LPA and Bankruptcy Insurance Scheme Proposal
Please refer to website www.jltinsolvencymanualgt.co.uk for full details of policy wordings
Please complete fully. If you have any difficulties completing this form please telephone (0121 626 7868)
Date of appointment Name of case
Name of practitioner(s) Type of appointment
Name of Broker/Insurer:
Post Code Telephone/Fax
Material Damage - All Risks Cover Property Owners Liability cover will Automatically Apply
We recommend insurance on buildings and contents are arranged on a reinstatement basis. Include VAT where necessary
Premises Sum Insured Sum Insured Sum Insured Sum Insured
Full address – each premises Buildings Contents Rent Receivable Unexpired Portion of Lease
£ £ £ p.a. £
(2 Year Cover)
£ £ £ p.a. £
(2 Year Cover)
Is full cover for Terrorist Activities required? Yes No Help
This cover is provided automatically if the property is a ‘Private Dwelling House’ occupied by
the bankrupt or their family only. No rent must be received or the property owned on a
commercial basis, for this cover to operate automatically.
Are the premises Occupied? Yes No Help
If yes, advise by whom ______________________________
Are any of the premises now, or about to become Unoccupied? (A building or Yes No Help
range of buildings is deemed 'unoccupied' when vacant, void or disused).
If “Yes”, have you complied with the Unoccupied Buildings Condition? Yes No Help
If "No" please give reasons
If the premises are Unoccupied, please advise scecurity provider ______________________________
Does the premises have an intruder alarm system? Yes No Help
Subsidence - Please advise whether to the best of your knowledge there is a history of subsidence damage to the premises or
surrounding area or if the premises are erected over made-up ground or underground mining.
Is a Fire Risk Assessment required? Yes No Help
Is a Health & Safety survey required? Yes No Help
Motor Vehicles - is cover required? Yes No Help
The MID requires submission of vehicle regisratios, make& model within14 days.
If yes, state number of vehicles in use not in use in use not in use
Private cars and commercials up to Coaches/buses with over
7.5 ton gvw 12 passenger seats
Commercial vehicles over
7.5 ton gvw Motorcycles
Motorised mobile plant Tankers
No. of trailers
Engineering - do any items of plant require inspection? Yes No Help
Are there any steam boilers, steam pressure vessels or air pressure vessels? Yes No Help
Are there any lifts, cranes, fork lift trucks or other lifting plant? Yes No Help
Certain items of plant are subject to statutory inspection by an approved company.
These inspections will be provided where necessary by the Insurers using their preferred supplier, Bureau Veritas. In order
that appropriate visits can be set up copies of the last Inspection Certificates should be supplied as soon as possible.
When pre-appointment Statutory Inspection Certificates are available, Inspection will be carried out when next due. If such
Certificates are not available, then the plant should not be used until satisfactory inspection has taken place
It is a criminal offence to operate plant which is subject to statutory inspection without a valid certificate.
Is cover required in respect of engineering plant Yes No Help
(please forward a plant schedule if required).
Loss Recovery Insurance will automatically be included to provide indemnity (see Not required Help
web site for full wording) for Loss Assessors fees for claims in excess of £10,000
for property damage unless specified to the contrary. Please indicate if not required.
Environmental Impairment Liability cover will automatically be included for all Not required Help
Commercial premises (other than for 'high-hazard' sites) up to a limit of £ 1.0m any
one incident. Higher limits of indemnity are available.
In addition to the Open Cover provided under the Insolvency Practitioners & Receivers Policy, JLT Specialty
Limited are able to arrange a variety of insurance products that function as 'transaction enablers' and offer the
potential to maximise income when seeking to sell assets.
Please indicate should you require additional information or a quotation in respect of any of the following:
After the Event Insurance / Adverse Costs Insurance - possible no cost More Not required
methods to pursue both insolvency and general commercial litigation. Information
Defective Title Insurance - protection against problems arising from More Not required
missing property deeds. Information
Restrictive Covenant - protection against a third party enforcing specified More Not required
legal rights concerning the use of land. Information
Latent Defects - an efficient and beneficial alternative to collateral More Not required
warranties for owners of newly constructed buildings. Information
Name of Manager
Name of Case Administrator
Signature of Partner: _______________________________ Date: _______________ Office: ______________________
Duty of Disclosure: In addition to providing all basic information necessary to enable us to place the risk, you must ensure
that you are complying with your legal duty of disclosure of all material matters relating to the risk. In particular you must
satisfy yourself as to the accuracy and completeness of the information you provide to Insurers.
In this respect you must provide all information relating to the risk, whether favourable or not, which would influence the
judgement of a prudent Insurer in determining whether he will take the risk, and, if so, for what premium and on what terms.
If all such information is not disclosed by you, Insurers have the right to void the contract from its commencement which
may lead to claims not being met.
When complete e-mail to JLTCRRmail@JLTGroup.com, or fax on 0121 626 7896 or by post to JLT
Specialty Limited, Corporate Recovery Risks, St Philips Point, Temple Row, Birmingham B2 5AB.