DIRECTORS AND OFFICERS LIABILITY INSURANCE PROPOSAL


 

It is important that you disclose fully and accurately all Material Facts. If you require more space please continue on your headed paper and then sign, and attach to this form. Failure to do so may result in the insurance being void. Material Facts are those which may affect Underwriters assessment of the risk. If you have any doubt as to whether something is a Material Fact it is recommended that you disclose it.

Any insurance issued following the completion of this proposal is subject to the policy terms and conditions.

If you are aware of any claims, or potential claims (“circumstances”) and you are currently insured via ourselves, please report them immediately, in a separate letter, to our claims department. The information contained within this proposal form is for underwriting purposes only and not for claims processing .

This type of policy is written on a “claims made” basis. There are no days of grace for renewal negotiations under this type of policy. Cover will terminate at expiry date.

1.Name of Company.


2.Main address (and registered address if different).


3.Company Registration Number.


4.Company’s total consolidated turnover as shown in the latest annual report and accounts?

£


5.Please confirm the following statements by marking YES if they are true.

a) The Company has been established for more than 12 months?
Yes No
b) The Company principal business activities are that of a tour operator and/or travel agent?
Yes No
c) The Company’s latest annual report and accounts shows positive net income? (after tax)
Yes No
d) The Company’s latest annual report and accounts shows positive shareholder funds/net worth?
(shareholder funds are total assets minus total liabilities)
Yes No
e) The Company does not have any assets or subsidiaries in the USA or Canada?
Yes No
f) The Company’s shares are not publicly traded on any stock exchange?
Yes No
g) No claims have been made against any past or present Director or Officer of the Company or its Subsidiaries?
Yes No
h) The proposer is not aware, after enquiry, of any circumstance which may give rise to a claim?
Yes No

Please submit full details to the Insurer if you are unable to confirm any statement within part 5. above.

6. Limit of Indemnity Required:


CONTACT/ REPLY DETAILS.

Please give the details of the person who you wish to receive our services.

Full name. Email.

Any addittional comments.

DECLARATION

I declare that I am authorised to complete this proposal on behalf of the Company and that, to the best of my knowledge and belief, the statements and particulars in this proposal are true and correct and no material facts have been suppressed or mis-stated. I undertake to inform Insurers of any change to any material fact which occurs before any insurance based on this proposal is effected and acknowledge that this proposal, together with any other information supplied to Insurers, shall be the basis of such contract.

Full Name.
Position.
Date.

I have read and understood the above declaration
Type 'I AGREE' to confirm.

 


Cover provided by W. R. Berkley Insurance (Europe) Limited’s Private Company D&O Insurance policy.

Telephone: 01406 423311, enquiries@tourindemnity.co.uk
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