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PROFESSIONA L INDEMNITY INSURA NCE FOR MEMBERS OF THE A SSOCIA

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					    P R OFESSI ON A L I N D EM N I TY
            I N SU R A N CE

                              FOR

M EM B ER S OF TH E A SSOCI A TI ON OF
    M ED I CA L I N TER M ED I A R I ES




       Pinsure Limited: Authorised and Regulated by the Financial Services Authority
              nsure Limited
Authorised and regulated by the Financial Services Authority. FSA Register No: 306497

Professional Indemnity Insurance                  Association Of Medical Insurance Intermediaries
(AMII) member s scheme information


Pinsure Limited is a recognised professional indemnity insurance specialist.

                                A
Pinsure offers AMII members FS compliant Professional Indemnity Insurance under an exclusive member s Scheme.
The AMII member s scheme has been placed with a leading insurer HCC International Insurance Company plc. to
ensure that all members, regardless of size, are able to secure approved cover at an affordable cost.

The professional indemnity policy provides FSA compliant coverage, details of which can be found on our website
Public and Employers Liability Insurance extensions can also be granted at an appropriate additional premium and
subject to a liability proposal form being completed and accepted by insurers. Full details of the coverage provision
provided by these valuable extensions are available on our web site.

                                                             A
The minimum level of cover needed to comply with the FS s requirements will be catered for under the standard
member s scheme coverage provision. However should you require extended coverage for any reason quotations can
be sought on request. We have for your convenience and to achieve competitive pricing, made the compliant
coverage levels available to you within pre-rated blocks of fee income levels as detailed within the attached insurance
request form. Being pre-rate the majority of members are able to obtain a scheme quotation instantly by merely
selecting the level of cover required on the two page insurance request form. Please note that the fee figure to
be used for rating purposes MUST be that from your most recently completed financial years
accounts, you must not use an estimated figure. As soon as your proposal form and insurance request form
has been received and approved, coverage will be effected immediately. The due premium must be settled within 14
days of the inception date of the policy. The premium may be paid by cheque, credit card or for larger premium cases,
in instalments.

To effect cover please:-
1) Complete the attached proposal form
2) Complete the Insurance Request Form to confirm the coverage options you require by ticking the relevant boxes
and confirm the total premium at the bottom where prompted
3) Confirm on the insurance application form how you intend to settle the due premium.
4) Should you be wishing to renew an existing Policy confirm the due renewal date
Both the proposal form and Insurance Request Form must be signed and dated.

Should you require quotations for a limit of indemnity in excess of the standard scheme level please complete the
proposal form and return it to us with a covering letter requesting the coverage level you need. A quotation will be
provided for you within 3 working days.

In addition we recommend the public and employers liability extensions which can be included at realistic rates for
AMII members subject to the completion of a supplementary liability proposal form.

Full details of coverage provisions are available on request.
Copies of all relevant documents can be obtained via the AMII or Pinsure Limited on request. Alternatively the form
and full scheme details can be downloaded from Pinsure s web site.

Please address your enquiries to:-           Tel.:   01903 815111
Pinsure Limited                              Fax.:   01903 815123
58 High Street                               Email:          pinsure@pinsure.co.uk
Steyning                                     Web site:       www.pinsure.co.uk
West Sussex, BN44 3RD
   P i nsure Limited
    Terms of Business Agreement
The Financial Services Authority (FSA) is the independent watchdog that regulates financial services. It requires us to
provide you with the following information, use it to decide if the services are appropriate for you. Please be aware that
you may also require other forms of insurance for which Pinsure Limited is unable to advise.

Permitted to arrange general insurance contracts Pinsure Limited is an FSA regulated firm trading in compliance with
                                                                                                        A
FSA regulations. Our FSA firm registration number is 306497, details of which may be checked on the FS s Register by
visiting their website www.fsa.gov.uk/register or by contacting the FSA on 0845 606 1234.

Pinsure offer quotations from a single insurer, chosen on your behalf for their potential suitability to provide you with a
product that meets your requirements.

We will not advise or make a recommendation for you in respect of the Professional Indemnity policy and therefore
you will need to make your own choice as to how to proceed. The HCC International Insurance Professional Indemnity
Insurance will normally meet the needs of a member of the Institute of Certified Book-keepers.

Pinsure Limited normally receives a commission from the insurer with whom we place your business.

Pinsure Limited makes a charge to cover the administration of your insurance: details of which will be shown on your
insurance request form, page 1.

Please be advised that in the majority of cases professional liability insurances cannot be cancelled by the policy holder.
Refer to your specific policy wording for the insurer s procedure. Pinsure Limited will charge a cancellation fee of £100
to cover administration should cancellation be granted.

All client monies received by Pinsure Limited are protected in Statutory Trust Client Bank Accounts pending settlement
to insurers. Please be aware that Pinsure may transfer funds to other FSA authorised underwriters for them to make
settlement to insurers. We do not pay any interest on premiums held by us in the course of arranging and administering
your insurance.

We will treat all your personal information as private and confidential to us and anyone else involved in the normal
course of arranging and administering your insurance, even when you are no longer a customer. We will not give
anyone else any personal information except on your instructions or authority, or where we are required to do so by
law, or by virtue of our regulatory requirements. We may use information we hold about you to provide information
to you about other products and services, which we feel may be appropriate to you. Under the Data Protection Act
1998 you have the right to see any personal information about yourself, which we hold in our records. If you have any
queries please write to us at our usual office address.

Our aim is to provide a first class service, however, if you wish to register a complaint, please contact us by writing to
Kevin Locke, Pinsure Limited, 58 High S      treet, Steyning, West S  ussex, BN44 3RD or, by phone Telephone 01903
815111, by fax 01903 815123
We will provide you with a copy of our full complaints procedure and respond to you as a matter of urgency, and
always within 5 working days. We will aim to make a final response to you within four weeks, or keep you informed as
to why this is not possible. In the event that your complaint relates to activities or services provided by another party,
we will ensure that your complaint is appropriately forwarded, and will track the progress of the complaint and
responses of that party.
After our final response has been issued, if you still cannot settle your complaint with us, you may be entitled to refer it
to the Financial Ombudsman Service, for an independent assessment and opinion.
The FOS Consumer Helpline is on 0845 080 1800 and their address is: Financial Ombudsman Service, South Quay
Plaza, 183 Marsh Wall, London E14 9SR. We are covered by the Financial Services Compensation Scheme (FSCS). You
may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of
business and the circumstances of the claim. Insurance advising and arranging is covered for 100% of the first £2000.00
and 90% of the remainder of the claim, without any upper limit. For compulsory insurances e.g. employer s liability,
insurance advising and arranging is covered for 100% of the claim, without any upper limit. Further information about
compensation scheme arrangements is available from the FSCS.
 Pinsure Limited                                       Information Page
 Definitions


Professional Indemnity
Professional indemnity insurance (PI) is a mandatory requirement of AMII membership.
The certificate will cover you against loss arising from a claim or claims made against you in respect of any civil liability
(including liability for claimant s costs and expenses and matters brought by mediation) incurred in connection with
the conduct of the activities you are licenced / registered to undertake as authorised by your membership standing.
Notification of a potential claim under the policy must be made to insurers immediately you become made aware of
the circumstance. A valid policy must be in force at the time you become made aware of and notify an incident for it
to be covered. If you are not sure whether or not an incident is notifiable always contact Pinsure for advice or err on
the side of caution and notify it anyway. Please refer to your policy terms and condition for full coverage and claims
notification procedures.

Retroactive Date
Insurers shall not be liable to indemnify the Insured in respect of any claim arising from any act or omission that
occurred prior to the date specified.

If none is specified the policy has full retrospective coverage and Insurers will be liable to indemnify the Insured in
respect of any claim arising from any act or omission that occurred from the commencement date of the company.


Limit of Indemnity
This is the maximum amount of money that your PI insurance will pay out in respect of each and every incident.
However there is no aggregate restriction to the number of incidents to which the certificate will respond so long as
the incidents result from differing causes. Also, costs and expenses incurred in the defence of the claim will be paid in
addition to the limit of indemnity. Please refer to the policy wording for full details.

Excess
This is the amount of each and every claim that is uninsured. As such you will be asked to pay back this amount to the
Insurers in the event of a successful claim, brought against you, being settled by insurers. You will not however be
asked to contribute to the costs and expenses incurred in the defence of the claim.



Material Fact

It is your responsibility to provide complete and accurate information to insurers when you take out your insurance
policy, throughout the life of your policy, and when you renew your insurance.

It is important that you ensure that all statements you make on proposal forms, statement of fact, claim forms and
other documents are full and accurate.

Please note that if you fail to disclose any information or change in circumstances to your insurers which could
influence their cost, or their decision to accept your insurance, this could invalidate your insurance cover, and could
mean that part or all of a claim may not be paid.
PUBLIC LIABILITY
If taken up it will cover you in the event that a member of the public is injured or property owned by them is damaged
and the cause of such is deemed to be the accidental fault of your business.
It is defined as being: The insurance of liability for accidental bodily injury or damage to the property of third parties.
Public liability insurance is designed to compensate you in the event that you are sued by a member of the public or
company where they feel they have suffered a loss as a direct result of your actions or those of your employees. An
example of how a public liability claim could arise is if a customer walked into a shop and fell over on a wet floor, and
there was no visible sign of warning to the customer. In 2002 there was approximately £3.5billion paid out in public
liability claims. In the event that your business is sued by a member of the public or company and you are ordered to
pay compensation to them, if you are not insured for public liability insurance, you could be liable to make such
payment from your personal assets (you may be forced to sell your business, home, cars etc).


EMPLOYERS LIABILITY
By law companies within the UK that have employees must hold and maintain Employers Liability insurance. The
Employers Liability Insurance extension option, if taken up, will cover you in the event that an employee is injured,
diseased or dies and you are sued for being responsible for the cause of the injury / disease / death.
It is defined as being: The Insurance of Employers Liability to their employees for injury, disease or death occurring
to their employees arising out of and in the course of their employment.
Employers Liability insurance is basically designed to cover you in the event that you are sued by an injured employee.
In the event that an employee is physically injured or dies in the course of their employment then you could be sued
for negligence.
Employers Liability claims could arise in a number of different ways. Here are a couple of examples of how employer s
liability claims arise:
An employee is spraying paint on to a car that they have just fixed. The employer has no signs on display nor has he
given the employee any instructions that he is meant to wear any safety equipment. After 3 years of working at the
garage the employee becomes ill due to the fact that his lungs are infected by the gas from the paint. The employer
would be sued for thousands of pounds, as they were negligent in not ensuring that adequate safety measures were
met.
An office worker is carrying a filling cabinet up a flight of stairs and falls over and breaks their leg. They could sue the
employer as they were not shown how to lift heavy items.



PLEASE REFER T O YOUR POLICY W ORDIN G FOR FULL DET AILS OF T H E IN SURAN CE S
TERMS, CONDITIONS AND EXCLUSIONS PAYING PARTICULAR ATTENTION TO THE CLAIMS
NOTIFICATION CONDITIONS.
                                              P i nsure Limited
        PROFESSIONAL INDEMNITY INSURANCE PROPOSAL FORM                                              AMII MEMBERS SCHEME

Where there is insufficient space for full information, please provide additional details on your own headed paper
(Please note that in some cases Insurers may require additional information prior to offering quotations)


1.     Name of practice:                                                              A
                                                                            .. Date FS approval first granted:               /    /

        Contact Tel No:                         .               ..e-mail:          ..             .Mobile No:

       Address(es):                                                                 ..                       ..Post code:

2.        Is firm associated financially or otherwise with any other firm(s) or company(s)                                  YES / NO
          (if yes please provide details of organisation and description of relationship)

3.     Details of ALL Principals, Partners or Directors: (please continue on a separate page if necessary)
        Name                                      Qualifications   Date Qualified      Number of years with this firm



4.     Numbers of staff:
       i) Qualified:          ii) Administrative and Others:                  .

5.     Annual fee / brokerage income for last three years.           (if new practice please provide a first year projection)

       200 £                 . 200 £                ..    200    £                . Estimate for next year 200 £                       .

       Date of year end:                   / .. / 20 .
       Is all of your work undertaken within and derived from clients based in the United Kingdom:                       YES / NO
       (if no please provide full details)

6.     For how long have you held and maintained professional indemnity insurance:                               years

7.     To the best of your knowledge have any officers of the proposer ever been prosecuted or convicted or
       involved in acts of fraud or dishonesty. (if Yes please provide full and precise details)        YES / NO

8.     Do you or have you ever had any involvement in any FSA regulated investment products?                             YES / NO

9.     Do you or have you ever had any involvement in Payment Protection Insurance products?                         YES / NO
       (If you have answered yes to this question you will need to complete an additional questionnaire. Please call
       us to request form or download it from our web site.)

10.    Can you confirm that you currently undertake, intend in the future to undertake and have only in the past undertaken
       work related to the placement of medical insurance products?                                        YES / NO

       If No Please provide details of all other work including the percentage of the above declared fee income that this related to

11.    Has any Insurer ever declined to offer terms, imposed special terms or cancelled or voided any insurance for the Firm
       or any Principal, Partner or Director? (if Yes please give full details)                             YES / NO
12.    Have any claims been made against the Firm or its predecessors or any past or present Principal, Partner or Director
       whether successful or not? (if Yes please give full details)                                         YES / NO
13.    Are you or any of the Principals, Partners, Directors or Employees AFTER FULL ENQUIRY aware of any
       circumstances which may give rise to a claim against the Firm or its predecessors or any past or present Principal,
       Partner, Director or Employee?             (if Yes please give full details)                         YES / NO

Please attach a copy of your current membership certificate to the proposal form.
DECLARATION:             I/we declare that the statements and particulars contained in this proposal form are true
and that I/we have not suppressed any material facts. I/We agree that this proposal form together with any other
information supplied by me/us shall form the basis of any contract effected hereon. I/We undertake to inform
Underwriters of any material alteration to these facts occurring before the completion of the contract of
insurance, throughout the life of the policy and upon renewal.

