1.
Please state amount of preferred Total Sum Insured and Excess:
Note: Usually subject to the following minimum Sums Insured
and Excess:
a) Policy One - Professional Indemnity.
Total Sum Insured - $1,000,000 Excess - $1,000
b) Policy Two - Public/Products Liability.
Total Sum Insured - $5,000,000 Excess - $500, property damage claims only
2a.
Do you currently hold professional indemnity and/or liability insurance?
2b.
If you are not currently insured, have you ever held professional indemnity and/or liability insurance?
If the answer to either of the above is "Yes" ,please complete the table below for the past 2 years you were insured.
3.
Have you ever had a professional indemnity or liability insurer decline a proposal, impose special terms, decline to renew or cancel your insurance?
If the answer is "Yes" , Please provide details
4.
Please enter the full nature of the activities to be covered and type of advice given
5.
Particulars of all Principals and Directors
6.
Resume/CV: If not contained on your website,
please copy & paste or email a brief resume for each Principal and/or
Director.
7.
Total number of:
(a)
Qualified staff-including Principals
(b)
Other technical staff
(c)
Non-technical staff (including typists, receptionists etc.)
Total of all staff
8.
Have you amalgamated or merged with any other business?
If yes , please provide details:
9.
Is any Partner, Principal or Director connected or associated (financially or otherwise) with any other business?
If yes , please provide details:
10.
Are you a member of a professional association or society?
If yes , please provide details:
11.
Please provide the following information:
12.
State fully the nature of your business, including the primary purpose of software and systems provided, sold or
licensed. (Please copy & paste or email any brochures or other
documentation which may assist in explaining your
business activities).
13.
Please state the approximate percentage of your income disclosed in answer to Question 11(a) or 11(b) which is
derived from the following fields of activity:
a)
Software Developer
Asset/Inventory Management
%
Business Systems
%
Communication Systems
%
E-Commerce
%
Financial/Accounting
%
Gaming
%
Geographical/Spatial
%
Graphics/CAD
%
Manufacturing (Control)
%
Media/Entertainment
%
Medical Systems (Non-Life)
%
Mining/Oil/Gas and Utilities
%
Miscellaneous
%
Modelling, Analysis
%
Retail Systems (POS)
%
Systems Software
%
Transport Systems
%
Utility Software
%
Websites
%
b)
Data Processing/Warehousing Services
%
c)
Education and Training
%
d)
Facilities Management or Outsourcing
%
e)
General Consulting
%
f)
Hardware Sales (Own Developed)
%
g)
ISP/Web/Internet Services
%
h)
IT Recruitment and Placement Services
%
i)
Maintenance and Repair
%
j)
Reseller of Third Party Software and Hardware
%
k)
Systems Integration
%
l)
Telecommunication Services
%
m)
Other (please describe)
%
n)
Total
%
14.
Do you import any products associated with the fields of activity listed in Question 13?
If the answer is "Yes ", please provide details:
15.
Have you discontinued developing, manufacturing, producing or handling any software /hardware or information
technology system?
If the answer is "Yes" , please provide details:
16.
Do you provide services or products intended for use in the following areas?
If the answer is "Yes ", please advise the percentage of your income disclosed in answer to Question 11(a) or 11(b)
which is derived from such services or products.
Aerospace, aircraft and radar navigation systems
%
Credit Card processing or Billing systems
%
Electricity Generation or Distribution
%
Financial or Banking services
%
Medical/Surgical applications
%
Military systems
%
Nuclear Installations
%
Oil, Pipelines and Refineries
%
Robotic control or manufacturing mining process controls including PLC and SCADA programming
%
Web portal programming
%
ERP systems
%
Fire/Security/Emergency services
%
Mobile phone/Wireless Access programming
%
Note: We may require further information about your involvement in these areas and coverage may not be available
for these risks.
17.
Do you act as an agent for any company(ies)?
If the answer is "Yes" , please provide details
18.
Please provide a brief description of the two (2) largest projects undertaken by you in the past five (5) years.
19.
Do you wish to cover your consultants, sub-contractors or agents, in respect of work performed on your behalf?
If Yes , a) Please give details of the nature of work performed and the names of all consultants, sub
contractors and agents to be covered.
b)
Please state the gross professional fees paid to consultants, sub-contractors and agents to be covered, during the past 12 months.
20.
Have you ever undertaken, or are you likely to undertake, work outside of Australia and New Zealand?, If the answer is "Yes ", please give details below
21.
Please state the approximate percentage of Your activities (based on income) applicable to each State, Territory and Overseas.
22.
Has any Partner, Principal, Director or staff member ever been subject to disciplinary proceedings for professional misconduct?
If "Yes" , please give the details below:
23a.
During the past 10 years, has any claim been made or has negligence or breach of professional duty been alleged, against the business, or any of the present or former principals, partners or directors, or have any circumstances which may give rise to a claim been notified to insurers?
If the answer is "Yes ", please give details below
23b.
Have any claims been made against you for information & communication technology liability including professional indemnity and product liability?
If the answer is "Yes ", please give details below
24.
Are any of the partners, principals or directors aware of any claim or circumstances which may give rise to a claim aganist the business or any prior business, partners or directors or any of the present or former principals?
If the answer is "Yes ", please give details below
25.
Has any contract or project experienced cost overruns, delays in implementation, failure of system(s) and/or product(s) to meet full functionality?
If the answer is "Yes ", please give details below
26.
Has any client refused payment or requested a refund of monies paid?
If the answer is "Yes ", please give details below
27.
Do you have International Standards Organisation (ISO) certification?
28.
Do you have a formal customer acceptance procedure?
29.
Do you require a final acceptance letter or other sign-off agreement from the customer?
30.
Do you maintain written logs for customer reports of problems or down-time?
31.
Do you retain all records in terms of products and services supplied for a period of at least seven (7) years?
32.
Are all employees required to sign statements that they will not use any previous employers' trade secrets or other information?
If NO , What controls do you have to prevent potential infringement of trade secrets or property information of third parties?