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Etico Group Limited

Solicitors Professional Indemnity Insurance

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If yes, please provide details on a separate sheet including how the matter was resolved and the procedures / processes in place to avoid re-occurrence.

c) After making full enquiry of all Principals/Members/Directors and employees in your practice, are you aware of any circumstances, incidents or claims that have not been reported to your current or prior insurers including any letters of complaint about your service or dispute as to outstanding fees)? (

If yes, please provide details on a separate sheet.

Yes No

d) After making full enquiry of all Principals/Members/Directors and employees in your practice, are you aware of any circumstances, incidents or claims that have been notified to your current or prior insurers but have not been accepted by insurers as a valid or effective notification? If yes, please provide details on a separate sheet.

Yes No

e) Has any lender requested a file from the firm, or any prior practice of the firm, which either does not appear on the claims experience or has not been accepted by the Insurer as a circumstance? If yes, please provide details on a separate sheet.

Yes No

PLEASE NOTE THAT YOU HAVE AN OBLIGATION UNDER YOUR CURRENT PROFESSIONAL INDEMNITY POLICY TO NOTIFY ALL CIRCUMSTANCES AND CLAIMS AS SOON AS PRACTICABLY POSSIBLE. ALL SUCH NOTIFICATIONS OF WHICH YOU ARE AWARE THAT HAVE NOT BEEN REPORTED TO YOUR PREVIOUS INSURERS MUST BE DECLARED.

10 . Previous Insurance

a) Is the firm, or has the firm, or any prior practice, ever been in the Assigned Risks Pool? If yes, please provide details on a separate sheet.

Yes No

b) Have you ever failed to pay either your premium and/or any excess? If yes, please provide details on a separate sheet.

Yes No

c) Have you ever failed to pay or defaulted on a repayment where the premium was financed? If yes, please provide details on a separate sheet.

Yes No

d) Have you or any prior practice ever been refused professional indemnity insurance? If yes to the above please provide details on a separate sheet.

Yes No

) . Alternative Business Structure (ABS 11

Has the practice been approved as an Alternative Business Structure? If yes, please forward a copy of your license.

Yes No

Does the practice have an intention to convert to an Alternative Business Structure in the next 12 months? ) If no, move onto next set of questions. If yes, please answer the following (

Yes No

Has the practice registered its intent to convert with the Solicitors Regulatory Authority? Yes No

Has the practice completed stage one of the application process? If yes, please submit a copy of the application.

Yes No

Has the practice completed stage two of the application process? If yes, please submit a copy of the application.

Yes No

Is the practice intending to have outside investors? If yes please provide further information to their role (if any) within the practice.

Yes No

Please give an overview of the changes which will happen to the current practice if it is approved as an Alternative Business Structure.

Yes No

Please provide any additional information which you feel will support your application for insurance.

12 . Area of practice

Is your business that of a Solicitors Practice only? If not please provide further details including types of work undertaken and fees received.

Yes No

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15 . Risk Management

Does the practice always obtain satisfactory written references when engaging new Principals, Members or Directors and employees, including procedures for verifying qualifications, previous experience, previous claims and/or circumstances?

Yes No

Is any Principal, Member, Director or Employee allowed to sign cheques on his/her signature alone? If yes, is there any upper limit for a sole signatory and if so what?

Yes No

Are employees who receive cash/cheques in the course of their duties required to pay in daily? If no, please provide details on a separate sheet.

Yes No

How often are checks carried out on all entries in the Cash Book with all paying in books, receipts, counterfoils and vouchers?

Which Legal Services Commission Quality Marks or other quality standards, e.g. LEXCEL, Investors In People, Law Society Conveyancing Quality Scheme is your practice currently accredited with? Please specify and give the date of accreditation.

Do you have written work instructions or checklists for the services provided? Yes No

Do you have a time recording system? Yes No

If you have an e-mail capability do you have an e-mail/internet user policy in place and enforced? Yes No

Please outline the steps taken to review work undertaken by staff and describe how they are supervised:

If necessary, list further details on a separate sheet.

