Griffiths & Armour Professional Risks

Griffiths & Armour Professional Risks Griffiths & Armour Professional Risks acts as manager for the professional indemnity division of Griffiths & Armour Griffiths & Armour Professional Risks Ltd is an appointed representative of Griffiths & Armour which is authorised and regulated by the Financial Services Authority in the United Kingdom GROUP OFFICES Liverpool London Manchester Glasgow Dublin Guernsey Professional Indemnity Insurance Proposal Form for Accountants This Proposal Form must be completed in ink by a Partner, Principal or Director of the Practice. PLEASE TYPE OR CLEARLY PRINT YOUR ANSWERS. All questions must be answered to enable a quotation to be given. The completion and signature of this proposal does not bind the Proposer or Underwriters to complete a Contract of Insurance. If there is insufficient space to answer questions, please complete the continuation page/s at the end of this form. Practice Details 1. (a) Name of individual or Practice(s) and date established (including subsidiary Practices requiring cover): (b) Address(es) of the Practice (specifying which Partner/Principal/Director is responsible at each location): Telephone Number: Website Address: (c) During the past six years, has the name of the Practice(s) been changed or has any YES NO amalgamation or takeover taken place or any Partners departed, retired or deceased? If YES, please give full details: Are there any predecessor Practices for which cover is required? If YES, please advise: YES NO Name of Predecessor Practice Date Established Date of Cessation Details of any claim(s) against Predecessor Page 1 of 14

Is cover required for any Partner/Director/Member for his/her own liability prior YES NO to joining the Practice(s)? If YES, please advise: Name of Partner/Director/Member Name of previous Practice(s) Date of leaving previous Practice(s) 2. Please advise the following (including when a sole Practitioner): (a) Name of all Partners, Principals, Directors Age and Qualifications Date Qualified Number of years in this capacity (at this Practice) If less than five years experience in this occupation, please give details of previous occupations: Name of all Partners, Principals, Directors Age and Qualifications Date Qualified Number of years in this capacity (at this Practice) (b) Name of all Consultants Age and Qualifications Date Qualified Number of years in this capacity (at this Practice) If less than five years experience in this occupation, please give details of previous occupations: Name of all Consultants Age and Qualifications Date Qualified Number of years in this capacity (at this Practice) (c) Please list those former Partners, Principals, Directors of the Practice for whom cover is required: 3. (a) Is the Practice admitted to membership of any professional body or Association? YES NO Page 2 of 14

(b) Has any person in the Practice been subject to disciplinary proceedings by any professional body YES NO or other relevant body? 4. Please state the total number of: (a) (b) (c) (d) Partners, Principals or Directors Qualified staff Other Technical staff (excluding Administrative staff) Administrative and all other staff TOTAL: 5. Are you a Sole Practitioner? YES NO If YES : (a) is this a part-time occupation? YES NO If YES, please give brief details of your present full-time occupation: (b) What arrangements have you made for the running of the Practice in the event of sickness or holidays? 6. (a) Have any major changes in the Practice s activities/structure taken place YES NO in the past twelve months? If YES, please give full details: (b) Are any major changes in the Practice s activities/structure/fee growth YES NO expected in the next twelve months? Work Profile 7. Please advise for each of the last five financial years (and an estimate for the forthcoming year): 20 20 20 20 20 (a) Total gross fees (b) (c) Largest total fee from any one client or group Average fee per client or group Please state financial year end (day/month): Estimate of forthcoming year Page 3 of 14

(d) Split your fees for the last completed financial year: Number of Clients Less than 15,000 15,000-40,000 Over 40,000 Total Total Fees (e) If more than 15 of your Gross Fees are received from any one Client or Group, please specify the name, its activities, location, amount of fees/commission and type of work you undertake: (f) Please provide a summary of the Practices main client trades and professions: (g) Please summarise the business activities of your three largest clients by total fee: Total Fee 8. Please indicate the approximate percentage for each of the following categories in the last two years: (a) Audit Split as: (i) Quoted Companies (ii) Unquoted Companies (iii) Other Accountancy and Company Tax Split as: (i) Quoted Companies (ii) Unquoted Companies (iii) Other, including Farmers, Small Traders, etc. (b) Other Taxation (c) Management Consultancy (d) Consultancy only (e) Secretarial and Share Registration (f) Executorship and Trusteeship (g) Insolvencies, Liquidations and Receiverships (h) Insurance, Building Society, Stock Exchange or Investment Commissions (i) Directorships Page 4 of 14

(j) I.T. Consultancy please give full details below: (k) Corporate Finance (l) Mergers, Acquisitions, Disposals (m) Any Others please give full details below: Are any substantial changes in the above percentages envisaged during YES NO the forthcoming year? If YES, please give full details: For any activities where you have answered Nil, please give details if you have been engaged in such work during the last six years: 9. Is cover required for any independent Accountant to whom work is sub-contracted? YES NO If YES, please state: Name Qualifications Fees Paid (Last Financial Year) Does the Sub-Contractor hold their own PI Insurance? 10. Have you undertaken any work for any client(s) in the Entertainment Industry where YES NO you have obtained an individual fee greater than 5,000 in any one financial year? If YES, please advise client name(s), nature of business, services provided and gross fees received: 11. (a) Please state the gross fees received for each of the last three financial years and an estimate for the next financial year in respect of fees billed to clients based in the following territories: Year Overseas - excluding USA/Canada, but including Channel Islands and Isle of Man 20 20 20 Next Financial Year USA/Canada Page 5 of 14

(b) If any fees are declared above please provide the following additional information for each individual client below or on a separate sheet of paper if insufficient space: country, nature of client, work undertaken, fee received, is all work carried out in the UK? (If your work is restricted to UK Tax for UK domiciled clients, e.g. Overseas Property Rentals, then only brief details are required). (c) Does the Practice perform work for: (i) British companies with USA/Canada subsidiaries or with assets in the USA/Canada? YES NO (ii) USA/Canada based companies? YES NO If YES, to (i) or (ii) above, please provide the following additional information for each individual client: nature of client and business, work undertaken and fees received, is all work carried out in the UK and for what purposes is the work carried out? (d) Does the Practice have any representation overseas? YES NO If YES, please give full details: (e) Does your Practice carry out any work in the United Kingdom for any client who has any YES NO representation overseas (e.g. work for a UK subsidiary of a USA/Canada parent)? If YES, please give full details and confirm that the work is done under UK Law and that the contract is with the UK client only: Financial Services Activities 12. (a) Is the Practice authorised to conduct investment business and/or financial services? YES NO (b) Has the Practice or any Practice you have acquired ever carried out any regulated activities as defined in the Financial Services and Markets Act 2000 (other than in connection with general insurance products) as: (i) Financial Adviser, execution only, tied agent or appointed representative? YES NO (ii) Introductory Agent only? YES NO If you have answered YES to (a) or (b)(i), please complete our Financial Services Questionnaire. If you have answered YES to (b)(ii), please answer the following questions: (i) Do you have any financial interest or controlling interest in YES NO the Practice you are an introducer to? (ii) Can you confirm that gross commission/fees received in any YES NO one of the last six financial years as introductory agent did not exceed 10,000 or 10 of your total fee income? (iii) Can you confirm that you only introduce to an Independent Financial Adviser YES NO who is authorised and regulated by the FSA? Page 6 of 14

(c) Please advise details of income received (if any) from the following: (i) Private Client Portfolio Management (please state whether discretionary)... (ii) Institutional Fund Management (iii) Dealing in Securities Please state percentage of foreign securities (iv) Off-shore investment (please give details) Audit and Personal Appointments 13. Do you act as Auditors to any of the undermentioned? If so, please provide Client Name(s), Fee(s) and details of any other services provided: (a) Banks or other Financial Institutions: (b) Insurance Companies, Lloyd s Syndicates or Funds (including Captive Insurance Companies): (c) Any Off-shore Companies: 14. Does any Partner, Principal, Director or Employee of the Practice(s) hold appointments YES NO as Director or Company Secretary of any company? If YES, please provide the following: Appointee Company Position Held Fees earned during last financial year Page 7 of 14

15. Does any Partner, Principal, Director or Employee of the Practice(s) act as Trustee of any Trust? YES NO Appointee Trust Name Type of Trust Location from where Trust is administered Trust Funds under management Fees earned during last financial year Please provide details of the services provided, with full details of any management or discretionary powers: Are any trustee appointments as a sole trustee? YES NO Associated Companies 16. Does the Practice undertake work for any Partnership, Practice or Organisation YES NO in which they or any Partner, Principal, Director or Employee holds a position whereby they are able to make major decisions on behalf of such Partnership, Practice or Organisation? 17. Is the Practice or any Partner, Principal or Director connected or associated YES NO (financially or otherwise) with any other Practice, Company or Organisation? 18. Has the Practice or any Partner, Principal or Director been a Partner, Principal or Director or YES NO been associated with any business which has ceased trading, either voluntarily or compulsorily? Page 8 of 14

19. Has any Partner, Principal or Director been made personally bankrupt? YES NO 20. What percentage of income is derived from Associated Companies, as detailed above? Professional Indemnity 21. Is the Practice currently insured or been insured previously for Professional Indemnity? YES NO If YES, please give the following details: (a) Name of Insurers (b) Indemnity Limit (Please state whether Aggregate or Any One Claim) (c) Excess (d) (e) Date of expiry of coverage Number of consecutive years that the Proposer has been insured 22. Has any Insurer ever: (a) declined to offer insurance for the Practice or any Partner, Principal or Director? YES NO (b) imposed any special terms for the Practice or any Partner, Principal or Director? YES NO (c) cancelled or voided any insurance for the Practice or any Partner, Principal or Director? YES NO If YES to any of the above, please give details: 23. (a) What Limit of Indemnity is now required? 250,000 500,000 750,000 1,000,000 Other (b) What self-insured excess (each and every claim) is the Practice prepared to carry? Practice and Risk Management 24. (a) Does the Proposer always obtain satisfactory written references YES NO when engaging senior employees? (b) Is any Partner, Principal, Director or Employee allowed to sign cheques YES NO on his/her signature alone? If YES, please describe circumstances and cheque limit: Do all cheques for more than 25,000 require two signatures? YES NO Page 9 of 14

(c) Are Employees who receive cash/cheques in the course of their duties YES NO required to pay in daily? If NO, please give details: (d) How often are checks carried out on all entries in the Cash Book with all paying-in books, receipts, counterfoils and vouchers being reconciled with bank statements, including the balance of cash and unpresented cheques, independently of Employees receiving or banking monies belonging to the Practice as well as in trust on behalf of others? Weekly Monthly Quarterly Other 25. (a) What is the management structure of the Practice? Managing Partner Managing Executive Management Committee Executive Committee Other (please specify) Have there been any material changes in the management structure YES NO within the last three years? (b) If the Practice is managed by a committee, does this committee meet YES NO on a regular or ad-hoc basis? (c) Does the Practice employ a full-time non-accountancy administrator? YES NO (d) Does the Practice designate or employ an individual with management responsibility for YES NO evaluating or dealing with complaints, actual or potential claims and other such matters? (e) Does the Practice have written risk management procedures which include YES NO professional liabilities? (f) Are risk management procedures regularly reviewed, circulated and/or discussed within YES NO the Practice and have all qualified and technical employees been made aware of them? (g) Does the Practice always use engagement letters? YES NO If YES, do the engagement letters outline: (i) the scope of services to be performed? YES NO (ii) any statement/assumptions upon which the engagement is based? YES NO (iii) the responsibilities of the client? YES NO (iv) any limitations/restrictions in respect of any services performed? YES NO Does the client sign the letter of engagement? YES NO Do you provide any advice or services, which fall outside the scope YES NO of the letter of engagement? (h) Do you have a written policy specifying the conflicts of interest procedures, YES NO which include a cross-check system and back-up? (i) In the event of a conflict of interest, do you: (i) inform the client in writing? YES NO (ii) advise the client to seek independent advice? YES NO (iii) continue to act for the client? YES NO (j) Does the Practice have a policy which requires prior approval in writing for a N/A YES NO Partner, Principal, Director or qualified employee to serve as an Officer and/or a Director of a client or third party? (k) Does the Practice operate a diary system with manual back-up? YES NO If YES, please answer the following: (i) Are periodic checks made to ensure that the diary system YES NO is being strictly followed? Page 10 of 14

(ii) Does the diary system provide for employees being absent YES NO or to ensure that deadlines are not missed? (l) Does the Practice have a file review system, which requires randomly selected YES NO files to be audited by a Partner, Director or Manager other than the person handling the file? (m) Does the file review system include Partner-to-Partner auditing? YES NO (n) Please provide any additional information to assist underwriters understanding of your file review procedures or other professional liability risk management procedures: (o) Does the Practice offer and promote continued training? YES NO Page 11 of 14

Claims Please note it is imperative to answer these questions correctly. Failure to do so could prejudice your rights. If space is insufficient, please use the continuation sheet found at the end of this form. 1. FIDELITY (a) Has the Practice sustained any loss through the fraud or dishonesty of any person? YES NO (b) Does the Practice know of any fraud or dishonesty at any time of any past or present YES NO Partner, Principal, Director or Employee? If YES to either of the above, please give full details and state the steps taken to prevent recurrence: 2. PROFESSIONAL INDEMNITY (a) Has any claim, whether successful or not, ever been made against the YES NO Practice or its predecessors in business or any past or present Partner, Principal, Director or Employee? If YES, a full answer should be given, including dates, amounts involved, brief details of the nature of the claim and whether the claim is paid or still outstanding: (b) Are you, or any of the Partners, Principals, Directors or Employees, AFTER FULL ENQUIRY, YES NO aware of any circumstances which may give rise to a claim against the Practice, its predecessors in business or any past or present Partner, Principal, Director or Employee? If YES, a full answer, as in (a) above, should be given: Page 12 of 14

IMPORTANT NOTICE CONCERNING DISCLOSURE It is your duty to disclose all material facts to Underwriters. A material fact is one which may influence an Underwriter s judgement in the consideration of your proposal. If your proposal is a renewal, it is likely that any change in facts previously advised to Underwriters will be material and such changes should be highlighted. If you are in any doubt as to whether a fact is material, you should disclose it. FAILURE TO DISCLOSE could prejudice your rights to recover in the event of a claim or allow Underwriters to void the policy. I/We declare that the statements and particulars contained in the proposal are true and that I/we have not mis-stated or suppressed any material facts. I/We agree that this proposal, together with any other information supplied by me/us shall form the basis of any Contract of Insurance effected thereon. Dated day of 200 Name of Partner, Principal or Director Signature of Partner, Principal or Director A COPY OF THIS PROPOSAL SHOULD BE RETAINED BY YOU FOR YOUR OWN RECORDS Page 13 of 14

Additional Information Proposal Form Accountants - apo t Page 14 of 14