• Management Liability Proposal Form

  • IMPORTANT NOTES

    This proposal form is only for Numark members only.

    This proposal form must be completed by a Principal, Partner or Director of the Proposer/s. The person completing the proposal form should be authorised by the Proposer/s to do so and should make all necessary enquiries of his fellow Partners, Directors and Employees to enable all the questions to be answered.

    All questions must be answered to enable a quotation to be given.

    Completing this proposal form does not bind the Proposer/s or Numark Insurance Services / Jensten Insurance Brokers to enter a contract of insurance.

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

  • Your Details

    Your business

  • Your Details

    Your business (continued)

  • Your Details

    Your Cover
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  • Statement of fact

    Please confirm that you agree with the following statement. If you are in any doubt or have ay questions please call the Numark Insurance Services team on 0800 783 5709

  • Please confirm that all of the following is true:

    • Turnover is under £50m
    • You are a UK registered company
    • You are not a Public Limited Company (PLC)
    • You are in profit or are predicting profit in next 36 months
    • You do not require cover for assets in the USA
    • You are not involved in the education or care sector
    • You do not require cover for turnover coming from USA where it forms more than 40% of overall turnover
    • You do not have more than one claim or claims above £5,000 any section
    • You have not had more than 5 redundancies or made more than 10% of the workforce redundant in last 3 months and none of these redundancies have resulted in complaints
    • You do obtain external HR/legal advice for dismissals or register for referral to rradar
    • All duties are segregated so that dual control exist on all payments; reconciliation of payroll, customer and bank account statements
    • You are not involved in the supervision of children or vulnerable adults
    • You do not provide any financial or legal advice.
    • None of your directors/partners/members have been disqualified, left non-voluntarily or been a director of a company that has entered administration/receivership or become insolvent in the last 5 years’

  • Limits of Cover and Premium Indication

  • Your Premium Indication

  • IMPORTANT!

    The Premium excludes taxes. Your cover will only start when Jensten Underwriters Limited accepts your proposal. Your Numark Insurance Services adviser will confirm cover with you.
  • Flex your levels of cover
     

    Directors's and Officers' Liability

    Company Legal Liability

    Employment Practices Liability
    Cover level selected {pleaseSelect} {pleaseSelect} {pleaseSelect}

    You can speak to your adviser about flexible options for your cover limits. In some cases, reducing the level of cover in one area can reduce your overall premium. Please speak to your adviser to find our more. 

  • We can't provide you with a Premium indication right now as your answer(s) requires us to review your proposal form. 

    Please send your proposal form to your Numark contact, and they'll refer you to Underwriters.

  • Please note: If you have had to provide further information to any of the previous questions, we will need to consider the information you have given us before we can confirm your premium and excess levels. This means that your premium and excess levels may be different from those shown below. Our terms of cover may also be different. 

    The compulsory primary cover is D&O, and to this either or both Company Legal Liability and Emplyment Practices cover can be added. The limit of indemnity on these additional sections can be less than or equal to the D&O section but not in excess of it.

  • Declaration

  • If you have not given full and true answers to all questions asked on this proposal form, your insurance may not protect you in the event of a claim.

    Jensten Underwriting Limited is part of the Jensten Group of companies which takes your privacy very seriously. For details of how we use the personal information we collect from you and your rights please view our privacy policy at https://jensteninsurance.co.uk/privacy-notice. If you do not have access to the internet please contact us and we will send you a printed copy.

    Please read this declaration carefully and then sign below

    • I/We understand that all relevant information , which is information that may influence AXA Insurance UK plc in the acceptance of this insurance and the terms provided, has been disclosed and recorded
    • I/We declare that all particulars given in this proposal form whether made by me/us or on my/our behalf are true and complete.
    • I/We understand that if full and true answers have not been given or if all relevant information has not been disclosed that this insurance may not protect me/us in the event of a claim.
    • I/We will tell you of any change to the details given before the start date of the contract.
  • Clear
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  • Should be Empty: