Docstoc

Prof_Indemnity_IT

Document Sample
Prof_Indemnity_IT Powered By Docstoc
					HOULDER INSURANCE SERVICES




  PROFESSIONAL INDEMNITY

      PROPOSAL FORM




 INFORMATION TECHNOLOGY
             INDUSTRY



     Michael's House, 10-12 Alie Street,
             London, E1 8DE
               PLEASE READ THE FOLLOWING BEFORE


                 COMPLETING THIS PROPOSAL FORM:




•   ALL QUESTIONS SHOULD BE COMPLETED IN INK.




•   WHERE A QUESTION IS NOT APPLICABLE          TO   YOUR   PARTICULAR
    CIRCUMSTANCES, PLEASE WRITE ‘N/A’.




•   PLEASE TICK THE YES OR NO BOXES.




•   IF THERE IS INSUFFICIENT SPACE TO ANSWER QUESTIONS PLEASE USE AN
    ADDITIONAL SHEET AND ATTACH IT TO THIS PROPOSAL FORM.




•   COMPLETING AND SIGNING THIS PROPOSAL FORM DOES NOT BIND THE
    PROPOSER OR INSURERS TO COMPLETE THIS INSURANCE.




•   IF THIS PROPOSAL RELATES TO A NEW BUSINESS OR VENTURE, PLEASE
    COMPLETE THE QUESTIONS AS FAR AS POSSIBLE, GIVING ESTIMATED OR
    ANTICIPATED INFORMATION.
SECTION(1): DETAILS OF PROPOSER

1   Name of Individual or Firm requiring cover:




2   a) Principal address:




                                                                                          Post Code:



    b) If other locations please specify town/city only:




3   Date established:




4   Please provide details of all Partners, Principals and Directors:
                                                                                                              Length of time
    Name                        Qualifications                 Date Qualified             Age                 position held




    Please attach a CV for any unqualified Partner, Principal or Director




SECTION (2): DETAILS ABOUT YOUR BUSINESS

1   Please advise the total number of:

    a) Partners, Principals or Directors

    b) Qualified staff

    c) All other staff




2   If you are a sole Practitioner please advise:

    a) Details of your full time occupation (if any)




    b) What arrangements are in place in the event of sickness or holidays to ensure continuance of the business?




PPLIT                                                                                                                          3
3   a) Do you engage consultants or sub-contractors?                                                   YES     NO

    If YES please give details of the nature of activities undertaken by such consultants or sub-contractors




    b) Do you check that the consultant or sub-contractor                                              YES     NO
    i) has appropriate qualifications


    ii) maintains professional indemnity insurance?                                          YES         NO




4   Please give details of membership of any Association or Professional Body




5   Do you use standard Contract Conditions/Letter of Appointment                                      YES     NO

    If YES please attach a copy

    If NO please provide details of how you define your duties to your client:




6   Is work undertaken for any entity in which any Partner, Principal or                               YES     NO
    Director of the Proposer is able to exercise a controlling interest?

    If YES please give full details and income derived from this source:-




7   Are you associated financially or otherwise with any other entity?                                 YES     NO

    If YES please give full details:-




PPLIT                                                                                                               4
8    Are you a member of a Consortium or Joint Venture?                                                 YES         NO

     If cover is required in respect of your own liability as a member of the consortium
     please provide the following:-



     a) Name of Consortium




     b) Type of services being provided




     c) Annual income/fees received from the Consortium




9    a) Please confirm the gross fees for the last 2 completed financial years and estimates for the current and forthcoming years:

                                                                                    Territorial Split

     Year End                   Gross fees                     U.K                  Overseas (excl.               USA/Canada
                                                                                    USA/Canada)


     ……………                      £………………                        ………………%              ………………%                       ………………%

     ……………                      £………………                        ………………%              ………………%                       ………………%

     ……………                      £………………                        ………………%              ………………%                       ………………%

     ……………                      £………………                        ………………%              ………………%                       ………………%


     b) Please confirm the largest fee derived from any one entity:                 £……………………

     c) Please advise the average fee earned per entity:                            £……………………

     d) Please advise fees paid to consultants/sub-contractors                      £……………………




10    Please confirm the approximate division of work undertaken during the last complete financial year between the
      following market sectors:

      Government Work                                            %        Military Work                                     %

      Finance House                                  %         Aerospace Industry                                 %

      Commercial Firms                                         %          Leisure Industry                                  %

      Manufacturing/Industrial Firms                           %          Construction                                      %

      Health Care/Medical Services                             %          Other Work                                        %
                                                                          (please give details below)




PPLIT                                                                                                                                 5
11     Please confirm the approximate division of work undertaken during the last complete financial year between
       the following activities:-

       Packaged Software                                        %            Turnkey Systems                                 %

       Custom Software Development                              %            Hardware Sale/Supply/Maintenance/Installation   %

       Systems Analysis/Software Design                         %            Software Maintenance                            %

       Data Processing/Bureau                                   %            System Audit                                    %

       Facilities Management                                    %            Training Services                               %

       Business Consultancy                                     %            Strategic Planning                              %

       Data/Voice Communications Consultancy                    %            Other Work                                      %
                                                                             (please give details below)




12     a) If you supply ‘Package Software’ was this written originally by you or on your behalf? Please provide an approximate split
          of software written by you or on your behalf and software you are distributing for a third party:

       Own software                        %

       Third party software                %


       b) Do you have access to standby equipment in event of problems with any computers YES                NO
          or ancillary equipment.

       If YES please give details




       c) Do you ensure that duplicate computer systems records are maintained by yourselves               YES        NO
          or your clients and kept separately from the original records?

       If NO please give reasons:




13     Please provide details of the 3 largest contracts undertaken in the

       Client                    Fee earned                     Total Contract                 Date                 Date
                                                                   Value                    Commenced             Finished



i)




ii)




iii)




PPLIT                                                                                                                                  6
14    a) Have any major changes to your activities or structure taken place in the past 2 years?   YES   NO

      If YES please provide details:




      b) Are any major changes expected to your activities or structure in the next year?          YES   NO

      If YES please provide details:




      c) Have you carried out any activities other than those disclosed in this Proposal?          YES   NO

      If YES please provide details:




SECTION(3): YOUR P.I. REQUIREMENTS

1    Have you previously been insured or currently have Professional Indemnity Insurance           YES   NO
     in force?

     If YES please advise:

     a) Name of Insurers


     b) Renewal Date


     c) Limit of Indemnity


     d) Excess


     e) The number of consecutive years you have been insured




2    What Limit of Indemnity do you require?

     £250,000         £500,000                      £1,000,000


     Other (Please specify amount):        £




PPLIT                                                                                                         7
SECTION (4): PREVIOUS INSURANCE & CLAIMS HISTORY

1   In respect of the Proposer or any Partner, Principal or Director has any Insurer ever cancelled,   YES          NO
    declined to provide or renew any Professional Indemnity Insurance or imposed special terms?

    If YES please give details:




2   Has any Partner, Principal, Director or Employee been subject to disciplinary proceedings by       YES          NO
    any Association or Professional Body?

    If YES please give details:




3   a) Has any claim, whether successful or not ever been made against the Proposer or its             YES          NO
    predecessors in business or any past or present Partner, Principal, Director or Employee?

    If YES please give details of dates, amount claimed, allegations and current position

    PLEASE NOTE: If any Partner, Principal, Director or Employee is aware of any claim relating to activities
    carried out by them in previous practice or employment, details should be disclosed under this question:




    b) Are you or any Partner, Principal, Director or Employee AFTER FULL ENQUIRY aware                YES         NO
        of any circumstance or any circumstances which may give rise to a claim against the
       Proposer, its predecessors in business or any past or present Partner, Principal, Director
       or Employee?

     If YES please give full details:




I/We declare that the statements and particulars given in this Proposal are correct and that no material fact has been omitted.
I/We agree that this Proposal together with any other information supplied shall form the basis of the contract.



    Signature        ………………………………………………………………



    Position         ………………………………………………………………                                                Date      ……………………………



PLEASE NOTE: It is necessary for you to disclose all Material Facts which may influence us in acceptance or assessment of this
Proposal. Failure to do so could invalidate this insurance. If you are in doubt whether any fact is material you should disclose it.




PPLIT                                                                                                                                  8
                         YEAR 2000 - SUPPLEMENTARY QUESTIONNAIRE

Q1 Does your products function depend on date related calculations?

A




Q2 Are the date functions in your software compatible with your customers’ hardware?

    (i.e. 2 or 4 digit dates and how they are actually read by the hardware?)

A




Q3 Does your acceptance testing include year 2000 compatibility testing?

A




Q4 Does your five year customer support take into account the date change at the millennium?

A




Q5 Does any software you are currently selling require any date modification? And are you planning to do any?
   (If not, why not?)

A




Q6 Are you selling updates to previous software to ensure year 2000 compatibility?
   (If not, why not?)

A




Signed: ………………………………………………………………………..                                                   Dated: ………………………………




PPLIT                                                                                                           9

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:6
posted:9/20/2011
language:English
pages:9