PROPOSAL FORM Professional Indemnity Insurance for Surveyors (and Related Professions) Important tice 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the individual, company, partnership, limited liability partnership, organisation or association proposing cover. 2. This proposal must be completed in ink, signed and dated. All questions must be answered to enable a quotation to be given but completion does not bind you or Underwriters to enter into any contract of insurance. If space is insufficient to answer any questions fully, please attach a signed continuation sheet. You should retain a copy of the completed proposal (and of any other supporting information) for future reference. 3. All facts material to the proposed insurance must be disclosed, fully and truthfully to the best of your knowledge and belief. Failure to do so may make the contract of insurance voidable or severely prejudice your rights in the event of a claim. A material fact is one likely to influence Underwriters assessment or acceptance of the proposal; if you are uncertain what may be a material fact, you should consult your broker. 4. You are recommended to request a specimen copy of the proposed policy wording from your insurance broker and to consider carefully the terms, conditions, limitations and exclusions applicable to the cover. General Information 1. a. Name of Business or Practice (Assured):... b. Address of Registered or principal office:............ c. Post Code:... d. Telephone number:... e. Fax number:... f. E-mail address... g. Website address:... 2. a. Has the Business or Practice been established for at least three years and are at least 50% of all directors, partners, principals and consultants suitably qualified or have at least three years relevant experience? If NO please answer the following questions b. Date when the Business or Practice was first established...
c. Provide the following information in respect of those directors, partners, principals and consultants who are not suitably qualified or have less than three years experience i. Name... ii. Qualifications...... iii. Year obtained... iv. Period of relevant experience...... v. How long position held with this Business or Practice...... d. What is the total number of i. Directors, partners and principals... ii. Consultants... iii. Qualified staff... iv. Unqualified staff... 3. What are your gross income/fees for your last complete financial year?... 4. Select which of the following activities apply to your business and provide a percentage breakdown of your gross income/fees against each category for your last complete financial year emanating from each geographical area % OF INCOME/FEES TYPE OF WORK UK/EU USA Elsewhere Quantity Surveying, Insurance Agency (1), Mortgage Broking, Building SocietyAgency, Town Planning, General Practice, Residential Estate Agency, Auctioneering (ex Fine Art) Commercial Estate Agency Property Management (2), Project Co-ordination (3), Auctioning (Fine Art) Project Management (4), Architectural Design and Planning (5) Residential Surveying and Valuing (6) Commercial surveying and Valuing (7) Other (please provide details of work undertaken below) Total ( = 100%) : Professional Indemnity Insurance for Surveyors Proposal Form Page 2
If any income is derived from Insurance Agency please answer question 5.a If any income is derived from Property Management please answer question 5.b If any income is derived from Project co-ordination please answer question 5.c If any income is derived from Project Management please answer question 5.d If any income is derived from Architectural Design and Planning please answer question 5.e If any income is derived from Residential Surveying and Valuing please answer questions 5.f & 5.g If any income is derived from Commercial Surveying and Valuing please answer questions 5.h & 5.i ONLY ANSWER THE FOLLOWING QUESTIONS IF REQUESTED ABOVE (OTHERWISE PLEASE PROCEED TO QUESTION 6). 5. a. Insurance Agency Are you authorised by the Financial Services Authority to issue cover notes or certificates? If NO please provide full details... b. Property Management Please provide details of type and size of portfolio managed Type Value i. Residential property... ii. All other property... (Please provide details of the type and size of property managed) c. Project Co-ordination i) What was the maximum building/contract value during the last five years?... ii) What was the average building/contract value during the last five years?... d. Project Management i) What was the maximum building/contract value during the last five years?... ii) What was the average building/contract value during the last five years?... Professional Indemnity Insurance for Surveyors Proposal Form Page 3
e. Architectural/design and Planning i) What was the maximum building/contract value during the last five years?... ii) What was the average building/contract value during the last five years?... f. All Surveying and Valuing Can you confirm that all lending institutions for whom you carry out survey and valuation work are either UK clearing banks or building societies and that you have not encountered any problems with any such lending institution for whom you have carried our surveying and valuation work? If NO please provide full details... g. Residential Surveying and Valuing i) Maximum valuation undertaken in last five years?... ii) Average valuation during last five years?... iii) Please provide details of the type of property involved in respect of the maximum valuation referred to above together with a brief resume of usual type of residential survey work h. Commercial Surveying and Valuing i) Maximum valuation undertaken in last five years?... ii) Average valuation during last five years?... iii) Please provide details of the type of property involved in respect of the maximum valuation referred to above together with a brief resume of usual type of residential survey work Professional Indemnity Insurance for Surveyors Proposal Form Page 4
6. Can you confirm that a. you do not anticipate any major changes in these activities in the forthcoming twelve months? b. there have not been any fundamental changes in your activities over the last five years? c. you do not anticipate any major changes in the proportion of total income emanating from the three geographical areas? d. your total fee income from each of your last three financial years and your estimated fee income from your current financial year does not vary from one successive year to another by more than ±25%? e. no contract or client represents more than 20% of your work in any of your last three financial years or your current financial year? f. all work undertaken by you is subject to the jurisdiction of a court of law within the European Union? g. the Business or Practice is not represented in any way in the USA? If NO to any of the above please supply full details... 7. Has the Business or Practice at any time entered into collateral warranties, duty of care agreements or similar agreements? If YES please answer the following questions i. Are such agreements in accordance with JCT Standard Form of Agreement for Collateral Warranties? ii. Are all such agreements limited to two assignments? If NO to either 7.i or 7.ii please provide full details.... Professional Indemnity Insurance for Surveyors Proposal Form Page 5
8. a. Do you require third party consultants or sub-contractors to carry Professional Indemnity insurance in accordance with their professional or governing body where appropriate and in any event subject to a minimum limit of 250,000? If NO please answer the following question b. Please provide full details including whether or not such persons are fully supervised by your own staff (Please note: Underwriters retain rights of recourse against sub-contractors unless specifically agreed otherwise) 9. Can you confirm the following good practice? a. Satisfactory written references are always obtained from former employers for the three years immediately preceding the engagement of any employee responsible for money, accounts or goods b. all cheques drawn for more than 25,000 require two signatories c. cash in hand and petty cash are checked independently of the employees responsible at least monthly and additionally, without warning, at least every six months d. bank statements, receipts, counterfoils and supporting documents are checked at least monthly against the cash book entries independently of the employees making cash book entries or paying into the bank e. employees receiving cash and cheques in the course of their duties are required to pay in daily f. employees are required to account for money received at least weekly If NO to any of the above please provide details of your system... 10. a. Is cover required for Partners Previous Business? (This extension of cover is not available where the Previous Business was a Limited Liability Company) If YES provide the following information for each Partner/Principal for whom such cover is required for each Previous Business b. Name of Partner/Principal... c. Name of Previous Business... d. Dates during which he or she was a Partner/Principal... e. Nature of work undertaken by Previous Business... f. Reasons for leaving... g. Was there a dissolution agreement? If YES please provide a copy of the agreement Professional Indemnity Insurance for Surveyors Proposal Form Page 6
h. Were there any claims made against the Previous Business or were there any circumstances or incidents which may give rise to a claim? If YES please provide full details... i. Was the Previous Business at any time refused similar insurance or quoted increased premiums or had special terms imposed? If YES please provide full details... j. Is the Previous Business still in existence? 11. a. Have you previously been insured or are you currently insured for the risks being proposed? If YES please answer the following questions b. What is the Retroactive Date of your current policy?... c. Who are your current Insurers?... 12. Are you able to confirm that a. no claims (successful or otherwise) have been made against you, your predecessors in business, or present or past directors, partners, principals or consultants to which this proposal relates, within the last 5 years? b. neither you nor any of the past directors, partners, principals or consultants are aware (after having made full enquiries, including of all staff): i. of any circumstances which may give rise to a clam against you, your predecessors in business or any past or present director, partner, principal or employee, ii. of the receipt of any complaints whether oral or in writing, regarding services performed or advice given by you? c. neither you nor any of your predecessors have, at any time, been refused similar insurance, or quoted increased premiums or had special terms imposed? If you have said NO to any of the above please answer the following question Professional Indemnity Insurance for Surveyors Proposal Form Page 7
d. Please provide full details, including (if claims have been made against you within the last 5 years) whether or not such matters have been notified to current or previous insurers... 13. What indemnity limit is required? 500,000 1,000,000 2,000,000 5,000,000 Other (please specify)... Professional Indemnity Insurance for Surveyors Proposal Form Page 8
Data Protection Act 1998 Consent to use of information Underwrites will use the information provided herein to manage the insurance policy, including underwriting and claims handling. This may include disclosing it to other insurers, regulatory authorities or to Underwriter s agents providing services on their behalf. In order to detect and prevent fraud Underwriters may at any time: a. Share information about the Proposer and/or its partners, principals, directors, officers and/or employees with other organisations and public bodies including the Police; b. Check and/or file the Proposer s and/or its partner s, principals, directors and/or officers details with fraud prevention agencies and databases and if Underwriters suspect fraud, Underwrites will record this. Underwriters and other organisations may also search these agencies and databases to: i. Help make decisions about the provision and administration of insurance, credit and related services for the Proposer, its partners, principals, directors and officers; ii. Trace debtors or beneficiaries, recover debt, prevent fraud and to manage the Proposer s accounts and insurance policies; iii. Check identities to prevent money laundering; c. Undertake credit searches and additional fraud searches. Underwriters can supply on request further details of the databases that they access or contribute to. Declaration I hereby declare that I am authorised to complete this proposal on behalf of the Proposer and that the statements and particulars in this proposal are true and complete and no material facts have been mis-stated or suppressed. I undertake to inform Underwriters of any material alteration or addition to these statements or particulars which occurs before any contract of insurance based on this proposal is effected and acknowledge that this proposal (together with any other information supplied to Underwriters) shall be the basis of such contract. *Signed: Name: *Capacity Date: *the signatory should be a director or senior officer of, or partner in, the Proposer. Professional Indemnity Insurance for Surveyors Proposal Form Page 9
About Us Markel International Limited is the London based subsidiary for the international operations of Markel Corporation and is one of the UK s leading specialist insurance companies. The company has developed its expertise through understanding and catering for niche markets. In each of these markets Markel aims to provide quality products and excellent customer service thereby establishing the Markel brand as a market leader. The company operates in the UK through two commercial entities: Markel International Insurance Company Limited, its London based insurance company and Markel Syndicate 3000, its 100 per cent owned Lloyd s syndicate. In both of these business environments Markel International offers a wide range of products, with its considerable underwriting expertise organised around the following product lines: Marine & Energy, n-marine Property, Specialty, Professional Liability and Retail. For more details about our products, please visit our website at www.markelintl.com The Markel Building, 49 Leadenhall Street, London EC3A 2EA Tel: +44 (0)20 7953 6000 Fax: +44 (0)20 7953 6001 www.markelintl.com Professional Indemnity Insurance for Surveyors Proposal Form Page 10