PROFESSIONAL INDEMNITY PROPOSAL FORM (OVERSEAS) · provide accurate information. Insurers regard the proposal form as a reflection of the quality of the business seeking insurance;

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PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM FOR ACCOUNTANTS

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CONTENTS

A. ADVICE ON COMPLETING THE PROPOSAL FORM

B. PROPOSAL FORM

C. RISK MANAGEMENT SUPPLEMENTARY QUESTIONNAIRE

D. SUPPLEMENTARY FINANCIAL SERVICES QUESTIONNAIRE

E. TAX MITIGATION QUESTIONNAIRE

F. 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 UK Group Limited 16 Eastcheap London EC3M 1BD 0207 133 1300 [email protected] www.howdengroup.com

Howden UK Group Limited 16 Eastcheap, London, EC3M 1BD, United Kingdom. www.howdengroup.com

Howden is a trading name of Howden UK Group Limited, part of the Hyperion Insurance Group. Howden UK Group Limited is

authorised and regulated by the Financial Conduct Authority in respect of general insurance business. Registered in England and

Wales under company registration number 725875. Registered Office: 16 Eastcheap, London EC3M 1BD. Calls may be monitored and

recorded for quality assurance purposes.

mailto:[email protected]

http://www.howdengroup.com/

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A. ADVICE ON COMPLETING THE PROPOSAL FORM

To allow us sufficient time to time negotiate with Insurers, please ensure you return this proposal form as soon as possible. It is essential that you allow sufficient time to complete the proposal form and provide accurate information. Insurers regard the proposal form as a reflection of the quality of the business seeking insurance; a poorly completed, untidy or inaccurate form can reflect badly on a business and will not assist us in securing terms. 1. Definitions of terms used in this proposal form

‘Principal’ means: Any Partner(s), Director(s), Member(s)

‘Employee’ means: Any person who is or has been under a contract of service for or on behalf of the Firm.

‘Senior Management’ means, in accordance with the Insurance Act 2015: those individuals who play significant roles in the making of decisions about how the Insured’s activities are to be managed or organised. Under Section 4 of the Insurance Act 2015 an Insured must disclose all material circumstances known to its ‘senior management’ and those persons responsible for the Insured’s insurance. Please see Question 11 in this proposal form.

2. Duty of fair presentation

Under English law, you owe a duty of disclosure to the insurer which includes your duty to make a fair presentation of the risk. A ‘fair presentation’ is one:

which clearly discloses all material circumstances which the Insured’s Senior Management, including persons responsible for the Insured’s insurance, know or ought to know following a reasonable search or which is sufficient to make the insurer ask questions about the risk. A circumstance is material if it would influence an insurer’s judgment in determining whether to take the risk and, if so, on what terms. If you are in any doubt whether a circumstance is material we recommend that it should be disclosed;

which discloses information in a manner which is clear and accessible to a prudent insurer (i.e. no ‘data dumping’);

in which every material representation as to a matter of fact is substantially correct and every material representation as to a matter of expectation or belief is made in good faith.

Failure to disclose a material circumstance may entitle an insurer to:

in some circumstances, avoid the policy from inception and in this event any claims under the policy would not be paid;

impose different terms on your cover; and/or

proportionately reduce the amount of any claim payable.

This duty applies:

before your cover is placed;

when it is renewed; and

at any time that it is varied.

Your policy wording may also provide that this duty continues for the duration of the policy.

You should contact us immediately for assistance if you are unsure whether information may be material, or if it comes to your attention that you may have not disclosed full and accurate information.

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3. 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.

If the proposal form is completed by just one of the Principals, please ensure that full consultation is made with the Senior Management, prior to submission of this form and that they, in turn, have consulted those for whom they are responsible.

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.

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 on 0207 133 1300.

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

4. Providing additional information

If you feel there is additional information required in order to make a fair presentation of the risk which is not requested by this form, such information should be set out clearly 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;

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;

Standard Terms of Engagement.

5. Claims and circumstances

Whilst every question on the proposal form is important and constitutes material information upon which Insurers rely, Insurers will be particularly interested in your 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

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

Details of any amounts: o Paid by Insurers o Reserved by Insurers o Legal fees incurred by Insurers

In order to ensure that all notifiable matters are declared, the recommended practice would be for each Principal including all members of the Senior Management and other 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 declared 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.

Data Protection Act

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

convictions, age), will be processed by Howden UK Group 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.

