FENTON GREEN & CO INSURANCE BROKERS
INSURANCE BROKERS
AFS LICENCE NO.247258
GPO Box 3181
MELBOURNE VIC 3001
TELEPHONE: (0061) 3 9642 3888
FACSIMILE: (0061) 3 9670 2265
NATIONAL AUSTRALIA BANK
INTRODUCERS PROGRAM
PROFESSIONAL INDEMNITY INSURANCE
As part of entering into the agreement with NAB to become part of their Introducer Program,
NAB requires you to purchase Professional Indemnity Insurance protection against allegations of
professional negligence in your capacity as an Introducer.
Their reasons behind this are as much for your own protection as any other. The policy not only
covers damages that may be adjudged against you but also the legal costs and exposures involved
in defending such matters. In many cases even if there has been no error on your part significant
costs may be incurred in protecting your position.
Fenton Green & Co has established a facility with CGU Professional Risks, one of Australia’s
Largest Professional Indemnity Insurers, to offer coverage to participants of the program.
COVERAGE DETAILS
INSURER: CGU Professional Risks
LIMIT: a) $1,000,000 any one claim and $2,000,000 in the aggregate
b) $5,000,000 any one claim and $10,000,000 in the aggregate
EXCESS: $ 1,000 each and every claim
RETROSPECTIVE
LIABILITY DATE: Unlimited, excluding known claims and claim
circumstances
TERRITORIAL/
JURISDICTIONAL LIMITS: Worldwide excluding USA/Canada
ENDORSEMENTS: This policy is subject to the following:
• Non cancellable
• Run off cover
• Limit per introducer
To arrange this insurance you will need to complete the proposal form contained herewith and
return it to us with either a cheque for the amount selected or the credit card payment slip. You
should allow 5 working days for your application to be processed.
We will confirm cover to you which you will, in turn, need to confirm to NAB. We will also
confirm to NAB, on your behalf, that coverage is in force in our monthly report.
PREMIUM OPTIONS
PERIOD OF COVER: From the date of receipt of your satisfactorily completed
proposal form and payment
To the common due date of 1st November, 2009
As all policies issued under the NAB Introducer program will expire on the common due date of
1st November, 2009 any policies that are issued for periods of less than 12 months will be
adjusted for such shorter periods as shown in the tables below.
$1,000,000 limit
For cover starting in May, June or August,
July, 09 September
or October,
09
Amount Payable
By cheque $300 $175
By Credit card $306 $178.50
$5,000,000 limit
For cover starting in May, June or August,
July, 09 September
or October,
09
Amount Payable
By cheque $550 $300
By Credit card $561 $306
All premiums include GST and applicable state stamp duties as well as our fee of $50 (including
GST).
Credit card payments also include the Merchant provider’s fee and administration costs which are
responsible for the higher amounts payable.
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We Welcome
Credit Card Payment
Cardholder’s Name:
Card Type (Circle): Mastercard / Visa / American Express
Cardholder’s signature:
Card Number:
Expiry: /
The amount that will be charged to your credit card will be the
amount shown in the premium options tables and will be
determined by the date upon which your cover will start, the
amount of cover you select and the method of payment that
you choose
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NATIONAL AUSTRALIA BANK
INTRODUCERS PROGRAM
INDEMNITY
PROFESSIONAL INDEMNITY INSURANCE
PROPOSAL FORM
NOTICE TO THE PROPOSED INSURED
(pursuant to the provisions of the Insurance Contracts Act 1984)
Your Duty of Disclosure Subrogation
Before you enter into a contract of general insurance with an Insurer, Where you have agreed with another person or company, who would
you have a duty, under the Insurance Contracts Act 1984, to disclose to otherwise be liable to compensate you for any loss or damage which is
the Insurer every matter that you know, or could reasonably be expected covered by the Policy, that you will not seek to recover such loss or
to know, is relevant to the Insurer’s decision whether to accept the risk damage from that person, the Insurer will not cover you, to the extent
of the insurance and, if so, on what terms. permitted by law, for such loss or damage.
You have the same duty to disclose those matters to the Insurer before Utmost Good Faith
you renew, extend, vary or reinstate a contract of general insurance. Every insurance contract is subject to the doctrine of utmost good faith,
which requires that parties to the contract should act toward each other
Your duty however does not require disclosure of any matter:- honestly and fairly, avoiding any attempt to deceive in assuming and
performing contractual obligations.
- that diminishes the risk to be undertaken by the Insurer;
- that is of common knowledge; Failure to do so on the part of the insured may permit the insurer to refuse
- that you Insurer knows or, in the ordinary course of its business, to pay a claim or cancel the policy or both.
ought to know;
- as to which compliance with your duty is waived by the Insurer Average Provision
One of the provisions of the insurance states that where the amount
It is important that all information contained in this application is required to dispose of a claim exceeds the sum insured under the Policy the
understood by you and is correct, as you will be bound by your answers insurer shall only be liable for that part of the total costs and expenses
and by the information provided by you in this application. You should expended in the investigation, defence, avoidance or reduction of any claim
obtain advice before you sign this application if you do not properly as the total sum insured bears to the amount to dispose of the claim.
understand any part of it.
