Mortgage & General Insurance Brokers Professional Indemnity
Proposal Form
Once completed please return this form to:
Scott Clay (CeMAP, CeFA) / Ifyou wouldliketo discuss ProfessionalIndemnity Insurance prior tocompletingthis form,please contact Scottwho willbe happy to answer any questions. Themore informationyou can provide aboutyour business, the better. Aformermortgage brokerwho isCeMAP qualified andhasworked inthemortgage industry, Scotthasa deepunderstanding for theworkof Mortgage Brokers and theindustry at large. Scott regularly providescommentary inindustry press and trade journals.Email / / Tel: / 0161 348 7390
Post / Broadstone Mill, Broadstone Road, Stockport, Cheshire, SK5 7DL
If you have any questions whilst completing this form, please contact us anytime.
ABOUT US:ProfilePIisaspecialistintermediaryforMortgageBrokersProfessionalIndemnityInsurance.Weoffercover whichis compliantwith FCA regulations for MortgageBrokersonbehalf ofLloyd’s underwritersandoffer A+(Excellent)Rated security.
ADDITIONAL COVER:
ProfilePIcanalsoquotefor:
- CommercialCombinedInsurance:(EmployersLiability,PublicLiabilityOfficeInsurance)
- EstateLettingAgents:CombinedCommercialInsuranceScheme
IMPORTANT NOTICE:
The InsuranceAct2015requires thatyoumakeafairpresentation ofyourrisk.
The questionsin thisfact-finder aredesignedtoguideyousothatyouknow what informationwe are likelytoneedwhen we underwriteyour risk.Itis not anexhaustive questionnaireandcannotcaterfor everypossiblecombinationof circumstances.Wherewe have notaskeda directquestionaboutabusinessactivitythatyou undertake,whichisrelevant to thisinsurance, then providingyou giveussufficientinformationsothat we canmake further enquiriesofyouthenthe informationyouhave providedtouswill stillrepresentafairpresentationofyour risk.
PLEASE READ CAREFULLY:
Cover will onlybeprovided fortheactivities you haveselected andwhereyouhavedeclared therelevantgrossincome. The excesses,premiumsandlimits ofindemnityarealwayssubjecttofinalunderwriting.
Pleasecompleteallsectionsofthis formusingtheadditionalinformationsectionsshouldyouneedtoinform underwritersof materialinformation.ProfessionalIndemnity policiesrespondonaclaimsmadebasis,which meanscovermust beinforceatthe timeyoufirstbecome aware ofaclaim orcircumstancewhichcouldlead toaclaim.
ProfessionalIndemnityInsuranceCertificatesareissuedasannualcontracts andyoucannot cancel the insurancemid- term.
ABOUT YOU / YOUR FIRM
Name of Firm / Individual: / Click here to enter firm/individual name /
Trading Address: / Click here to enter trading address /
Post Code: / Click here to enter postcode /
Date Firm Established: / Enter date dd/mm/yyyy /
Company Status: / Choose a company status /
Is This a New Start-up Business? / ☐ Yes ☐ No
CONTACT DETAILS
Key Contact Person: / Click here to enter text. / Title: / Click here to enter text. /
Telephone: / Click here to enter daytime tel no. / Mobile: / Click here to enter mobile no. /
Fax: / Click here to enter fax no. / Website: / Click here to enter web address /
Email: / Click here to enter email /
BUSINESS STRUCTURE
Please state the total number (including part time staff) of:
Directors / Partners / Enter no. / Number of Self Employed Advisers / Enter no. /
Admin / Other / Enter no. / Number of staff NOT permanently based at main office address (if any) / Enter no. /
Advisers / Sales Consultants / Enter no. /
Number of Appointed Representatives (if any) / Enter no. / Registered Introducers / Enter no. /
Which case tracking system do you use? / Click here to enter text. /
Please provide names of any other businesses including AR’s for which cover is required under this policy:
Click here to enter text.
FINANCIAL CONDUCT AUTHORITY (FCA)
Please provide your FCA Firm Reference Number:
(please insert TBA if you are currently applying for authorisation) / Enter FRN or TBA
Please confirm you are directly authorised by the FCA / ☐ Yes ☐ No
Appointed Representative / ☐ Yes ☐ No
Appointed Representative (if applied to leave please provide details below) / ☐ Yes ☐ No
Please state name of Network or Principal / Click here to enter network or principal /
Mortgage Packager / ☐ Yes ☐ No
Not Currently Authorised / Other / ☐ Yes ☐ No
Please provide additional information here:
Click here to enter additional information.
