Profit First Professionals - Insurance Proposal

  • Profit First Professionals

    Insurance Proposal Form - Professional Indemnity and Public Liability

  • DUTY OF DISCLOSURE
    Before any person/s enter into an insurance policy with us, they have a duty under the Insurance Contracts Act 1984 (Cth) to disclose to us every matter that they know, or could reasonably be expected to know, is relevant to our decision whether to accept the risk of the insurance and if so, on what terms.
    They have the same duty to disclose those matters to us before they renew, extend, vary or reinstate the Policy.
    The duty applies until the Policy is entered into, or where relevant, renewed, extended, varied or reinstated (Relevant Time). If anything changes between the time disclosures are made and the Relevant Time, the person/s need to tell us.
    What we do not need to know; A person does not need to tell us about any matter that:
    •diminishes our risk;
    •is of common knowledge;
    •we know or should know in our business as an insurer;
    •we tell the person we do not need to know.
    Who does the duty apply to?
    The duty of disclosure applies in relation to everyone who is insured under the Policy.
    What happens if the duty of disclosure is not complied with?
    If the duty of disclosure is not complied with we may cancel the Policy and/or reduce our liability under the Policy in respect of a claim. If fraud is involved, we may treat the Policy as if it never existed and pay nothing.
    UTMOST GOOD FAITH
    The Policy is based on the utmost good faith requiring us and the proposer/Insured(s) (including third party beneficiaries after the Policy is entered into) to act towards each other with the utmost good faith in respect of any matter relating to the Policy. A failure to comply is a breach of the Insurance Contracts Act 1984 (Cth).

  • 8. Has your (business) name ever been changed*
  • 9. Have You ever purchased or been purchased by any other business, or amalgamated or merged with any other business?*

  • WorkForce Details

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  • 11. Do You use sub-contractors or sub-consultants?*
  • 12. Do You verify that all sub-contractors and sub-consultants have a current professional indemnity policy in place prior to commencing work with You?*

  • Description of Business Activities

  • 15. Do any of your activities require you to have an Australian Financial Services Licence (AFSL)?*
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  • 20.Are You eligible for Small Business Exemption for Stamp Duty in New South Wales in accordance with section259B of the Duties Act 1997 (NSW)?*

  • If yes (20), please complete the NSW Stamp Duty Exemption form https://form.jotform.com/BenjaminandBenjamin/IME_NSW_SD_FORM 

  • 22. Are You or any Partner/Principal/Director a member of a Professional Body or Association?*
  • 23.Do any individual contracts or clients represent more than 25% of Your annual fee revenue?*
  • 24.Do You expect any significant changes to Your activities in the next 12 months?*
  • 25. Do you have a standard contract of engagement?*
  • 26. Does the contract clearly state a scope of works to be undertaken by you?*
  • 27. Does the contract include limitations of liability to Your clients?*

  • 28: CLAIMS/HISTORY DETAILS - Has any Insurer ever:

  • 28a: Declined to offer insurance to You or Your Partners, Directors, or Principals (including past Partners, Directors or Principals)?*
  • 28b: Cancelled or voided any insurance held by You or any Partner, Director, or Principal?*

  • 29: Have You, including any Partners/Directors/Principals or employees:

  • 29a: Been the subject of any disciplinary proceedings for professional misconduct?*
  • 29b: Been declared bankrupt?*
  • 29c: Held office in a company that was trading while insolvent and/or entered administration/receivership/liquidation?*
  • 29d: Been convicted of a criminal offence?*
  • 30.Has any claim been made against You, including any present or former Partners, Directors, Principals, Consultants or Employees?*
  • 31.Are You or any Partners, Directors, Principals, Consultants or Employees, after enquiry, aware of any facts or circumstances which may give rise to a claim?*
  • 32. Do you currently have a Professional Indemnity Insurance Policy in place?
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  • 33. Please select the Limit of Professional Indemnity cover you require:*

  • PUBLIC AND PRODUCTS LIABILITY COVER

  • 34. Please select the Limit of Public and Products Liability cover you require*
  • 35. Do you provide any services that involve manual labour and/or use of heavy equipment or machinery, including their supervision or direction?
  • 36. Do You manufacture, import, export, sell, or supply any products?
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