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PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS

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CONTENTS

1. ADVICE ON COMPLETING THE PROPOSAL FORM

2. PROPOSAL FORM

3. RISK MANAGEMENT SUPPLEMENTARY QUESTIONNAIRE

4. SUPPLEMENTARY FINANCIAL SERVICES QUESTIONNAIRE

5. OTHER INSURANCE REQUIREMENTS

CONTACT US

Your completed proposal form can either be emailed or posted to us using the contact details below. Please retain a copy for your own records. Please do not hesitate to contact us if you have any questions. Howden Insurance Brokers Limited 71 Fenchurch Street London EC3M 4BS 0207 133 1300 pii@howdengroup.com www.howdengroup.com

Howden Insurance Brokers Limited 71 Fenchurch Street, London, EC3M 4BS, United Kingdom. www.howdengroup.com

A subsidiary of Howden Broking Group Limited, part of the Hyperion Insurance Group. Howden Insurance Brokers Limited is regulated

by the Financial Conduct Authority: firm reference number 312584. Registered in England and Wales under company registration

number 203500. Registered office 16 Eastcheap, London, EC3M 1BD.

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ADVICE ON COMPLETING THE PROPOSAL FORM

To allow us sufficient time to negotiate with Insurers, please ensure you return this proposal form as soon as

possible. Wherever the word ‘Principal’ appears herein, this is deemed to read ‘Partner(s), Director(s), Member(s)

or Principal(s)’.

Many businesses either fail to allow sufficient time to complete the proposal form and/or provide inaccurate

information. Insurers regard the proposal form as a reflection of the quality of the business seeking insurance;

a poorly completed, untidy form can reflect badly on your business and will not assist us in securing terms.

1.1 General instructions relating to completion of the form

Please ensure this Proposal Form is completed by a Principal of the business.

A response to all questions must be entered. Where a question is not relevant to your business, please

respond N/A.

Where the Proposal Form is completed by just one Principal, we often find that disagreements arise

regarding the responses provided. It is imperative that full consultation within the business has taken

place, prior to submission of this form.

If you are completing this Proposal Form electronically, the boxes will expand accordingly. If you are

completing this Proposal Form by hand, it should be completed in black ink and preferably in block

capitals.

If you have completed the Form electronically, please print and sign it before returning it to us, either

electronically or by post.

A number of questions request YES or NO answers. Please place an x in the appropriate box or

underline the appropriate response.

If there is insufficient space to answer any questions please provide full details on your headed paper.

Please ensure that any additional information is signed, dated and makes clear reference to the

question(s) on the Proposal Form, to which it refers.

If a supplement is attached to this proposal form, please tick here .

Depending upon the qualifications and/or experience of the Principal(s), Insurers reserve the right to

request a Curriculum Vitae and details of any circumstances or claims pertaining, in the past 5 years,

irrespective of whether they were employed by the business at the time.

Completion of this proposal form does not automatically bind the Principal, the Firm or Insurers to effect a

contract of insurance.

Wherever the word ‘Employee’ appears herein, this is deemed to read ‘Any person who is or has been

under a contract of service for or on behalf of the Firm’.

If you have any questions about completing this Form please contact us 0207 133 1300

A copy of this proposal should be retained for your own records.

1.2 Providing additional information

The proposal form is the basis of the contract of insurance which may ultimately ensue and the information

contained herein forms the basis of disclosure to Insurers. Failure to disclose something which could be

considered material may render the insurance contract voidable. This form confines itself to dealing with

essential issues such as income and claims. If you feel there is additional information that is relevant to

Insurers’ appraisal of your business, but is not requested by this form, this should be set out on your headed

paper and attached to this proposal form.

Additional information, where not requested by the proposal form, could include:

Corporate brochure(s);

Organisation chart(s);

An overview of risk management;

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CV’s of the Principal(s);

A description of any services provided in the past 6 years which are no longer provided and/or any new

services the business intends to provide in the future;

An overview of the client base;

Terms of Engagement, particularly if they restrict your liability.