FINANCIALS AND WORK SPLIT
Last Complete Financial Year / Past / Present / Estimate
Please state your firms GROSS INCOME for the following years? / £Enter amount / £Enter amount / £Enter amount
Please confirm your firms GROSS INCOME is 100% UK / ☐ Yes ☐ No
Please provide an approximate percentage split of your income for the following activities for the last complete business year:
Full Status Regulated Mortgages / Enter amount or 0%
Interest Only Mortgages / Enter amount or 0%
Sub-Prime Mortgages / Enter amount or 0%
Self-Certification Mortgages / Enter amount or 0%
Secured Loans / Enter amount or 0%
Unsecured Loans / Enter amount or 0%
Buy-to-Let Mortgages / Enter amount or 0%
Islamic / Faith Compliance Mortgages / Enter amount or 0%
Commercial Mortgages (please also supply largest/average below) / Enter amount or 0%
Pure Protection / Enter amount or 0%
Equity Release / Enter amount or 0%
Lifetime Mortgages / Enter amount or 0%
Packager Mortgages / Enter amount or 0%
Referral Income (please provide details below) / Enter amount or 0%
Other (please provide details below) / Enter amount or 0%
Click here to enter additional information /
GENERAL QUESTIONS
a) / Hasanyemployee,or authorisedrepresentative ever been convicted, orhave any prosecutions pending,or beengivenan officialpolicecautioninrespectoffraudordishonesty? / ☐ Yes ☐ No
b) / DoesthebusinessoperateasaNetworkPrincipal? / ☐ Yes ☐ No
c) / Does thebusiness, oritsappointedrepresentatives,operate anydelegatedor binding authorityonbehalf ofmortgage lenders, insurers oranyother business? / ☐ Yes ☐ No
d) / Inrespectofmortgageandsecuredlendingonly, doesthe business holdclientmoneyorassets? / ☐ Yes ☐ No
e) / Isityour practice toalways providekeyfactillustrations that areclear andcomprehensive and toretainthese onyour filefor at leastsixyears? / ☐ Yes ☐ No
f) / Doyou always ensurethatyour clientsarefullyandclearlyinformedasto therisksand suitabilityofanymortgage productyoutransacton their behalf? / ☐ Yes ☐ No
g) / InrespectofInterest Onlymortgages, doyou always ensurethattheclientisaware oftheneedfor arepaymentvehicleandcanyouconfirm thatthisinformationis alwaysrecordedin writing andretainedonfile? / ☐ Yes ☐ No
h) / Have any mortgagesbeenarrangedonbehalfof any client with termsthatextend pasttheclient’splannedretirementage?
If YES to above: / ☐ Yes ☐ No
- Can you confirm both client and lender are aware mortgages extends into clients retirement?
- Can you confirm the affordability has been assessed?
- Can you confirm this is not a pension mortgage?
i) / Areallrecommended providers ofEquityRelease/HomeReversion/Home IncomePlans membersofSHIPLtd(SafeHomeIncomePlans)? / ☐ Yes ☐ No
j) / Canyouconfirm allCommercialMortgage advice/sales(other thanBuy-To-Let) are conductedinaccordancewiththeNationalAssociationofCommercial FinanceBrokers(NACFB) regulations andfiles arekeptin similar manner toregulatedbusiness? / ☐ Yes ☐ No
k) / Ifyouhave ever transactedCommercialMortgages,haveanyoftheseever been over
£1,000,000? / ☐ Yes ☐ No
l) / Isallmortgagebusinessplaced withUK lendersandsecuredonUKproperties? / ☐ Yes ☐ No
m) / Doyouregularlyauditmortgageadvisors fromallofficesfor whomyou areresponsibleto ensurecompliance withregulatoryrequirementsgoverningthe saleand arrangement of mortgages? / ☐ Yes ☐ No
n) / Doyouhave anyfinancialassociationtoanyestateagencypractice? / ☐ Yes ☐ No
o) / During thelast5years,haveyou had anyClaims,orCircumstanceswhich may giverise toa claim, againstthebusinessprincipal, orpartners,or directors oremployee,or appointed representatives,or predecessor inthebusinessinrespectofthe typeofliabilities towhichthis proposalrelates? / ☐ Yes ☐ No
PI INSURANCE REQUIREMENTS
Please select the Limit of Indemnity you require. All limits of indemnity below are sufficient for mortgage advisers and meet minimum FCA requirements. However, please note if you undertake insurance intermediation you must select £1.75m coverage to comply with the FCA regulations as a minimum.