Dated this                 . day of                      .. 20 .

                                                                                                             .
Signature of Principal, Partner or Director                                 Name of signatory in capitals
                                                                                  P i nsure Limited
AMII MEMBERS PROFESSIONAL LIABILITY INSURANCE SCHEME - INSURANCE REQUEST FORM                                                   PAGE 1 of 2

APPLICANTS DETAILS                        RENEWAL DATE OF EXPIRING POLICY             ../    ./    . Or no previous insurance

MEMBERS TRADING NAME:                                         .. AMII MEMBERSHIP NUMBER:

MEMBERS TRADING ADDRESS                   :                                                               T
                                                                                                       POS CODE                     ..

COVERAGE OPTIONS:-

LIMIT OF INDEMNITY for Professional Indemnity Insurance: ANY ONE CLAIM (Defence costs in addition) - £1,200,000.00
All premiums are inclusive of insurance premium tax levied by the government at a rate of 5%
ANNUAL COMMISSION/FEE                    PROFESSIONAL             EMPLOYERS/PUBLIC/PRODUCTS                         PUBLIC/PRODUCTS
INCOME OF YOUR PRACTICE                  INDEMNITY                LIABILITY                                         LIABILITY
                                         PREMIUM                  EXTENTION                                         EXTENTION
                                                                  PREMIUM **                                        PREMIUM**
                                                                  LIMIT £10M                                        LIMIT £1M

£0-£50,000                               £614.25                  £157.50                                           £105.00

£50,001-£100,000                         £682.50                  £157.50                                           £105.00

£100,001-£150,000                        £761.25                  £262.50                                           £157.50

£150.001-£200,000                        £840.00                  £262.50                                           £157.50

£200,001 and above:
Please send a fully completed proposal form to Pinsure Limited. A personalised quotation will be provided for you within 3 working days of its receipt.

* Quotations for higher levels of indemnity are available on request.
** Public and Employer s Liability extensions are subject to the completion of a liability supplementary questionnaire which is available to you on request.
Employer s liability can only be purchased in conjunction with a Public Liability extension
The excess levels applicable to this insurance are NIL in respect of all coverage excepting for the Public liability extension which is subject to a £250 excess
applicable to each and every claims arising from third party property damage.
AMII MEMBERS PROFESSIONAL LIABILITY INSURANCE SCHEME - INSURANCE REQUEST FORM CONTINUED                                               PAGE 2 of 2
APPLICANTS DETAILS
MEMBERS T RADIN G N AME:                                .. AMII MEMBERSH IP N U MBER:

A) I hereby confirm my instructions to Pinsure Limited to effect cover for me within the categories ticked on page 1.
B) I understand that cover is subject to insurers acceptance of my proposal form that I hereby enclose.
C) I confirm that the total premium due for payment is: £
D) I confirm that I will be paying the due premium by (please tick preferred option):

         Cheque.
Please find enclosed my cheque made payable to Pinsure Limited for the amount declared under item C) above.

       Cheque.
Please send me your Debit Note for payment within 14 days of the inception date of the policy.

          HCCI Rolling Monthly Policy Plan. The premium can be paid by interest free direct debits on a monthly basis. The first direct debit will collect the
first two months premiums and thereafter payments are collected monthly in advance. Please contact us for full details and the Direct Debit application
form.
Please be aware that your cover will be cancelled if you fail to keep up payments under this monthly premium payment facility.

       Credit card.                             Debit card. I hereby authorise you to debit my following detailed card with the amount declared under item C)
above + a 2.50% service charge if I am paying by Credit Card.
Pinsure will contact you regarding your card payment once your cover has been confirmed.
Please provide daytime contact details:

e-mail                                                 telephone
Please note your certificate of insurance cannot be sent until payment has been made. All card details will be securely destroyed.

For all methods of payment please sign below:

SIGNED                                                 DATE OF SIGNING               /           / 200_

NAME (IN CAPITALS) OF SIGNATORY
_____________________________________________________________________________________________________________________Ple
Please return this form together with your proposal form by post to Pinsure Limited, 58 High Street, Steyning, West Sussex, BN44 3RD
or by facsimile on number 01903 815123.              For assistance telephone us on 01903 815111 Monday to Friday 9.15 am to 5.30 pm

				
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