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B. PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM

ACCOUNTANTS

SECTION 1 – GENERAL DETAILS

1.1 Name and principal address of Firm.

1.2 Name of all subsidiaries, entities or predecessors of the Firm for which cover is required.

Date of

establishment

Date of

closure

(where applicable)

1.3 Please give details of all Licensed Insolvency Practitioners within the Firm for which cover is required.

Name Age Qualifications Number of years in this capacity

at the Firm

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SECTION 1 – GENERAL INSURANCE DETAILS (CONTINUED)

1.4 Name and position of person responsible for completing this form

Forename Surname Position within firm

Telephone number Email address

Website

1.5 How many other offices does the firm trade from?

S

1.6 Network(s) or Association(s) 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 financial 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 4 – BUSINESS ACTIVITIES

4.1 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 types of work)

AUDIT

Quoted Companies (please state which market below) %

FTSE 100 %

FTSE 250 %

AIM %

Other %

Unquoted Companies %

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

TAXATION

Corporate %

Corporate (Avoidance Schemes) %

Personal %

Personal (Avoidance Schemes) %

ACCOUNTING WORK %

FORENSIC AND INVESTIGATIVE ACCOUNTING %

DEBT / FUNDING ADVICE %

COMPANY, SHARE AND BUSINESS VALUATION %

COMPLIANCE WORK %

EXPERT WITNESS %

MERGER, ACQUISITION AND DISPOSAL %

PAYROLL %

FINANCIAL SERVICES

FCA Regulated %

Non FCA Regulated %

MANAGEMENT CONSULTANCY %

SECRETARIAL AND SHARE REGISTRATION %

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SECTION 4 – BUSINESS ACTIVITIES (CONTINUED)

4.1 (Continued)

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)

%

CORPORATE FINANCE %

OTHER (PLEASE GIVE DETAILS BELOW) %

4.2 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 %

4.3 Please provide the average fee per client or group

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4.4 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

4.5 Does the Firm(s) or any Partner, Director or Member undertake any services in the entertainment business?

YES/NO

4.6 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

4.7 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 for which cover is required? 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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4.8 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:

4.9 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


4.10 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


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

Partner, Director, Member or member of staff e.g. Tax Advice?

YES/NO

If YES, please provide details:

4.12 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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4.13 Does the Firm(s) provide services to any companies with assets in USA/Canada or to any subsidiaries of

USA / Canadian based companies located in the UK or elsewhere? YES/NO

If YES, please give details

SECTION 5 – FINANCIAL SERVICES AND TAX PLANNING

5.1 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:

5.2 Has the Firm(s) ever provided any tax planning advice to clients (directly or indirectly including referrals

only) 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, please complete the attached Tax Mitigation questionnaire.

SECTION 6 – FRAUD / DISHONESTY

6.1 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:

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

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SECTION 6 – FRAUD / DISHONESTY (CONTINUED)

6.3 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:

6.4 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 7 – 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 UK Group)

Name of Insurers

Limit of Indemnity

Excess

Retroactive date:

Policy Renewal date

Premium

SECTION 8 – 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

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SECTION 8 – PREVIOUS APPLICATIONS FOR INSURANCE (CONTINUED)

If any answer is YES please give full details (copy of current policy and previous proposal forms for example)

SECTION 9 – NEW INSURANCE ARRANGEMENTS

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

9.2 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 10- CLAIMS

10.1 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 reasonably be expected to 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)

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

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SECTION 11 – KNOWLEDGE OF THE INSURED

Under Section 4 of the Insurance Act 2015 an Insured must disclose all material circumstances known to its Senior Management and those persons responsible for the Insured’s insurance. The Act defines Senior Management as those individuals who play significant roles in the making of decisions about how the Insured’s activities are to be managed or organised. For these purposes please list below the positions / roles within your firm that you consider to be your Firm’s Senior Management and include the roles of those persons responsible for the Firm’s insurances.

Position Role

DECLARATION

Before signing this declaration please familiarise yourself with your ‘Duty of fair presentation’ which is outlined under section A. 2. at the beginning of this form. Please read the declaration carefully and sign at the bottom.

I/We declare that I/We have made a fair presentation of the risk, by disclosing all material circumstances which I/we know or ought to know or, failing that, by giving the Insurer sufficient information to put a prudent Insurer on notice that it needs to make further enquiries in order to reveal material circumstances.

No Yes

Completing this Proposal Form does not bind the Proposer or Insurers to complete this insurance.

Signature of Principal

Name (IN CAPITALS) Date

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

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C. RISK MANAGEMENT SUPPLEMENTARY QUESTIONNAIRE

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

Managing Partners

Managing Executive

Management Committee

Executive Committee

Other (please specify below ):

1.2 Have there been any material changes in the management structure within the last three years? YES/NO


1.3 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

1.4 Does the Firm employ a full time non-accountancy administrator? YES/NO

1.5 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

2.1 Does the Firm have written risk management procedures? YES/NO

2.2 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)

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

system and back up? YES/NO

4.2 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

4.3 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


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

If YES,

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

(b) Does the diary system provide for accountants being absent or deadlines are not missed?

YES/NO

7.1 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

7.2 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/NO

(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


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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D. FINANCIAL SERVICES SUPPLEMENTARY QUESTIONNAIRE

(ONLY TO BE COMPLETED IF QUESTION 5.1 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:

5.1 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

5.2 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)


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. If YES, please complete the Tax

Mitigation Questionnaire.

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 or Endorsement

F Venture Capital Trusts (VCT)

G Investment in deposits with Arch Cru funds?

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7. (Continued)

YES NO

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

I Enterprise Investment Schemes (EIS)

J Viatical Settlements

K Precipice Bonds and SCARPS

L Carbon Trading

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 j) 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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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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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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E. TAX MITIGATION QUESTIONNAIRE

(IF QUESTION 5.2 ANSWERED’YES’)

1. Please list the individuals at the firm who are responsible for providing tax advice and, for each, advise:

Name Title Qualification Period at Firm

2. Has the firm introduced, recommended, promoted or provided any advice (including scheme design) in relation

to Tax Mitigation Schemes (which are intended to provide a tax advantage by way of Tax Avoidance, Tax

Deferral, National Insurance Minimisation etc) which have fallen, or are of a type which in your reasonable opinion

will fall, under the scrutiny of HMRC’s DOTAS and GAAR rules ? If Yes, please provide details below:

Name of

Scheme

Number

of

Investors

Year

Invested

Total Amount Invested Maximum

amount

invested by

any one

investor

Average

Amount

Invested

Number of

Investors

Remaining

in Scheme

3. Are any of these Tax Mitigation Schemes highlighted on the HMRC website ‘Spotlights’ page? YES / NO

If YES, please state which:

4. Have any of the Tax Mitigation Schemes been reviewed or are they being currently reviewed under the

General Anti Avoidance Rule (GAAR)? YES / NO

If YES, please state which and the outcome of the review / anticipated completion of an ongoing review:

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TAX MITIGATION QUESTIONNAIRE (CONTINUED)

(IF QUESTION 5.2 ANSWERED ‘YES’)

5. Has the firm ensured that all Tax Mitigation Schemes have been disclosed to HMRC under the Disclosure of

Tax Avoidance Scheme (DOTAS) rules? YES / NO

If NO, please provide details:

6. If the firm has introduced or recommended a client to a Tax Mitigation Scheme or third party adviser, please

advise:

a. Has the firm received a commission, referral fee or other form of remuneration? YES / NO

b. How is this disclosed to or discussed with the client?

c. What would form the firm’s due diligence (PI cover, experience etc) for the selection criteria of a

third party adviser?

d. How does the firm ensure that it limits or excludes liability for advice provided by third party

scheme promoters/providers/advisers?

e. Does it ensure that the clients enter into separate terms and conditions with such scheme

promoters/providers/advisers? YES / NO

f. Has the firm attended meetings with the client and the third party advisers? YES / NO

g. Does the firm request that the client signs a KYC form, or similar document, demonstrating that

there is no advice provided or responsibility etc and a copy retained? YES / NO

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7. a) What risk appetite and investment strategy review is undertaken with clients before recommending them

for any Tax Mitigation Scheme?

b) Are these schemes only recommended to sophisticated investors? How would the firm’s selection

criteria be adopted/approached?

8. Has it always been the firm’s practice when recommending Tax Mitigation Schemes:

a. To comply with CIOT guidelines to ensure clients are made fully aware of the risks of entering

into any Tax Mitigation Scheme? YES / NO

b. To make clear the risks of such schemes not succeeding in their objectives? YES / NO

c. To make clear that such schemes may be subject to litigation, legal costs, uncertainty or

possible changes in law? YES / NO

If you answered NO to any of the above, please provide details of how you advised clients of the risks involved:

Please attach a sample letter of recommendation and any KYC or similar documentation the client is asked to

sign.

9. Is the firm still actively introducing, recommending, promoting or providing any advice (including scheme

design) in relation to Tax Mitigation Schemes? YES / NO

If YES, please provide details and confirm how often are these schemes reviewed or checked to ensure they

remain compliant:

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10. Follower Notices and/or Accelerated Payment Notices

a) Has the firm been made aware of any clients that may be the subject of any Follower Notices or

Accelerated Payment Notices? YES / NO

b) Have any clients made any complaints or claims against the firm in relation to any such

Notices? YES / NO

11. Does the firm limit its liability to clients in its terms and conditions? YES / NO

If YES, please detail the language and limit applied:

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F. 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

Keyman and Shareholder Protection

Directors and Officers Insurance

Cyber Insurance

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:

Documents

PROFESSIONAL INDEMNITY PROPOSAL FORM (OVERSEAS) · provide accurate information. Insurers regard the proposal form as a reflection of the quality of the business seeking insurance;