Suitable for Mortgage Brokers only / Suitable for Mortgage & General Insurance Brokers
£500,000 in the aggregate / ☐ / £1,750,000 in the aggregate / ☐ /
£1,000,000 in the aggregate / ☐ /
EXISTING PI INSURANCE
How many years have you held continuous PI cover?
If not applicable, enter N/A / Enter number of years or N/A /
Please provide details of your current insurer (if applicable):
Name of Insurer / Enter name of current insurer /
Limit of Indemnity / £Enter limit of indemnity amount
Excess / £Enter excess amount
Retro-active date (if known) / Click here to enter a date. /
Renewal Date (date existing cover expires) / Click here to enter a date. /
Annual Premium / £Enter total annual premium
DATA PROTECTION:
Bysigningthisproposal formyouconsenttoGamstadNo.1t/aProfilePI usingtheinformationwe holdaboutyoufor the purposesofprovidinginsurance contractsandwhereappropriate,assistanceinrelationtohandlingclaims,if any,andto processsensitive personaldata aboutyouwhere thisisnecessary.Thismaymeanthat we have togive somedetails to thirdpartiesinvolvedin providing insurance cover. Thesethirdpartiesmay includeinsurance carriers,thirdpartyclaims adjusters,frauddetection andpreventionservice,reinsurance companies andregulatory authorities.Inthecourseof performingourobligations toyou,thisinformationmaybedisclosedtoagentsorservice providersappointed byus, insurers(includingtheir reinsurers,legal advisers, lossadjusters oragents).Wheresuch informationrelatestoanyone other thanyou,youmustobtain explicitconsent oftheperson towhomtheinformationrelatesbothto the disclosureof such information tousandby itsuse by usassetout above. The information providedwillbe treatedin the strictest confidenceandwhererelevant, incompliancewith theDataProtectionAct1998.You havetherightto applyforacopyof your information(for whichwemaychargeasmall fee) andto haveanyinaccuraciescorrected.
DECLARATION:
I/ Weherebywarrantthatalladvicehasbeen/is/willbegiveninstrictaccordancewiththetermsprovisionsofthe FinancialConductAuthorityandwhereappropriateanypriorregulator(s). I/ Wealsowarrantthatifcoverisrequiredfor non-regulatedproductsI/Weoperategoodpracticeandcomplianceproceduresfornon-regulatedproductssimilar to that for regulated productswhen providingadvice and throughoutthesales process.
I/ WedeclarethatI/ Wehaveansweredthisquestionnairehonestlyandtothebestofmy/ourknowledgeandafterfull enquiryofallPrincipals,Partners,Directors,Employees,Consultants andAppointedRepresentatives,I/Wedeclare that I/Wearenotaware of anycircumstanceor matterthatmaygiverise toaclaim.
I/ WedeclarethatI/ Wehavenotwithheldanymaterialinformationthatwouldaffecttheunderwritersjudgmentofthis insuranceandI/WeundertaketoinformGamstadNo.1Ltdt/asProfilePIofanymaterialalterationtothesefactsoccurring beforethecompletion ofthe contract ofinsurance.
I / We declare that I / We have never:
a)Been declared bankrupt
b)Been disqualified from being a company direct
c)Been convict, or have any prosecutions pending, or been given an official caution in respect of fraud or dishonest
d)Had a company go into liquidation or become insolvent
e)Had any insurance proposal declined, renewal refused, had an special or increased terms applied or had insurance cancelled or avoided by underwriters
I/Weagreethatthis proposaltogether with anyothersupportinginformationsupplied by usshallformthebasisof any contractofinsurance effectedthereon.
Signing thisproposal formdoes notbind the proposingentityorGamstadNo.1 Ltd t/asProfilePIto completethis Insurance.
Full Name: / Enter full name / