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SOLICITORS PROFESSIONAL INDEMNITY INSURANCE

PROPOSAL FORM 2019

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Important Notes

This Proposal Form should be completed and signed by a Partner, Director or Principal of the Firm.

It is your duty to disclose all material facts to Insurers. The duty of disclosure under Irish law is a duty to pass

on to the Insurers all material information relating to the risk under consideration. ‘Material’ in this context

refers to all information which prudent Insurers (not necessarily the Insurers in question) would wish to take

into account when considering whether or not to accept the risk, upon what terms and at what price. Material

information does not necessarily increase the risk.

The duty of disclosure continues up until the Insurance has been concluded and ‘resurrects’ in the event of any

amendment to the risk during the policy period or extension/renewal. It may also be that the terms of the policy

include specific ongoing disclosure conditions or warranties which effectively extend the duty of disclosure

post inception of the policy.

In completing a proposal or claim form or any other material document relating to an insurance policy and in

providing information to or for Insurers, the accuracy and completeness of all answers, statements and/or

information is the policyholder’s own responsibility and it is of paramount importance that all relevant information

is provided and that it is accurate. Should you so require, you may request that we assist you by providing

examples of the types of matters which ought to be disclosed as being material or arguably material, in general

terms or specific to your risk from the knowledge we gain from working with you to understand your risk.

In the event of a breach of the duty of disclosure, the Insurers have the right to avoid the Insurance from its

commencement. Under such circumstances, the Insurers would be entitled to seek recovery of any claims

already paid by them under the Insurance, although at the same time the Insurers would generally be obliged to

return paid premium (in the absence of dishonest conduct).

The completion and signature of this Proposal Form does not bind the Proposer or Underwriters to complete a Contract

of Insurance. A copy of this completed Proposal Form should be retained for your own records.

When completed, please return to the JLT Ireland Solicitors Professional Indemnity Team at one of the two below

addresses:

JLT Ireland

Friends First House, Cherrywood Business Park,

Loughlinstown, Dublin 18

Tel: 01 202 6000

www.jlt.ie/solicitorsprofessionalindemnity.html

Email: solicitors@jlt.ie

or

JLT Ireland

Building 5200

Cork Airport Business Park Cork

Tel: 021 4549 500

www.jlt.ie/solicitorsprofessionalindemnity.html

Email: solicitors@jlt.ie

Ray O’Higgins ACII, Senior Partner JLT Ireland

T: +353 (0)1 2026015

M: +353 (0)87 2745499

E: raymond.ohiggins@marsh.com

Marcus Carey BSc. CIP, MDI, ACII,

Account Manager JLT Ireland

T: +353 (0)1 2026046

M: +353 (0)87 0998020

E: marcus.carey@marsh.com

David Loughrey MDI. CIP, Account Executive

JLT Ireland

T: +353 (0)1 2026088

E: david.loughrey@marsh.com

John Murphy CIP, Regional Director, JLT Ireland T:

+353 (0)21 4549505

M: +353 (0)87 6468087

E: john.murphy@marsh.com

Insurers hereby deem the questions asked in the Proposal Form to be their own and sufficient for underwriting purposes.

Insurers may request additional information if applicable.

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1 General Information

Name of Policyholder

Principal Address

Law Society Firm Number

Firm Telephone Number

Firm E-mail Address

Date of establishment and date of change of status if applicable

Has your firm become a Succeeding Practice? If you have answered yes, please provide further details including year of succession.

Yes No

Contact Person

2 Solicitors & Fee Earners

Number of all persons working in your firm:

Partners / Principals

Other Solicitors / Consultants

Support Staff

Other Fee Earners

Please give details for all fee earners: (If space provided is insufficient, please use separate sheet)

Solicitors

Roll Number Name Date of Admission How long with you?

Other Fee Earners

Name Qualifications How long with you?

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3 Fee Income

Fee Income Year ending (dd/mm/yyyy) Total

ESTIMATED current financial year €

LAST COMPLETED financial year €

Financial year before last €

Financial year but two €

Financial year but three €

Financial year but four €

4 Business Activities

Please provide a percentage breakdown of the fee income for the last accounting period into the following categories:

Type of Work Percentage

Acting as arbitrator, adjudicator or mediator %

Commercial conveyancing %

Commercial/corporate work excluding public listed companies %

Commercial /corporate work for public listed companies %

Criminal law %

Debt collection (judgement debts over € 10,000) %

Defendant litigious work for insurers %

Employment %

Family (excluding children) %

Financial advice and services %

Immigration %

Intellectual property rights (excluding patent registration) %

Landlord and tenant %

Litigation and arbitration (other) %

Mergers and acquisitions %

Patent %

Personal injury – defendant %

Personal injury – litigant %

Personal insolvency %

Residential conveyancing (PPR) %

Tax %

Wills, trust and probate %

Other non-litigious %

Other low risk work* %

Other work (please state nature and percentage of work below):%

%

%

Total (must equal 100%) 100%

*Other low risk work includes debt collection under €10,000, children, mental health tribunal, welfare, administrating

oaths and taking affidavits, lecturing and related activity, expert witness and planning

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5 Conveyancing

If in the past five years your fee income includes income from conveyancing, please give a split of THAT fee income

figure as follows:

PPR conveyancing Commercial conveyancing

Number of undertakings that currently remain undischarged

Gross Fees Number of transactions

Gross Fees Number of transactions

PPR conveyancing

Commercial conveyancing

Estimate for current year (2019)

€ €

Last complete financial year (2018)

€ €

Financial year before last (2017)

€ €

Financial year but two (2016)

€ €

Financial year but three (2015)

€ €

Financial year but four (2014)

€ €

a Are you aware of any disputes, questions or queries arising from the provision of Undertakings

given or accepted by your firm? Yes No

b Have you received correspondence from any bank or financial institution threatening legal action

or a report to the Law Society in relation to a delay or non-compliance with any Commercial

Property Undertakings given by your firm?

Yes No

c In the last 6 years, has more than 10% of your conveyancing turnover derived from single source

or referrer? Yes No

d In the last 6 years, has your firm acted for multiple buyers of property in the same development

or in the same building? Yes No

e Have you always followed Law Society Guidelines when issuing Undertakings?

If yes to any of the above, please provide full details separately on your firms headed notepaper

Yes No

6 Claims and circumstances

a. Has your firm or any Preceding Practice made any claim or reported any circumstances in the

last 6 years?Yes No

b. Please provide details of all claims and circumstances, including firms referred to in (a) above, made to insurers for

each of the following years of experience, including firm referred to in question 1.

NOTE: Do not leave this section blank. If you have no claims, please state ‘No claims’.

Indemnity Period

Name of Participating Insurer / Assigned Risks Pool

Number of claims / circumstances

Claims / circumstances attached – YES / NO

2013-2014

2014-2015

2015-2016

2016-2017

2017-2018

2018-2019

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c. Please attach to this form your current claims report provided by the above participating insurer(s) or the Assigned

Risks Pool. If this is not yet available, please provide claims/circumstances details on a separate sheet.

d. Is any Principal or Partner aware, after careful enquiry, of any loss or claim or circumstance which may give rise to a

loss being sustained or claim being made against or involving any person or persons to be included in this

insurance, their predecessors in practice or any past partners, directors or members, where such has not been

previously notified to past or present insurers?

If yes, please provide full details separately on your firms headed notepaper.

7 Risk Management

a Does your firm have written risk management procedures and are these reviewed at least

annually by a Partner or Principal?

Yes No

Please confirm these written risk management procedures cover:

Engaging new clients and new matters Yes No

Supervision and training Yes No

File Management Yes No

Conclusion of Matters Yes No

File Management Yes No

Undertakings Yes No

Financial administration Yes No

b Have you applied for, or achieved, any risk management or quality standard? Yes No

If yes, please state which standard?

c Does the firm have in place for all of the following:

Procedures for the control of undertakings? Yes No

When were these established?

Critical dates diary system and are all key dates noted prominently on file? Yes No

Measures or controls to prevent or mitigate against fraud in the form of impersonation of your

partners or employees (impersonation fraud) and impersonation of your suppliers/vendors

(payment diversion fraud)?

Yes No

d How are fund transfers over €10,000 made? Are all instructions subject to authentication by the

employee receiving the request by one of the following:

Making a call back to the requestor using a predesignated telephone number held on file Yes No

Verifying that the requestor has the authority to make such instruction Yes No

Prior to the payment request being actioned, ensuring supporting documentation of the

payment transfer request is provided

Yes No

Verifying that any signature provided on any written instruction or telefacsimile matches that

held on file

Yes No

For e-mail instructions, verifying the requestors work e-mail address has been used Yes No

For telex or telefacsimile, ensuring the test key/algorithm matches that held on file Yes No

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8 Regulation

Has any Partner, Principal, consultant or any other legal employee:

a been subject of any investigation resulting in any adverse finding by the Law Society of Ireland or

Solicitors Disciplinary Tribunal?

Yes No

b been either refused or granted only a conditional practicing certificate by the Law Society of

Ireland?

Yes No

c been the subject of a finding of misconduct by the Solicitors Disciplinary Tribunal? Yes No

d been convicted of (or charged with but not yet tried for) any criminal offence involving fraud

or dishonesty?

Yes No

e previously been, or currently be, the subject of a petition for bankruptcy or any judgements or

decrees that remain unsatisfied , in whole or in part?

Yes No

f previously been a Partner, Principal or Consultant in a Firm that is now in the run off fund? Yes No

9 Financial Services

a Has your firm or any Preceding Practice, within the last 6 years, ever sold a financial product or

provided advice in connection with financial services where such activity is regulated by the

Central Bank of Ireland?

Yes No

b Has your firm or any Preceding Practice, within the last 6 years, ever established or administered

any investment scheme or product which was offered to two or more individuals?

If yes to either of the above, please provide details separately on you firms headed notepaper

Yes No

10 Significant Changes

a Has your firm undergone any significant changes in the past year, this includes any change

in partners or significant fee earners, or significant change in the area of practice the

firm undertakes?

If yes, please provide details separately on your firms headed notepaper

Yes No

b Is your firm considering or anticipating any significant change over the next 12 months?

If yes, please provide details separately on your firms headed notepaper

Yes No

11 Basis Of Cover

a. As a minimum we will provide insurance terms to you for a limit of indemnity in the amount of €1,500,000 in respect

of any one claim. If you require cover in excess of the minimum €1,500,000 limit of indemnity please state the total

amount required:

€ _____________________________

b. Please state your required policy deductible / excess

€ _____________________________ in respect of each and every claim

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12 Declaration

Please read carefully the following statements prior to signing where indicated.

The completion of this proposal does not bind the Practice or Insurers to affect a Contract of Insurance, but if a policy is

issued, this Proposal Form, together with any other information supplied prior to inception shall form the basis of any

Contract of Insurance affected thereon.

Any liability of Insurers, under any policy issued, to provide insurance cover over and above the minimum limit of

insurance cover required by the Law Society of Ireland will be subject to the terms and conditions specifically applicable

to such “Excess” cover, which terms and conditions may differ from the Minimum Terms and Conditions of Professional

Indemnity Insurance for Solicitors in Ireland as specified by the Law Society of Ireland. In particular but without limitation,

in the event that the Practice fails to disclose and/or misrepresents circumstances known to it at any time prior to the

inception of Excess cover (and not merely at the date that this Proposal Form is signed) which may give rise to a claim,

the Insurers reserve the right to take whatever action is deemed appropriate and necessary in accordance with the terms

and conditions applicable to the Excess cover.

I/We declare that the statements and particulars in this Proposal Form are true and that no material facts have been mis-

stated or suppressed after enquiry. I/We agree that this Proposal Form, together with any other information supplied shall

form the basis of any Contract of Insurance affected thereon. I/We undertake to inform the Insurers of any material

alteration to those facts occurring before the completion of the Contract of Insurance.

Signed: Date:

Principal / Partner / Authorised Signatory

(This form must be signed by a Principal, Partner or Authorised Signatory)

Important Notes

Professional Indemnity Insurance is written on a ‘claims made’ basis – that means that claims are dealt with by the

insurer on cover when a claim or circumstance is notified, not when the error is made. You should notify us

separately and immediately of any claim, or circumstance which you think may lead to a claim.

Please ensure that a copy of your up to date claims experience from all previous insurers is attached to this proposal

before posting.

Please also enclose details of any further information which you would like to be considered by insurers.

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Data Protection

JLT Ireland ("we", "us" and "our") will collect and use information about you where you are an individual or, where you

are a business client, about your data subjects such as names and contact details, which may also include special categories of personal data (e.g. about their health) and information relating to criminal convictions and offences.

The purposes for which we use personal data may include arranging and providing insurance cover and handling claims. More information about our use of personal data is set out in our Fair Processing Notice [JLT Ireland Fair Processing Notice]

Where you are a business client and provide us with personal data about your data subjects, you hereby agree to comply with all data protection laws and further, shall provide a copy of the Fair Processing Notice to your data subjects ensuring at all times that your data subjects have the necessary information about how we process their information and how they may exercise their rights as data subjects.

Where you are providing us with personal data about yourself, then please ensure that you review the Fair Processing Notice which will provide you with information in relation to the processing of your personal data and how you are able to exercise your rights as a data subject.

You shall not provide us with personal data or other information which may be used to identify any individual other than such personal data that is necessary for us to perform the services. The personal data you provide to us shall be accurate. We may pass personal data (which may include special categories of data) to third parties such as other intermediaries, insurers, reinsurers, loss adjusters, professional advisers, agents, partners, sub-contractors, our affiliates and to certain regulatory bodies who may require your personal data or that of your data subjects for the purposes described in the Fair Processing Notice [JLT Ireland Fair Processing Notice]

In certain circumstances, we may be required to collect, use and process special categories of personal data. Where you are a business client, you shall be responsible for obtaining all necessary and appropriate consents from your data subject to enable us to process such special categories of data which is necessary for the performance of the services. You acknowledge and agree that we shall rely wholly on the consents obtained by you from your data subjects and at our request, you shall promptly provide us with evidence of such written consent.

Where you are an individual, we shall where required obtain your written consent to collect, use and process your special categories of personal data. Although you may withdraw your consent at any time, if you do we may be unable to continue to provide services to you and this may mean that we are unable to process your enquiry or claim or that your insurance cover will stop.

Where you are a business client and provide us with your data subjects’ information, we shall notify each other without undue delay and in any event within twenty four (24) hours upon each of us becoming aware of any personal data breach relating to the data subjects and shall provide reasonable co-operation upon request. Such notification by either party is not an acknowledgement by that party of any fault or liability with respect to the personal data breach.

At times, the provision of our services may necessitate the transfer of personal data outside the UK and the European Economic Area (EEA) to countries that have less robust data protection laws. Any such transfer, including transfers to you if you are located outside the EEA, will be made with appropriate safeguards as stipulated by the applicable data protection laws.

If you have any questions in relation to how we process your personal data, please contact:

jltirelanddpo@jlt.ie Finbarr Walsh Data Protection Officer JLT Ireland, Friends First House Cherrywood Business Park Loughlintown Dublin 18

JLT Ireland

Friends First House Cherrywood Business Park Loughlinstown

Dublin 18

JLT Ireland

Building 5200

Cork Airport Business Park

Cork

JLT Insurance Brokers Ireland Limited trading as JLT Ireland, JLT Financial Services, GIS Ireland, Charity Insurance, Teacherwise,

Childcare Insurance, JLT Online, JLT Trade Credit Insurance, JLT Sport is regulated by the Central Bank of Ireland

Directors: Eamonn Bergin, Paul Doherty, Aidan Gordon, Amanda Harton, Patrick Howett, Michael Lacey, Dan McCarthy, Raymond

O’Higgins. Registered Office: Cherrywood Business Park, Loughlinstown, Dublin 18.

A member of Jardine Lloyd Thompson Group plc. Registered in Ireland No. 21622. A Private Company Limited by Shares. VAT No. 0042175W

© August 2018 272641