1.3 Claims and circumstances

Whilst every question on the proposal form is important and constitutes material information upon which

Insurers rely, Insurers will be particularly concerned with the history of claims and/or circumstances. Details of

all claims and circumstances notified to previous insurers must be declared on the proposal form, accompanied

by a brief description which should include:

Overview of the job/instruction being undertaken

Date the work, to which the allegation relates, was undertaken

Policy year in which the notification was made to Insurers

Alleged wrong doing

The Firm’s own view on the matter

Insurers’ view on the matter (clearly differentiated from the above)

Details of any amounts:

­ Paid by Insurers

­ Reserved by Insurers

­ Legal fees incurred by insurers

In order to ensure that all notifiable matters are declared, the recommended practice would be for each

Principal and all senior members of staff to sign a declaration to the effect that he/she has investigated the

areas for which he/she is responsible and can confirm that there are no claims or circumstances other than

those (if any) contained in the proposal form.

After completion of the proposal form and prior to the expiry of the firm’s current insurance, a check should be

undertaken within the Business to ensure that there are no claims or circumstances of which anyone is aware

other than those already notified in the proposal form.

If any new matters are discovered, these should be immediately notified to Howden if we are your current

Broker. If we are not your current Broker, then you should notify your current Broker/Insurers and Howden.

Such notifications should reach your current Broker/Insurers and Howden prior to the expiry date of the firm’s

current insurance.

1.4 Disclosure of material facts or information

When seeking a quotation, taking out or renewing an insurance contract it is essential that you disclose to

prospective Insurers any material facts or information (including any material circumstances or change in

circumstances) which might influence the judgement of Insurers in setting the premium and/or the terms and

conditions of the insurance contract or in determining whether they will accept the risk. This duty of disclosure

continues throughout the Policy period.

The statement made in this proposal form (including any supporting information) will form the representation to

Insurers and as such will be the basis of the insurance contract. Failure to disclose material information may

render the insurance contract voidable from inception, at the option of Insurers and enable them to repudiate

liability thereunder. If you have any doubt as to what constitutes a material fact or circumstance, please contact

us.

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PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

ACCOUNTANTS

Any information provided on this form, which may include sensitive data (e.g. medical history, criminal

convictions, age), will be processed by Howden Insurance Brokers Limited in compliance with the Data

Protection Act 1998 and will only be used for the purposes of providing insurance cover and handling

claims arising. In the course of our duty as insurance brokers we may be required to provide such data

to limited third parties including Insurers and/or circumstance required by law.

SECTION 1 – GENERAL DETAILS

1.1 Name and address of Firm (including any subsidiaries for whom cover is required).

Establishment Date

1.2 Name of all predecessors of the Firm for which cover is required.

Date of

establishment

Date of

closure

1.3 Name and position of person responsible for completing this form

Forename Surname Position within firm

Telephone number Email address

Website

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SECTION 1 – GENERAL INSURANCE DETAILS (CONTINUED)

1.4 Address and postcode of all other offices.

S

1.5 Network or Association to which the Firm(s) are admitted as members

SECTION 2 – PARTNERS / DIRECTORS AND STAFF

2. 1 Please give details of all Partners/ Directors/Members

Name Age Qualifications Date

Qualified

Number of years in

this capacity in the

Firm

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SECTION 2 – PARTNERS / DIRECTORS AND STAFF continued

2.2. If cover is required for any Partner/Director or Member in respect of his/her liability arising from any

previous business, please complete the following.

Partner/Director’s name Name of previous firm Date left previous business

2.3 Staff numbers

Partners/Directors/Members Other Qualified staff Other staff Self-employed persons

2.4 Is cover required under your PI policy for any Consultant or self-employed individual that is engaged by the

Firm? YES / NO

If YES please provide details:

Name Qualifications

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SECTION 3 – INCOME AND OTHER DETAILS

3.1 Financial year end …..…….. (day) ………..… (month)

3.2 Please state the GROSS FEE INCOME for each of the last four completed financial years:

Year UK Business USA Business Other overseas

Business

3.3 Estimated GROSS FEE INCOME for current year

Current year UK Business USA Business Other overseas

Business

3.4 Please provide for the last completed Financial Year the Gross Fees paid to Consultants and/or Sub

Contractors

£

3.5 Other than detailed in question 2.4, do you require Consultants and or sub-contractors to carry their own

Professional Indemnity Insurance? YES / NO

If YES, to what limit?

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SECTION 5 – BUSINESS ACTIVITIES

5.1 Please indicate as an approximate percentage of Gross Fee Income for the last completed Financial Year,

(appreciating that there may be an overlap between the typos of work)

AUDIT, ACCOUNTANCY AND COMPANY TAX

Quoted Companies (please state which market below) %

Unquoted Companies %

Others (Incl. Farmers, Sole Traders, etc.) %

PERSONAL TAXATION

Compliance %

Consultancy %

MANAGEMENT CONSULTANCY %

SECRETARIAL AND SHARE REGISTRATION %

EXECUTORSHIP AND TRUSTEESHIP %

INSOLVENCIES, LIQUIDATIONS, RECEIVERSHIPS %

INSURANCE, BUILDING SOCIETY AND STOCK EXCHANGE COMMISSIONS %

DIRECTORSHIPS %

COMPUTER CONSULTANCY (COMPUTER BUREAU SERVICES INCOME

SHOULD BE SHOWN SEPARATELY AS SHOULD TURNOVER RECEIVED

FROM THE SALE AND/OR SUPPLY OF HARDWARE)

%

OTHER (PLEASE GIVE DETAILS BELOW) %

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SECTION 5 – BUSINESS ACTIVITIES CONTINUED

5.2 Please provide the following details for the last completed Financial Year

Number of clients Percentage of income

Less than £15,000 %

£15,000 - £40,000 %

Over £40,000 %

5.3 Please provide the average fee per client or group

5.4 Please provide the division of gross fee income between clients

Percentage of income

Located within the London area %

Located outside the London area %

Located overseas %

Individuals in the entertainment business (including

sportsmen/women) %

5.5 Please provide the largest total fee from any one client or group

Name of client or group

Amount of fee £

Type of work the client undertakes

The geographical location of the work

Services you undertake on its behalf

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SECTION 5 – BUSINESS ACTIVITIES CONTINUED

5.6 Does the Firm(s) or any Partner, Director or Member undertake any services for the following?

Banks, Building Societies, Investment Companies, Funds or Fund Managers / Stockbrokers or Insurance

Companies (including Captive Insurance Companies) / Underwriters / Lloyd’s Syndicates.

YES/NO

If YES to any of the above please give client name(s), fee(s), location(s) and details of services provided

Client name Fees Location Services provided

5.7 Does any Partner, Director, Member or Employee of the Firm(s) hold appointments as Director, Trustee or

Company Secretary of any other Company, including Trusts? YES/NO

If YES please provide the following information regarding current appointments:

Appointee Company name Position held

Fees received (last

completed

Financial Year)

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SECTION 5 – BUSINESS ACTIVITIES CONTINUED

5.8 Other than in respect of shares held in public companies, does the Firm(s) or any Partner, Director or

Member undertake any work for any other Partnership, Company or Organisation in which the Firm(s) or

such Partner, Director or Member has/have a financial association or interest? YES/NO

If ‘YES’ please provide details:

5.9 Does the Firm(s) or any Partner, Director or Member exercise a controlling interest in any of the above

Partnerships, Companies or Organisations? YES/NO

If ‘YES’ please provide details:

5.10 Is (or has) the Firm(s) or any Partner, Director or Member (or previously been a member) of a Joint

Venture or Consortium or working in association with any other Partnership, Company or Organisation?

YES/NO

If ‘YES’ please provide details:

5.11 Does any Partner, Director, Member or member of staff provide formal professional advice to any other

Partner, Director, Member or member of staff? YES/NO

If YES, please provide details:

5.12 In connection with any overseas business undertaken by the Firm, please identify the Countries involved

and whether English or overseas jurisdiction applies. Please advise the nature and method of handling

such business:

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SECTION 5 – BUSINESS ACTIVITIES CONTINUED

5.13 Does the Firm(s) provide services to any companies with assets in USA/Canada or to any subsidiaries of

USA / Canadian based companies located anywhere in the World? YES/NO

If YES, please give details

SECTION 6 – FINANCIAL SERVICES AND TAX PLANNING

6.1 Does the Firm(s) undertake any FCA regulated Activities (as defined in the Financial Services and Market

Act 2000)? YES/NO

If YES, please complete the attached Financial Services supplementary questionnaire.

If the Firm(s) has previously undertaken any FCA/FSA/PIA Regulated activities please advise when this activity

ceased:

6.2 Has the Firm(s) ever provided any tax planning advice to clients in respect of any product which falls (or

would have historically fallen) under the Disclosure of Tax Avoidance Schemes (DOTAS) regulations? YES/NO

If, YES, was such advice purely as part of general tax planning advice to existing clients only and did they

receive appropriate risk warnings (please provide an example)? YES/NO

If NO, please provide full details

6.3 Has the Firm(s) ever been directly involved in the design, marketing, promotion or investment in any product

which falls (or would have historically fallen) under the Disclosure of tax avoidance schemes (DOTAS)

regulations?

If YES, please complete the attached Financial Services supplementary questionnaire.

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SECTION 7 – FRAUD / DISHONESTY

7.1 Has the Firm(s) sustained any loss through the Fraud or Dishonesty of any person? Does the Firm(s)

know of any Fraud or Dishonesty at any time committed by any past or present Partner, Director, Member

or Employee? YES/NO

If ‘YES’ please give details and state the precautions taken to prevent a recurrence:

7.2 Does the Firm(s) require references when engaging new Employees? YES/NO

7.3 Is a Partner, Director, Member or Employee of the Firm(s) allowed to sign cheques on his signature alone?

YES/NO

If ‘YES’ please describe the circumstances and state the limit:

7.4 How often are checks carried out on all entries in the cash book with paying-in books, receipts, counterfoils

and vouchers and reconciled with Bank Statements, including the balance of cash and unrepresented cheques,

independently of Employees receiving or banking monies in respect of monies belonging to the Firm(s) as well

as in trust on behalf of others?

SECTION 8 – CURRENT INSURANCE ARRANGEMENTS

Please provide the details of the existing Professional Indemnity Insurance (this information is not required

where the policy is currently arranged by Howden Insurance Brokers)

Name of Insurers

Limit of Indemnity

Excess

Retroactive date:

Policy Renewal date

Premium

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SECTION 10 – PREVIOUS APPLICATIONS FOR INSURANCE

Has an insurer ever:

a) Declined to insure this Firm or any Partner? YES/NO

b) Imposed special terms? YES/NO

c) Cancelled or voided an insurance policy? YES/NO

If any answer is YES please give full details

SECTION 11 – NEW INSURANCE ARRANGEMENTS

11.1 What limit of indemnity do you require a quotation for?

11.2 If you have any specific requirements with regard to your Professional Indemnity Insurance please state

these in the space provided below

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SECTION 12- CLAIMS

12. Is the Proposer aware, AFTER FULL ENQUIRY

(a) of any claim having been made against the Firm(s) or former Firm(s) or its/their present and/or past Partners or Directors whilst in this/these Firm(s) or any

Former Firm(s)? YES/NO

(b) of any circumstances which may give rise to a claim against the Firm(s) or former Firm(s) or its/their present and/or past Partners or Directors?