Are all relevant telephone conversations noted and a copy retained on the file? Yes No

Please describe the diary system in operation (including back-up procedures):

If necessary, list further details on a separate sheet.

Do you have the required procedures in place throughout your firm for:

Client retainer letter? Yes No

Vetting clients including checking for conflicts of interest? Yes No

Carrying out Money Laundering checks? Yes No

Registering claims and complaints? Yes No

Please confirm that all fee earners and employees are kept up to date with relevant changes in legislation and other legal developments which could affect the work and services they carry out.

Yes No

Please give the name and position of the people responsible for Risk Management and that have been designated to be your COLP and CO:

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. Current coverage 16

Please provide details of your current insurance.

Current insurer:

Current broker:

Premium £ Limit £ Excess £

Do you currently have an aggregated policy excess? Yes No

The minimum cover required is £2 million for sole practitioners and partnerships or £3 million for LLPs and incorporated practices registered at Companies House.

17 . Requested cover

Limit of indemnity – please limit to a maximum of four choices

£2 million £3 million £4 million £5 million £6 million £7 million

£8 million £9 million £10 million

Excess – please limit to a maximum of four choices

£1,000 £2,500 £5,000 £10,000 £25,000 £50,000

75,000 £100,000 Other – please specify £

Aggregate Excess

Aggregated/capped excess? (Normally three times the policy excess e.g. £2,500 excess would be capped at £7,500 for the policy period) Do you require a quotation for Aggregate Excess?

Yes No Include both options

18 . Significant change

Has there been any significant change in your practice in the last year or do you expect any significant change in the coming year?

Yes No

If yes, please provide full details:

19 . Other material information

Important notice All material information must be disclosed as part of the proposal and before insurance commences. Material information includes any fact

which we may reasonably wish to know in relation to our assessment of the risk, the exposure and in calculation of any appropriate

premium. You must disclose all such information whether or not a specific question has been included in this application form.

Is there any other material information that may be relevant to this application? Yes No

If yes, please provide full details:

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Signing this form does not bind you to accept any quotation provided by Etico Group Limited nor any of its incorporates.

THIS PROPOSAL FORM MUST BE SIGNED BY ALL PRINCIPALS/MEMBERS/DIRECTORS OF THE FIRM

Before posting, please ensure that you have included the following documents:

Document checklist

This form; fully completed, signed and dated.

A sheet of your practice’s current headed notepaper.

Claims summaries from the Qualifying Insurer, Insurers or the Assigned Risks Pool, for the last eight years for your practice and

any practice to which you are a successor practice.

Copies of your last two years statutory/management accounts.

If applicable, please provide the following:

If you are a newly established practice, a Curriculum Vitae for every Principal, Partner, Member, Director of the practice and

your Business Plan and Cash Flow Statement.

A copy of all reports issued by the SRA, LCS (formerly the CSS/OSS) Forensic Investigation Unit, Disciplinary Tribunal

and/or any regulatory body.

Any information provided on separate sheets.

If you would like to pay in instalments please provide copies of the annual accounts for your practice for your last two

completed financial years.

Number of additional sheets included with this application

Signature

Print name

Date

Date

Print name

Signature

Date

Print name

Signature

Date

Print name

Signature

Date

Print name Signature

N

o

Yes

N

o

Yes

Yes N

o N

o

Yes

N

o

Yes

Yes N

o N

o

Yes

Yes N

o

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Space for Additional Information

Please return the completed application by email, fax to:

Etico Group Limited

North Church Business House

84 Queen Street

Sheffield

S1 2DW

Main Line: 0114 379 2020

Fax: 0114 272 0422

Email: [email protected]

Web: www.eticogroup.co.uk

Etico Group Limited is authorised and regulated by the Financial Services Authority Our firm

reference number is 581197.

Contact Details for the Solicitor’s Team


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