Stratapractice

Completion instructions -you are applying for Professional Indemnity and Management liability Insurance coverage.

Note the Management Liability coverage is available only to Private Companies. If the Company proposed for Insurance is not a Private Company the Management Liability coverage will not be offered.

Please contact Insurance House Surety on 02 8913 9100 if you have any questions or need assistance in the completion of this application.

Step 1
Name of Insured/Proposing Company
ABN
Please provide details of all subsidary companies:
1.
2.
3.
4.
If there are more than 4 entities involved then please contact us:

Contact Name
Address
Suburb		State
Postcode		Tel No
Fax No		Mob No
Email Address

Step 2

Your business activity of Strata management is described as; Arranging Property Maintenance.

Advising on Asset Management. Keeping Financial Accounts. Obtaining Quotations and Placing Insurance

Please describe fully in the text box below business activities other than those described above:

Please complete the table below providing the number of schemes managed by your office:

Schemes less than 20 lots
Schemes greater than 20 lots & less than 50 lots
Schemes greater than 50 lots
Total number of schemes managed
Does the Company currently hold Professional Indemnity Insurance	Yes No
Name of Insurer
Limit of Indemnity	$
Renewal Date	(dd/mm/yyyy)

Step 3

Date the Company was first established (dd/mm/yyyy

List Principals, Partners, Directors:
Name	Qualifications/Experience
1.
2.
3.
4.

Are you connected , controlled, owned, affiliated or associated with any other Company, corporation or company?	Yes No
If you have answered "Yes" are any of your services provided to the affiliated or associated entity?	Yes No

During the past 5 years has the name been changed or has other business been purchased or any merger or consolidation taken place?	Yes No
If you have answered "Yes" have you assumed any service obligations or other liabilities of the affiliated, purchased, merged or consolidated Company?	Yes No

Are you involved in any joint ventures?	Yes No


Please advise the number of:
Principals, Partners, Directors
Employees
Others
Offices/Locations

Do you have any Consultants working on behalf of your Company?	Yes No
If you answered "Yes" do you require cover for these consultants	Yes No
List all of the consultants working for your Company:
First Name	Surname
1.
2.
3.
4.

Step 4
Financial Position
Gross Fees earned in the past financial year
Gross fees budgeted for in this financial year

Please provide a percentage breakdown of the budgeted fees relating to:

Strata Management
Other
Total

Please provide your budgeted fees as a percentage broken down by State:
	NSW	VIC	SA	WA	QLD	TAS	NT	ACT

The management liability policy contains an insolvency exclusion endorsement. The underwriter can consider its removal on the provsion of financial information of the company.
Do you request removal of the insolvency exclusion?	Yes No
If you answered "Yes" to the question above please complete (a) and (b) below. If you answered "No" go to the next question on the Company's ability to meet all its debts. (The following financial questions are to be answered based on the most recent financial statements available and should be no more than 1 year old).
(a) Date of Financial Statements (Note: enter the date the financial statements were compiled. For example if the financial statements are for the period 30/6/08 to 30/6/09 then enter 30/6/09
(b) Net Profit (Note: Net Profit is revenue less the cost of goods sold, all expense items and taxes)
Are there any circumstances that might affect the ability of the Company to meet all its debts as and when they fall due?	Yes No
Do the financial statements of the Company contain a contingent liability?	Yes No

Step 5
Please select the National or State Body you hold membership with:
The Insurer reserves the right to quote dependant on you receiving membership of the National & or State Body

Step 6
Is the Insured required to be licenced or accredited to undertake the business activities for which cover is being asked?	Yes No
Has the licence and or accreditation been maintained in force at all times	Yes No

General Insurance activities
Is your Company authorised to operate as a distributor or as an authorised representative of a General Insurer and or Insurance Broker	Yes No

Risk Management
Does your Company employ Agency and management agreements as recommended by State Professional Bodies?	Yes No
If not please provide a sample agreement to Insurance House Surety

Does your Company maintain a Complaints Register	Yes No

When recruiting employees to positions of trust involving handling of stock, money or financial or treasury functions does the Company undertake independent checks into their employment history?	Yes No

Step 7
General details-all questions are to be answered

Has the Company or any director, officer or employee ever been refused this type of cover,	Yes No
Has any person or entity proposed for cover suffered any loss in the past five years that would have been covered under the proposed Policy or had a similar policy cancelled, or had special terms imposed?	Yes No
Is the Company or any person proposed for coverage aware of any facts, circumstances, acts or ommissions that may give rise to any future claims under this proposed Policy?	Yes No
Have you, your subsidiaries, or affiliates or business predecessors been the subject of investigation or discilinary action by any authority or regulatory agency?	Yes No
Have any partners, principals, officers, or key employees of the applicant been the subject of agency disciplinary action or investigation by any authority or regulatory agency?	Yes No

If "Yes " to any question above please provide full details in an attachment or describe fully in the text box below:

Step 8
Which Limit(s) of Indemnity do You require (please tick)

Professional Indemnity
Note: Retroactive date is Unlimited excluding known Claims or circumstances if currently insured otherwise Inception
$1,000,000 any one claim and $2,000,000 in the aggregate
$2,000,000 any one claim and $4,000,000 in the aggregate
$5,000,000 any one claim and $10,000,000 in the aggregate
Other - please contact Insurance House Surety

Management Liability
$250,000 any one claim and in the aggregate
$500,000 any one claim and in the aggregate
$1,000,000 any one claim and in the aggregate
$2,000,000 any one claim and in the aggregate
$5,000,000 any one claim and in the aggregate