1a.
Please state the limit of indemnity required:
$
1b.
What excess do you wish to pay towards a claim?:
$
2.
Do you currently have professional indemnity insurance?
If yes , please provide details below:
Expiry date:
Insurance company:
Indemnity limit:
$
Excess:
$
Premium:
$
3.
Please enter the full nature of the activities to be covered and type of advice given:
4.
Total number of settlements over the past two years.
5.
Number of settlements over the past 12 months where you acted for both parties?
6.
Do you have clients based overseas or arrange settlements for overseas properties?
If Yes, how many settlements and what types of transactions?
7.
Have you settled any transactions to the value of $1,000,000 or more?
If Yes, Please detail the type of transaction and value of the settlement?
8.
What is your standard fee (including disbursements and GST) per transaction?
9.
Is your business using a software package to document/track all settlements?
If Yes, Please specify (eg. are Lawpoint, Safeguard, Ice Ridge
10.
Particulars of Principal
Resume/CV: If not contained on your website,
please copy & paste or email a brief resume for each Principal and/or
Director.
11.
Details of gross income/fees or commissions:
(a).
received / rendered during the last twelve months:
$
(b).
estimated for ensuing twelve months:
$
12.
Are any of your operations or clients located outside of Australia
If the answer to the above is "Yes", please specify which countries and percentage
of income deriving from each:
13.
Please state the approximate percentage of Your activities (based on income)
applicable to each State, Territory and Overseas.
14.
Have you ever had a liability insurer:
(a)
Decline a proposal?
(b)
Impose special terms?
(c)
Decline to renew your insurance?
(d)
Cancel your insurance?
If the answer to any of the above is "Yes", please provide details:
15.
During past years has any claim been made, or has negligence been alleged
against you or any of the present or former Principals, or have any circumstances
been notified to insurers which may result in a Claims?
16.
Are there any circumstances not already notified to insurers which may give rise
to a Claim against you or any prior corporate practice or any of the present
or former Principals?
17.
Has any principal or staff member ever been subject to Disciplinary Proceedings for professional misconduct?
If the answer to either of the above is "Yes", please provide details:
18.
Total number of:
(a)
Qualified staff-including Principals (please specify professional discipline)
(b)
Other technical staff
(c)
Non-technical staff (including typists, receptionists etc.)
Total of all staff
19.
Are you or have you or any parent, subsidiary
or other related entity either: (i) engaged in, or; (ii) have or had
a controlling share of an entity engaged in:
(a)
Actual construction, fabrication, erection or any form of sub contracting?
(b)
Real estate development?
(c)
The manufacture, sale or distribution of any product or process or patented production process?
If the answer to either of the above is "Yes", please provide details:
(i)
Names of the other entities involved, outlining their relationship to you:
(ii)
Full details, including a description of the nature of the involvement: