Employee Fraud Loss. Employee Client Fraud Loss. Forgery Or Alteration Loss Yes No. On Premises Loss Yes No. In Transit Loss Yes No

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1 Crime Insurance PRoPosAl FoRm Please answer all questions. If you have insufficient space to complete an answer, attach a separate signed and dated sheet and identify the question number concerned. Please enclose with this proposal form: a. Your current annual report and accounts (or equivalent) b. An explanation of the alternative methods you use to reduce your exposure to fraud if you answer 'No' to any of the questions 8 to 47 inclusive below. General Details 1. Name of Company 2. Principal office address Telephone Postcode 3. Annual Turnover at last year end 4. Number of locations 5. Number of employees 6. Number of these employees who handle, have custody or maintain records of money, securities or other property 7. Describe the type of business in which the company is engaged. In the case of multiple occupations please provide a split by revenue Coverage Requirements Please refer to the policy wording for full details of the cover provided Employee Fraud Loss Yes 3 Employee Client Fraud Loss Yes 3 Forgery Or Alteration Loss Yes No On Premises Loss Yes No In Transit Loss Yes No Money Orders And Counterfeit Money Loss Yes No Computer Fraud Loss Yes No Restoration Expense Loss Yes No - note Restoration Expense Loss is sub-limited to a maximum of GBP250,000 in the aggregate Employee Pension Plan Loss Yes No 1

2 2.9 Funds Transfer Fraud Loss Yes No 2.10 Card Forgery Or Alteration Loss Yes No 2.11 Claim Expense Loss Yes No - note Claim Expense Loss is sub-limited to a maximum of GBP250,000 in the aggregate Prior Coverage Effective Date Limit Retention/Excess Carrier Has any similar insurance been declined or cancelled during the past three years? Yes No Audit & Corporate Governance 8. Do external auditors audit all operations at least annually? Yes No 9. Have all recommendations by external auditors regarding internal controls been complied with, following your last audit? Yes No If no, please give details: 10. Is there an Audit Committee which monitors the effectiveness of internal controls and reports directly to the Board? Yes No 11. Do you have an Internal Audit Department? Yes No 12. Do they have an established audit cycle for all operations? Yes No Recruitment Procedure 13. When recruiting or promoting employees to positions of trust involving handling of stock, money, financial, treasury or mission critical functions, do you: A Undertake independent checks into their employment history? Yes No B Undergo a process to ensure their suitability for the position? Yes No Internal Financial Controls 14. Are wages/salaries independently checked against personnel records for unusual or excessive payments? Yes No 15. Are duties segregated so that no individual can control any of the following activities from commencement to completion without referral to others: a) Signing cheques or authorising payments (including capital expenditure) above 5,000? Yes No b) Issuing funds transfer instructions? Yes No c) Amending funds transfer procedures? Yes No d) Opening new accounts? Yes No e) Investment in and custody of securities and valuables (including blank cheques, travellers cheques, bills of exchange etc)? Yes No f) Refund monies or return goods above 5,000? Yes No g) Disbursement of assets or funds of any pension plan? Yes No h) Awarding contracts following a tender? Yes No 2

3 16. Are cheques stamped For Deposit Only as they are received? Yes No 17. Are invoices stamped Paid at the time a cheque is issued to ensure payment is not duplicated? Yes No 18. Are all supporting documents validated before authorising payments? Yes No 19. Are statements of accounts sent to customers independently of employees receiving payments? Yes No 20. Are bank statements independently reconciled by persons not authorised to deposit/withdraw funds, issue funds transfer instructions or dispatch accounts to customers? Yes No 21. Are procedures in place to assess the suitability of trustees, fiduciaries, administrators or officers of any of your pension plans? Yes No stock and Physical security 22. Is there controlled access to all locations? Yes No 23. Are all premises containing stock, money, securities, precious metals etc. connected to an intruder alarm? Yes No 24. Are intruder alarms maintained in proper working order and connected to a central station or police station? Yes No 25. Is an independent physical count of stock, raw materials, work in progress and finished goods undertaken and is this count reconciled against stock levels? Yes No How frequently? 26. Above what value is the transfer of money and securities usually made by a security or professional cash carrying company? 27. What is the maximum value of money, securities, precious metals and/or jewellery at any one location: a) during business hours? b) outside business hours? Computer systems 28. Are unique passwords used to give various levels of entry to the computer depending on the users authorisation? Yes No 29. Are passwords automatically withdrawn when people leave? Yes No 30. Are all amendments to programmes approved independently of the persons making the amendments? Yes No 31. Are programmes protected to detect unauthorised changes? Yes No 32. Is your computer system firewall protected to prevent unauthorised access? Yes No 33. Is your computer system protected by virus detection and repair software? Yes No 34. Do you have a contingency plan in place in the event of a catastrophic disruption to your computer systems? Yes No Fund Transfers Fund transfer means any instructions (other than cheques) given to a financial institution to pay or deliver funds 35. What is the approximate annual value of fund transfers? 36. Please specify the method of instruction (e.g. written, electronic, telephone etc.) 3

4 37. Can payment instructions be made to an account which has not been pre-agreed? Yes No 38. Is the financial institution required to authenticate the instruction before payment is released? Yes No 39. Please provide a brief description of the methods used to secure fund transfers (e.g. passwords, encryption, code words, call back). E-commerce 40. Are your Internet connections through a secure firewall? Yes No 41. What is the approximate value of sales that you make via the Internet? 42. Are all transactions encrypted? Yes No 43. Are you registered with a certification authority? Yes No 44. In business to business transactions do you require your counterparties to be registered with a certification authority? Yes No 45. How frequently do you back up data? 46. Is this stored off site in a secure location? Yes No Employee Welfare & Benefit Plans 47. Is an independent consultant retained to administer any Employee Welfare & Benefit Plans? Yes No 48. What are the total assets of all the benefit plans? loss History 49. a) Please provide brief details of any losses sustained during the past five (5) years and before application of any deductible, retention or excess whether insured or not. (Please include date discovered, location, nature of loss and amount.) b) Please describe what corrective measures have been taken to prevent similar losses arising in future. 4

5 Important It is necessary for you to inform us of all the facts which are likely to influence us in acceptance or assessment of your insurance. Failure to do so could invalidate your insurance. If you are in doubt whether any fact may influence us you should disclose it. Declaration signature of the proposer (Principal/Partner/Member/Director or functional equivalent) Must be signed by a Principal/Partner/Member/Director or functional equivalent I/We declare that to the best of my/our knowledge or belief, the statements and particulars given in this proposal are true and complete and that no material facts that are likely to influence the acceptance and assessment of this proposal have been withheld. (If you are in any doubt as to whether a fact is material, you should disclose it.) I/We agree to inform Travelers Insurance Company Limited of any change to any material fact. I/We also declare that if any information on this proposal has been written by another person on my/our behalf, that person acted as my/our agent for that purpose. I/We agree that this proposal and declaration shall be the basis of the contract between me/us and Travelers Insurance Company Limited. I/We also declare that no insurer has ever declined a proposal, declined to pay a claim in full or in part, cancelled or declined to renew my/our insurance or invited renewal at special terms. I/We declare that no partner or director has ever been convicted of or charged (but not yet tried) with a criminal offence other than a motoring offence or spent conviction as allowed for under the Rehabilitation of Offenders Act 1974, been declared bankrupt whilst being a director of a company that went into liquidation, receivership or administration or been disqualified from being a director. I/We declare that I/we have not suffered any loss/damage or incurred any liability (whether insured or not) as a result of the risk(s) for which cover is now required, or know of any incident which is likely to give rise to a loss that has not already been declared to Travelers Insurance Company Limited. Print name and position held For and on behalf of (Insert name of Company/Firm) Date No CoVER Is IN FoRCE UNTIl THIs PRoPosAl HAs BEEN ACCEPTED BY THE ComPANY AND THE PREmIUm PAID, EXCEPT As PRoVIDED BY AN official CoVERING NoTE IssUED BY THE ComPANY. PlEAsE RETAIN A CoPY of THIs ComPlETED PRoPosAl FoRm FoR YoUR RECoRDs. Using Personal Information Personal information which you supply to us may be used in a number of ways, for example: when considering an application; in conducting our relationship with you; underwriting insurance coverage; managing any policy issued; preventing and detecting fraud; providing risk management advice; and administering claims. We may pass the information to members of the Travelers group, our reinsurers, professional advisers, loss adjusters or agents for these and other lawful purposes or as required by law, including providing the information to government or regulatory authorities. This may involve its transfer to countries which do not have data protection laws equivalent to those in the United Kingdom in which case we shall ensure that the information is appropriately protected. We may also share the information with, and obtain information about you and/or your employees or agents from, credit reference agencies and/or fraud prevention agencies. For further information on how the information is used, how we maintain security of the information, and your rights to access information we hold on you and/or your employees and/or agents, please contact the Company Secretary at Travelers Insurance Company Ltd, Exchequer Court, 33 St Mary Axe, London EC3A 8AG or see our Privacy Policy at travelers.co.uk. By making an application for insurance you agree that all persons to whom the information relates consent to the processing and transfer of information described in this notice. You also confirm that you have taken all necessary steps to inform them of disclosure of information to us for the purposes described above. Travelers Insurance Company Limited London Road, Redhill, Surrey RH1 1NA Travelers Insurance Company Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Registered office: Exchequer Court, 33 St. Mary Axe, London EC3A 8AG. Registered in England travelers.co.uk TRV /14