Not a Renewable contract
Your duty of disclosure continues after the application has been Most Professional Indemnity insurances are not renewable contracts so the
completed up until the contract of insurance is entered into. policy will terminate on the expiry date indicated. If you therefore require
a subsequent policy, you will need to complete and submit a new proposal
Non-Disclosure form for assessment prior to the termination of the current policy.
If you fail to comply with your duty of disclosure, the Insurer may be
entitled to reduce its liability under the contract in respect of a claim or Privacy Statement
may cancel the contract. Fenton Green & Co and the Insurer (We) are bound by the obligations of
the Privacy Act 1988 as amended by the Privacy Amendments (Private
If your non-disclosure is fraudulent, the Insurer may also have the option Sector) Act 2000 regarding the collection, use, disclosure and handling of
of avoiding the contract from its beginning. personal information. We will protect the privacy of your personal
information. We may disclose your personal information to CPA Australia
Claims Made Contract which is utilised by CPA Australia to administer the Members’
Subject to its terms and conditions the Policy will cover your civil Professional Indemnity Scheme and to ensure compliance with CPA
liability for any claim:- Australia’s Constitution, Bylaws, pronouncements and regulatory
- first made against you during the Policy Period; requirements.
- resulting from any circumstance of which you become aware
during the Policy Period which could give rise to a future claim We will use the information you provide in this Proposal Form (including
against you provided you immediately inform us in writing of any supplementary documentation) to consider your application for
such circumstances within the Policy Period. insurance, to determine policy terms, to assess a claim, etc.
but limited by the provisions of any clause/s relating to retroactive
cover. We may disclose your personal information to third parties who we believe
are necessary to assist us. These third parties will only use your personal
The Policy will NOT cover your civil liability resulting from any claim, information for the purposes we provided it to them (or if required by law).
matter, occurrence or circumstance arising from any breach of a duty We may also be required to disclose your personal information to others for
owed in a professional capacity in connection with the Firm’s Business the purposes of public safety and/or law enforcement.
which was committed or alleged to have been committed of which you
were aware before commencement of, and after expiry of, the Policy If you provide us with personal information about other individuals you
Period. must ensure that you obtain consent from those individuals to disclose that
information to us.
Change of Risk or Circumstances
You should advise the Insurer as soon as practicable of any change to You are entitled to access your personal information and request any
your normal business as disclosed in the Proposal, such as changes in correction if required.
location, acquisitions and new overseas activities.
Agent of the Insurer
PLEASE NOTE THAT YOUR DUTY OF DISCLOSURE ALSO Please note that, in effecting this insurance, we will do so under an
APPLIES WHEN YOU AMEND, ALTER OR ENDORSE A POLICY. authority given to us by the Insurer and will be acting as their agents, not
yours. In all other respects we will act as your agents
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NAB INTRODUCERS PROGRAM
PROFESSIONAL INDEMNITY PROPOSAL FORM
PLEASE ENSURE THAT YOU ANSWER ALL QUESTIONS IN FULL (strokes are not sufficient).
If any information is not provided it may delay processing of your application.
If there is insufficient space please give details on your letterhead. The proponent alone is responsible for the accuracy of all
information furnished in connection with the proposal. Where applicable, tick to indicate your answer.
1. Full name of entity to be insured.
ABN No.:
2. Postal Address
Suburb State Postcode
Name of Person to contact: Mr/Mrs/Ms
Phone No.: Fax No.:
Mobile No.:
Email Address:
3. Please select the amount of Indemnity required: $ 1,000,000 □
$ 5,000,000 □
4. Please answer the following questions after enquiry within your organisation.
(a) During the past 10 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 which may give rise to a claim
against you or any of the present or former Principals arising out of the business of Finance broking
or referral been notified to insurers?
No Yes please give details
Year Insured With Claimant Nature of Problem Amount Paid
Notified and/or
Outstanding
(b) 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 arising out of the
business of finance broking or referral?
No Yes please give details
Name of Practice and Claimant Nature of Problem Estimate
Principal
(c) Are there any Claims against previous practices, which may give rise to Claim against either a
Principal or you arising out of the business of finance broking or referral.
No Yes please give details
Name and Practice of Claimant Nature of Problem Amount Paid
Principal and/or
Outstanding
(d) Has any Principal or staff member ever been subject to disciplinary proceedings for professional
misconduct?
No Yes please give details
Name and Practice Claimant Nature of Problem Amount Paid
and Principal/ and/or
Staff member Outstanding
Declaration
I/We hereby declare that:
My/Our attention has been drawn to the Important Notice accompanying this Proposal form and further I/we have
read these notices carefully and acknowledge my/our understanding of their content by my/our signature/s below.
The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information
given by me/us alter between the date of this Proposal form and the inception date of the insurance to which this
Proposal relates I/we shall give immediately notice thereof.
I/we authorise Fenton Green & Co, to collect or disclose any personal information relating to this insurance
to/from any other insurers or insurance reference service. I/we acknowledge that confirmation of the existence of
this insurance may be given to National Australia Bank in satisfaction of the referrer’s agreement. Where I/we
have provided information about another individual (for example, an employee, or client), I/we declare that the
individual has been or will be made aware of that fact and the section in the Policy on “The way we handle your
personal information”.
I/we also confirm that the undersigned is/are authorised to act for and on behalf of all persons who may be
entitled to indemnity under any policy which may be issued pursuant to this Proposal form and I/we complete this
Proposal form on their behalf.
Signature Date / /
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