YES/NO

If ‘YES’ to either of these questions please provide full details

Date of claim Details Amount

claimed Amount paid

Defence costs

(if known)

Insurers’ Reserve (if

known

12.2 Please confirm whether any steps have been taken to prevent a reoccurrence of the claims listed above (if applicable)

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IMPORTANT NOTICE CONCERNING DISCLOSURE OF MATERIAL INFORMATION

It is essential that every proposer or insured, when seeking a quotation, taking out or renewing an

insurance, discloses all material facts to Insurers. A material fact is one that is likely to influence the

judgement of an Insurer in fixing the premium or in determining whether to accept the risk. If your

proposal is a renewal it should include any changes in facts previously advised to insurers. If you have

any doubt about facts considered material you should disclose them.

Failure to disclose could prejudice your rights to indemnity in the event of a claim or cause Insurers to

void your policy.

DECLARATION

1. I/We declare that the statements made and particulars given in the Proposal are true and I/We have not

mis-stated or suppressed any material fact.

2. I/We undertake to inform Insurers of any material alteration to these facts occurring before completion

of the contract of insurance.

Dated

Signature of Partner/Director

Name of Partner/Director

A copy of this proposal should be retained by you for your own records

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RISK MANAGEMENT SUPPLEMENTARY QUESTIONNAIRE

1(a) Please advise the management structure of the Firm (please underline as appropriate)

Managing Partners

Managing Executive

Management Committee

Executive Committee

Other (please specify below ):

1(b) Have there been any material changes in the management structure within the last three years? YES/NO

If “yes”, please provide details:

1(c) If the Firm is managed by a committee, does this committee meet on a regular or ad hoc basis? (please

underline as appropriate)

Regular Ad Hoc

1(d) Does the Firm employ a full time non-accountancy administrator? YES/NO

1(e) Does the Firm designate or employ an individual with management responsibility for evaluating or dealing

with complaints, actual or potential claims and other such matters? YES/NO

2(a) Does the Firm have written risk management procedures? YES/NO

(b) Are the risk management procedures regularly reviewed, Circulated and/or discussed within the Practice and

have all Accountants been made aware of them? YES/NO

3. Does the Practice always use engagement letters? YES/NO

(a) If Yes, do the engagement letters outline:

The scope of services to be performed? YES/NO

Any statement/ assumptions upon which the engagement is based? YES/NO

The responsibilities of the client? YES/NO

Any limitations/ restrictions in respect of any services performed? YES/NO

Does the client sign the letter of engagement? YES/NO

(b) Do you provide advice or services which fall outside the scope of the letter of engagement? YES/NO

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RISK MANAGEMENT SUPPLEMENTARY QUESTIONNAIRE (CONTINUED)

4(a) Do you have a written policy specifying the conflicts of interest procedures which include a cross check

system and back up? YES/NO

(b) In the event of a conflict of interest do you:

YES NO

Inform the client in writing

Advise the client to seek independent advice

Continue to act for the client

(c) Does the Practice undertake any professional services for any client in which any Partner or Accountant holds

a partnership/directorship or have any other financial interest? YES/NO

If Yes, please provide details:

5. Does the firm have a policy which requires prior approval in writing for an Accountant to serve as an Officer

and/or a Director of a client or third party?

YES NO NOT APPLICABLE

6(a) Does the firm operate a diary system with manual back-up? YES/NO

If Yes,

(b) Are periodic checks made to ensure that the diary system is being strictly followed? YES/NO

(c) Does the diary system provide for accountants being absent or deadlines are not missed? YES/NO

7(a) Does the firm have a file review system which requires randomly selected files to be audited an Accountant

other than the accountant handling the file? YES/NO

7(b) Does the file review system include Partner to Partner auditing? YES/NO

Please provide any additional narrative in respect of your file review system to the above two questions

which will assist our understanding of the file review system currently being used:

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RISK MANAGEMENT SUPPLEMENTARY QUESTIONNAIRE (CONTINUED)

8. Does the firm have an email and/or internet user policy or any other formal guidelines for the use of email

and/or internet? YES/NO

9. Have you obtained ISO 9001 or similar accreditation? YES/NO

10. Does the firm offer and promote continuing training? YES/NO

11. Where the Firm acts as auditors to a group of companies;

(a) Is the audit fee exceeded by consultancy fees? YES/NO

(b) Do the audit fees give less than full recovery of time costs for every company in the group? YES/NO

(c) Is there an independent partner review in place which vets the audit process and opinion? YES/N0

(d) Is the foregoing clearly evidenced on file? YES/NO

Please provide any additional narrative in respect of your answers to the questions on group audits:

12. Do you limit your liability in your terms of engagement with your clients? YES/NO

If No, please provide details:

13. Where any documents used by the Firm are in electronic format please provide details of procedures in place

for the security and the daily back-up of such documents:

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FINANCIAL SERVICES SUPPLEMENTARY QUESTIONNAIRE

(ONLY TO BE COMPLETED IF QUESTION 6 ANSWERED ‘YES’)

1. Name of Firm(s) undertaking FCA Regulated Activities:

2. FCA Registration Number:

3. Principal address, including post code:

4. In respect of the firm(s) stated in Question 1 for which cover is required, please state the Financial Year End:

5. In respect of the Firm(s) stated in Question 1 for which cover is required, please state the total gross

brokerage/ commission/fee income, including trail income, generated by all principals/employees/self-

employed persons for the following years:

Total gross

brokerage/commission/fee

income, including trail

commission

IF APPLICABLE, total net retained gross

brokerage/commission/fee income, including

trail commission

Estimate for

forthcoming financial

year

Last completed

financial year

Previous completed

financial year

Please confirm that the figures declared above are included in the fees declared in the Proposal Form to which

this Financial Services Supplementary Questionnaire attaches YES/NO

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FINANCIAL SERVICES SUPPLEMENTARY QUESTIONNAIRE CONTINUED

(ONLY TO BE COMPLETED IF QUESTION 6 ANSWERED ‘YES’)

6. Please indicate the approximate percentage of the proposing Firm(s) (as stated in Question 1) gross

commission / brokerage/fees as stated in Question 5 derived from the following activities during your last

completed financial year. (Please ensure the combined total of Private and Corporate adds up to 100%).

Private Corporate

Pensions % %

Unit Trusts % %

Conventional Investment

Trusts

% %

Other Investments Onshore % %

Other Investments Offshore % %

Life and Protection % %

Endowments % %

Mortgages % %

Other Financial Services

(please specify below)

% %

All other business not declared above

7. Has/Have the Firm(s) received any commission/fees and/or provided any investment advice, including

investments via a self-invested personal pension (SIPP), small self-administered scheme (SSAS) or any other

personal pension plan, in any of the last 6 years in respect of any of the following products or services:

YES NO

A Investments in Harlequin Management Services (South East) Limited trading as

Harlequin Property

B Any product which falls (or would have historically fallen) under the Disclosure of

tax avoidance schemes (DOTAS) regulations

C Film Finance Schemes (if not included in b) above)?

D Any other investments in Unregulated Collective Investment Schemes (UCIS)?

E Investment in any Traded Life Policy or Viatical Settlements or any collective

investment with funds invested in either product?

F Venture Capital Trusts (VCT) or Enterprise Investment Schemes (EIS)?

G Investment in deposits with Arch Cru funds?

H Investment in deposits with Key data Investment Services Limited’s products?

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FINANCIAL SERVICES SUPPLEMENTARY QUESTIONNAIRE CONTINUED

(ONLY TO BE COMPLETED IF QUESTION 6 ANSWERED ‘YES’)

If YES to any of the above categories, please provide the following information on a separate sheet:

i. The relevant fund/product

ii. Original investment value

iii. Current investment value (where available)

iv. Percentage of Investor’s overall portfolio this investment represents

v. Was the client a High Net Worth/sophisticated investor?

8. If any clients have invested in (A) or (B) above please confirm that the holdings represent less than 10% of the

clients portfolio YES/NO

If NO, please clarify your approach to clients investing in a) and b) above and confirm the highest

concentration you would recommend for any one investment and into UCIS as a whole (continue on a

separate sheet on your own headed paper if necessary):

9. If Yes to any of the products listed in d) to g) above has the Inland Revenue indicated that they intend to

challenge the tax status of any of the products arranged on behalf of any client? YES/NO

If YES please provide details (continue on a separate sheet on your own headed paper if necessary):

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FINANCIAL SERVICES SUPPLEMENTARY QUESTIONNAIRE CONTINUED

(ONLY TO BE COMPLETED IF QUESTION 6 ANSWERED ‘YES’)

10. During the last 12 months has any Firm stated in Q.1:

YES NO

A Received notice of a visit from the FCA

B Been the subject of any FCA regulatory control visit or regulatory review

C Attended an FCA Roadshow or conducted a telephone interview with the FCA

D Received any warning letters from the FCA

E Been referred to enforcement, fined or suspended by the FCA

If YES to b), c), d) or e) above, please provide copies of the relevant letter(s) or report(s) or any other

correspondence with FCA relating to these subjects.

11. If advice or other activity for which coverage is being sought, has been undertaken outside the UK or in the

UK for clients domiciled in other jurisdictions by the proposing Practice(s)/Firm(s) please advise:

YES NO

A If you hold an Insurance Mediation Directive (IMD) passport

B If you hold a Markets in Financial Instruments Directive (MiFID) passport

C If you hold a domestic authorisation in any EEA State for business which falls

outside the remit of any passport

D The countries applicable outside of the EEA (please insert below)

Where appropriate above please provide details (continue on a separate sheet on your own headed paper if

necessary):

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FINANCIAL SERVICES SUPPLEMENTARY QUESTIONNAIRE CONTINUED

(ONLY TO BE COMPLETED IF QUESTION 6 ANSWERED ‘YES’)

12. The following information is required by the FCA to be recorded by regulated firms as ‘Key Performance

Indicators’. It is also of interest to underwriters in assessing the risk presented by the Firm(s). Please advise:

The number of policies Paid Up or lapsed in the last 12 months

The number of policies cancelled within “cooling off” period in the last 12 months

The number of recommendations “Not Take Up” in the last 12 months

The number of “policy replacement” recommendations made in the last 12 months to

discontinue premiums or surrender existing contracts and replace with similar

contracts

13. Does/Do the Firm(s) gather such Management Information and Key Performance Indicators that evidence

its/their service levels to clients? YES/NO

14. Where these indicators to show that performance is not to the required standard is/are the Firm(s)/Firm(s)

able to manage the rectification process? YES/NO

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OTHER INSURANCE REQUIREMENTS

It is vital your insurance programme meets the evolving needs of your business. Whilst many organisations keep a

close eye on their most expensive, business critical insurances, it is not uncommon for other forms of insurance to

be continued with no verification of whether they remain appropriate to business needs.

Combining our in-depth knowledge of the professional sectors we serve with the product expertise and global

knowledge of the Howden Broking Group enables us to handle the most complex insurance programmes. If you

are interested in other forms of insurance please tick the relevant box(s) below and we will arrange for a member

of the relevant specialist team to contact you:

Employee Benefits Bespoke Private Client Insurance

Pension Auto Enrolment (Household, Contents, Fine Art, Valuables,

Motor, Overseas Property

Group Death in Service

Private Medical Insurance Commercial Insurances

Keyman and Shareholder Protection Office Combined (EL, PL, Office and Contents)

Business Travel

Directors and Officers Insurance Expatriate Medical Insurance

Environmental Liability Insurance

Cyber Insurance Property Insurance

Intellectual Property and Patent

Insurance Block Management Insurance

Political Risk Insurance Motor Fleet

Transactional Risk Insurance Business Interruption

Single Project Insurance

Contractors all Risks

Other (please specify below)

If the person responsible for any of the insurances listed above is that other than the person responsible for buying

PII please complete the following:

Name:

Telephone Number:

Email address: