• Management Liability Insurance

  • Are you or have you been a Liability Brokers Client?*
  • Are you currently insured?*

  • Locations of Work
    Please note the percentage of Your activities (based on income) applicable to each State.

  • Insured's History

    After enquiry of all Partners, Principals, Directors, Officers, Trustees and Senior Managers

  • Have there been any claim(s) made against the Insured or any loss or expense incurred* which might fall within the terms of this insurance cover? OR Have any circumstances occurred which may give rise to a claim against the Insured or result in any loss or expense incurred* which might fall within the terms of this insurance cover?*
  • Has any claim(s) where the value of all claims notified exceeds $25,000 including current reserves been made against any Director, Officer or Employee of the Company for any matter that is or would be the subject of this insurance policy in the past 5 years; OR is any Director, Officer or Employee of the Company aware of any circumstances or incident which may give rise to a claim under the policy?
  • Has the Insured or any Partners, Principals, Directors, Officers, Trustees and Senior Managers ever been declined this type of insurance, or had similar insurance cancelled, or had an application for renewal declined (other than insurer exiting that area of insurance), or had special terms or restrictions imposed?*
  • Is the Insured domiciled in Australia with no subsidiaries outside Australia or New Zealand?*

  • Declaration

    By submitting this Declaration the Applicant acknowledges:

    • they are authorised by each of the other Applicants to make this Declaration,
    • the contents of the Declaration are true and complete,
    • they have read the information concerning the duty of disclosure (immediately below this declaration) and other important notices;
    • they have answered every question fully and frankly, have been truthful and accurate in completing this application and have not withheld any information likely to affect the acceptance of this insurance;
    • they realise that if they have not complied with the duty of disclosure, any claims may not be met
    • that if anything happens during the Period of Cover which alters any of the information provided, they will promptly inform the insurer;
    • they confirm that they have read and understood that this policy operates on a claims made and notified' basis; (refer - Claims Made Policy below)
    • they authorise the insurer to give or obtain from other insurers or insurance reference bureaus or credit reporting agencies, any information about this insurance or any other insurance held by the Applicant/s.
  •  - -

  • Duty of Disclosure: What you must tell us
    Before you enter into an insurance contract, you have a duty to tell the insurer anything that you know, or could reasonably be expected
    to know, may affect their decision to insure you and on what terms.
    You have this duty until they agree to insure you. You have the same duty before you renew, extend, vary or reinstate an insurance
    contract.
    You do not need to tell the insurer anything that:
    • reduces the risk they insure you for; or
    • is common knowledge; or
    • they know or should know as an insurer; or
    • they waive your duty to tell them about.
    If you do not tell the insurer something you are required to, they may cancel your contract or reduce the amount they will pay you if you
    make a claim, or both. If your failure to tell them is fraudulent, they may refuse to pay a claim and treat the contract as if it never existed.

    Claims Made Policy
    The Professional Indemnity section of this Policy operates on a 'Claims made and notified' basis. This means that the Policy covers you for Claims made against you and notified to us during the Period of Insurance.
    This Policy does not provide cover in relation to:

    • acts, errors or omissions actually or allegedly committed prior to the retroactive date of the Policy (if a date is specified);
    • claims made after the expiry of the period of insurance even though the event giving rise to the Claim may have occurred during the period of insurance;
    • claims notified or arising out of facts or circumstances notified (or which ought reasonably to have been notified) under any previous Policy;
    • claims made, threatened or intimated against you prior to the commencement of the period of insurance;
    • facts or circumstances of which you first became aware prior to the period of insurance, and which you knew or ought reasonably to have known had the potential to give rise to a Claim under this Policy;
    • Claims arising out of circumstances noted on the proposal form for the current period of insurance or on any previous proposal form.

    Where you give notice in writing to the insurer or any facts that might give rise to a claim against you as soon as reasonably practicable after you become aware of those facts but before the expire of the period of cover, you may have rights under Section 40(3) of the Insurance Contracts Act 1984 to be indemnified in respect of any claim subsequently made against you arising from those facts notwithstanding that the claim is made after the expiry of the period of cover. Any such rights arise under the legislation only. The terms of the Policy and the effect of the Policy is that you are not covered for claims made against you after the expiry of the period of cover.

  • Should be Empty: