurne from nother insurer? If, hs ny insurer refused terms or pplied speil onditions or restritions? Insurer/Detils Dte Applition mde

2 Generl 1 Hve ny lims previously ourred or hs there een osion to dout the honesty of ny employee? If, plese provide dte(s), irumstnes, mount involved, how it ws disovered nd steps tken to prevent reurrene 2 Do you hve doumented poliy on Seurity within your orgnistion? Does it omply with BS7799 or ISO 27001:2005? Does it inlude omputer seurity? Hs diretor or senior memer of stff een given responsiility to enfore nd review this? d Are ll stff mde wre of it? e Are ll employees mde wre of the person to whom they should report the disovery of possile loss or tivities whih my led to loss? f Plese enlose opy with this proposl form enlosed 3 Do ny employees to e insured reside or work outside Gret Britin, rthern Irelnd, the Chnnel Islnds nd the Isle of Mn? If, plese provide full detils 4 Are ll employees to e overed who hve responsiility for stok ontrol, wge or ounting funtions required to tke 14 onseutive dys holidy per nnum? 5 Do professionl uditors udit your ounts t lest one every 12 months? Do they udit ll lotions? Nme nd ddress of your uditors d Do you hve n internl udit tem? (If, you now need to omplete Appendix 1 Internl Audit) 6 Do you lwys otin stisftory written referenes diret from former employers overing the three yers immeditely preeding the enggement of ny employees responsile for money, goods, ounts, omputer opertions or omputer progrmming? 7 Hs ny insurer ever delined to insure you or to renew ny of your insurne poliies nelled ny of your insurne poliies voided ny of your insurne poliies for non-dislosure or misrepresenttion of ny mteril ft d refused to py lim or restrited over s result of reh or ny poliy term or ondition, or risk improvement requirements e imposed speil terms or onditions If to ny of the ove, plese provide full detils

3 Generl (ontinued) 8 Within the lst 10 yers hve you or ny diretor or prtner trded under different nme? If, plese provide full detils 9 Is there ny dditionl informtion or detil whih my ssist us in ssessing the nture of the insurne risk eing proposed, nd whih my influene our deision to ept this insurne, or in setting the terms nd premium? Exmples of suh informtion re: ny speil or unusul fts relting to your insurne risk ny prtiulr onerns whih led to you seeking insurne over nything tht would generlly e understood to provide fir desription of your insurne risk, tking ount of the nture of your usiness nd the tivity undertken t your premises or elsewhere If, plese provide full detils 10 Hve you or ny prtner, diretor, or ny other person responsile for mnging the usiness, either personlly or in ny usiness pity: ever een onvited of or hrged (ut not yet tried) with ny riminl offene other thn rod trffi offenes? reeived n offiil ution for riminl offene within the lst three yers other thn (rod trffi) motoring offene? ever een delred nkrupt or entered into n individul voluntry rrngement, or if ompny, gone into liquidtion, dministrtion, reeivership, dministrtive reeivership, or entered into ompny voluntry rrngement or reditors sheme of rrngement? d ever een diretor or prtner of ompny tht went into liquidtion, dministrtion, reeivership, dministrtive reeivership, or entered into ompny voluntry rrngement, or reditors sheme of rrngement or ws dissolved? e ever een proseuted for reh of ny sttute relting to helth or sfety of employees or others?ever een proseuted for reh of ny sttute relting to helth or sfety of employees or others? f ever een served with Prohiition tie under the Helth nd Sfety t Work et. At 1974 nd ssoited regultions? g ever een proseuted for filure to omply with ny environmentl protetion legisltion? h ever een the sujet of reovery tion y HM Revenue nd Customs? i ever een the sujet of County Court or High Court judgment? j ever een diretor of ompny tht hs reeived County Court or High Court judgment ginst it? k ever een disqulified under the Compny Diretors Disqulifition At 1986 or ny susequent legisltion from holding offie s diretor of ompny? If to ny of the ove, plese provide full detils Importnt tes: 1 Where the employer is unle to omply with the referene requirements for ny employee Allinz Insurne pl must e dvised. Cover will only operte when ll referenes hve een otined overing the requisite period nd re stisftory. 2 Referenes re to e retined for the durtion of n employee s servie with the employer plus two yers therefter. These my e requested y Allinz Insurne pl in the event of lim.

4 Cover Options (see prospetus for detils) Plese omplete: Setion A for Blnket Poliy Covers ll employees. or Setion B for Speified Nmes or Positions Poliy. Covers speified employees or speified positions within the ompny. A Blnket Poliy Stte mount of Gurntee required: Any one loss In ggregte during ny one period of insurne B Speified Poliy (A limit ny one loss will pply to ll employees seleted for over) Plese omplete i or ii i Speified Employees Nme of Employee Position of Employee Length of Servie Limit ny one loss ii Ctegory of Employee Ctegory of Employee or Deprtment Numer of Employees Totl Wges Limit ny one loss Plese stte ggregte required during ny one period of insurne if different from the ny one loss limit noted in either i or ii ove For A or B Is voluntry exess required? If, plese stte mount

5 System of Chek Importnt te: The terms of this insurne require tht the System of Chek in this proposl nd ny other preutions delred or required y us must remin fully opertive during the urreny of the poliy. 1 Hve you ppointed ompetent person to exerise ontrol over Aounts nd sh Plese onfirm wht qulifitions they hve nd how long they hve een in ontrol of those res? 2 Are employees reeiving monies required to nk dily? Are employees required to ount for monies reeived t lest: i weekly if Trvellers/Colletors? ii monthly ll other employees? 3 Is sh in hnd inluding petty sh nd unpid wges, heked independently of the employees responsile t lest monthly nd dditionlly, without wrning, t lest every six months? 4 Are nk sttements, reeipt ounterfoils nd supporting douments heked t lest monthly ginst the sh ook entries nd the lne tested with sh nd unpresented heques, independently of the employees mking sh ook entries or pying into the nk? 5 Are ll heques i prepred independently of employees who uthorise heques nd signtories? ii uthorised y employees independently of those who prepre or sign heques? iii signed y employees independently of those who prepre heques or uthorise heques? When heques re eing signed does eh signtory exmine supporting douments? Do ll heques drwn for more thn 10,000 require two signtories? 6 Are sttements of ount sent to ustomers diret y post independently of employees in position to reeive pyment of n ount t lest monthly? 7 Will ll wges nd slries e heked ginst wge lists nd wge figures independently of persons who prepre the wges? 8 Do you llow employees to hndle monies or goods other thn in the norml ourse of your Business (e.g. holidy lu money) nd re these to e overed y the Poliy? If, plese provide prtiulrs inditing wht steps re tken to ensure tht they re properly ounted for.

6 System of Chek (ontinued) 9 Does ny employee hve i the power to operte your Bnk Aount? If, wht is the mximum uthorised trnstion mount on the sole uthority of one employee? ii diret ontrol over your or your lients investments, seurities or stoks? Do you operte n Eletroni Funds Trnsfer system? (If, you now need to omplete Appendix 2 Funds Trnsfer) Are lients monies held in seprte ounts from tht of the usiness ounts? 10 Will ll stok inluding ompleted goods nd returned goods e physilly heked independently of the employees normlly responsile for it, t lest six monthly, with ny disrepnies investigted? Do you dditionlly rry out spot hek udits without wrning? If so how often? 11 Do you hold stoks of high vlue mterils or goods? (e.g. non-ferrous or preious metls, exerise stoks) If, plese indite 1 Nture of goods 2 Mximum vlue 3 Speil seurity preutions tken ginst theft y employees 12 Are different employees ting independently responsile for: ordering goods? reording reeipt of goods? uthorising pyment for goods? 13 Is the ppointment of suppliers rried out through the use of forml tendering proedure? If, plese provide detils

7 Computer Seurity 1 Are ny Wge, Aounts or Stok Control funtions omputerised? te: If, plese move on to the next pge. 2 Is physil ess to rooms ontining omputer terminls restrited to uthorised stff? Is omputer medi (diss, tpes, et.) seurely stored in loked inets when not in use y uthorised stff? Cn your systems e essed from terminls outside your premises? 3 Hs your omputer seurity een vetted y professionl omputer ompny or omputer seurity personnel of your uditor? 4 Did they mke ny reommendtions? If, hve they een fully omplied with? 5 Do employees with ess to the omputer system need seure, individul pssword to ess the system? Are users fored y the system to hnge psswords upon expiry, t lest one every six months? Is pssword ess deleted or invlidted immeditely n employee leves your employment? d Is omputer dt ked up dily nd stored seurely off site? 6 Do you employ your own omputer personnel? 7 Do you use ny omputer progrms tht hve een written or otined from nyone other thn third prty speilist omputer ompnies? If, plese speify Is it possile for person to write nd/or run progrm in respet of stok ontrol wges or ounts in n unontrolled mnner? 8 Cn your omputer stff ess or interfere with your wge, ounts or stok ontrol reords? 9 Are you wre of ny wrongful interferene y employees or otherwise with your omputer systems? If, would the interferene hve resulted in loss if undeteted? Plese provide detils 10 Do you hve omputer tril udit? (i.e. Do you udit ess to your system to ensure users re only essing those res of the system they re uthorised to nd tht ll ess is y uthorised users only)

8 Importnt Informtion Your Duty To Mke A Fir Presenttion Of The Risk You must mke fir presenttion of the risk to us t ineption, renewl nd vrition of your Poliy. This mens tht you must tell us out ll fts nd irumstnes whih my e mteril to the risks overed y your Poliy in ler nd essile mnner or give us suffiient informtion to lert us of the need to mke enquiries out suh fts or irumstnes. Mteril fts re those whih re likely to influene us in the eptne of or ssessment of the terms or priing of your Poliy. If you re in ny dout s to whether ft is mteril, you should tell us out it. If you fil to mke fir presenttion of the risk, we my void your Poliy (tht is tret it s if it hd not existed) nd refuse to py ny lims where ny filure to mke fir presenttion is: delierte or rekless; or of suh other nture tht, if you hd told us out mteril ft or irumstne, we would not hve issued, renewed or vried your Poliy. In ll other ses, if you fil to mke fir presenttion of the risk, we will not void your Poliy ut we my insted: redue proportiontely the mount pid or pyle on ny lim, the proportion for whih we re lile eing lulted y ompring the premium tully hrged s perentge of the premium whih we would hve hrged hd you mde fir presenttion (e.g. if we would hve hrged you doule the premium, we will only py hlf the mount of ny lims under your Poliy); nd/or tret your Poliy s if it hd inluded suh dditionl terms s we would hve imposed hd you told us out mteril ft or irumstne. Pyment of ny lim you mke will e sujet to the pplition of ny suh dditionl terms. For these resons it is importnt tht you hek ll of the fts, sttements nd informtion set out in your Commeril Selet Proposl Form or in ny other informtion provided re omplete nd urte. You must lso mke resonle enquiries to hek with nyone you employ in your usiness tht the fts nd sttements set out in your Commeril Selet Proposl Form or in ny other informtion provided re omplete nd urte nd tht there re no other mteril fts whih you need to dislose. IF ANY OF THE FACTS, STATEMENTS AND INFORMATION SET OUT IN YOUR COMMERCIAL SELECT PROPOSAL FORM, RISK PRESENTATION OR ANY ADDITIONAL INFORMATION PROVIDED ARE INCOMPLETE OR INACCURATE, YOU OR YOUR INSURANCE ADVISER MUST CONTACT US IMMEDIATELY. FAILURE TO DO SO COULD INVALIDATE YOUR POLICY OR LEAD TO A CLAIM NOT BEING PAID OR NOT BEING PAID IN FULL. Delrtion I/We delre tht: 1 I/We hve red this proposl nd understnd tht I/we re under duty to mke fir presenttion of the risk nd tht filure to do so ould result in my/our poliy eing invlidted nd/or lim not eing pid or not eing pid in full. 2 the fts, sttements nd informtion ontined within this proposl, whether provided y me/us or y others on my/our ehlf, re true nd omplete. 3 the fts, sttements nd informtion whih re not ontined within this proposl ut whih hve een provided to Allinz seprtely y me/us or y others on my/our ehlf re true nd omplete. 4 I/We hve delred ll mteril fts nd irumstnes whih my ffet the risk eing epted y Allinz under this poliy even if Allinz hs not sked me/us ny questions out suh fts. 5 I/We hve mde ll resonle enquiries of ny employed y me/us to ensure tht ll fts, sttements nd informtion provided to Allinz re urte nd orret. 6 I/We gree to ept Allinz s stndrd form of poliy for this/these lss/lsses of insurne. A speimen opy of the poliy is ville on request. 7 I/We understnd tht Allinz Insurne pl nd/or Allinz Legl Protetion reserve the right to deline ny proposl. 8 I/We hve red the Dt Protetion sttement ontined within this proposl nd onsent to dt eing used for the purposes speified. Authorised Signture Dte Position/Title Print Nme

9 Dt Protetion Allinz Insurne pl together with other ompnies within the Allinz SE group of ompnies ( Allinz Group ) my use the personl nd usiness detils you hve provided or whih re supplied y third prties inluding ny detils of diretors, offiers, prtners nd employees (whose onsent you must otin) to: provide you with quottion, del with the ssoited dministrtion of your poliy nd to hndle lims; serh redit referene, redit soring nd frud genies who my keep reord of the serh; shre with other insurne orgnistions to help offset risks, dminister your poliy, for sttistil nlysis, nd to hndle lims nd prevent frud; support the development of our usiness y inluding your detils in ustomer surveys, for mrket reserh nd usiness reviews whih my e rried out y third prties ting on our ehlf. Allinz Group my need to ollet nd proess dt relting to individuls who my enefit from the poliy ( Insured Persons ), whih under the Dt Protetion At is defined s sensitive (suh s medil history of Insured Persons) for the purpose of evluting the risk nd/or dministering lims whih my our. You must ensure tht you hve expliit verl or written onsent from the Insured Persons to suh informtion eing proessed y Allinz Group nd tht this ft is mde known to the Insured Persons. If your poliy provides Employers Liility over informtion relting to your insurne poliy will e provided to the Employers Liility Tring Offie (the ELTO ) nd dded to n eletroni dtse, (the Dtse ) in formt set out y the Employer's Liility Insurne: Dislosure y Insurers Instrument The Dtse ssists individul onsumer limnts who hve suffered n employment relted injury or disese rising out of their ourse of employment in the UK whilst working for employers rrying on, or who rried on, usiness in the UK nd s result re overed y the employers' liility insurne of their employers, (the Climnts ): i ii to identify whih insurer (or insurers) ws (or were) providing employers' liility over during the relevnt periods of employment; nd to identify the relevnt employers' liility insurne poliies. The Dtse nd the dt stored on it my e essed nd used y the Climnts, their ppointed representtives, insurers with potentil liility for UK ommeril lines employers' liility insurne over nd ny other persons or entities permitted y lw. The Dtse will e mnged y the ELTO nd further informtion n e found on the ELTO wesite Telephone lls my e reorded for our mutul protetion, trining nd monitoring purposes. Under the Dt Protetion At 1998 individuls re entitled to request opy of ll the personl informtion Allinz Insurne pl holds out them. Plese ontt the Customer Stisftion Mnger, Allinz Insurne pl, 57 Ldymed, Guildford, Surrey, GU1 1DB. Personl detils my e trnsferred to ountries outside the EEA. They will t ll times e held seurely nd hndled with the utmost re in ordne with ll priniples of English lw. By pplying for nd/or entering into this insurne poliy you will e deemed to speifilly onsent to the use of your dt nd your insurne poliy dt in this wy nd for these purposes nd tht your diretors, offiers, prtners, nd employees hve onsented to our using their detils in this wy.

10 Appendix 1 Internl Audit Where there is n internl udit deprtment: How mny people re employed in the internl udit deprtment? d How often re full internl udits mde? Are surprise udits regulrly onduted? Are ll premises udited? e Wht is the mximum length of time etween udits for n re or lotion of the usiness? f Is there n udit nd ontrol proedures mnul? g Are internl ontrols reviewed y externl uditors? If, re ny reommendtions rought to the ttention of mngement nd omplied with? Appendix 2 Funds Trnsfer Plese nswer the following (ut only if direted to y instrutions within the min proposl form): 1 Estimted nnul vlue of funds trnsferred: Mximum mount How mny fund trnsfers tke ple on verge per month? 2 Are omputers used to hndle fund trnsfers? If no, wht methods re used? If, to ) plese tth opy of the proedures followed - tthed 3 Do you use Csh Mngement System? If, plese nswer the following questions Nme of Servie Bnk nd system Do you omply with ll terms nd onditions ontined in the greement with the Servie Bnk? Is the system used for: i Blne reporting? ii Funds trnsfer instrutions to own prty ounts? iii Funds trnsfer instrutions to third prty ounts? iv Other? If, plese speify elow d Does the system impose limits on the mounts/vlues of instrutions? If, plese desrie e Within your orgnistion re there written proedures regrding the ontrol nd usge of the system?

11 Appendix 2 Funds Trnsfer (ontinued) f Are sh mngement system trnstion sttements reeived from the Servie Bnk verified y the end of the next usiness dy following reeipt? If, when re they verified? If, when re they verified? 4 With regrd to funds trnsfer (whether through Csh Mngement System or not) plese provide the following: In respet of funds trnsfer pplitions do you input instrutions in: i Fixed/pre-formt? If, desrie proedures for setting up nd mending uthorities ii Free-formt? Do the nk knowledge trnsfers? If, desrie y wht mens Who pproves trnsfers nd is dul uthoristion required? If, for over wht mount? d Are the detils of suh trnstions entered y someone who is not permitted to uthorise trnsfers? e f How mny persons re required to relese n eletroni funds trnsfer instrution? Do the terminls used feture lok-out mehnism tht denies ess fter ertin numer of filed ess ttempts nd logs the inident on n udit or supervisory report? g Are ll trnstions udited? If, y whom nd how often? ACOM160_ Allinz Insurne pl. Registered in Englnd numer Registered offie: 57 Ldymed, Guildford, Surrey, GU1 1DB, United Kingdom. Allinz Insurne pl is memer of the Assoition of British Insurers. Allinz Insurne pl is uthorised y the Prudentil Regultion Authority nd regulted y the Finnil Condut Authority nd the Prudentil Regultion Authority. Finnil Servies Register numer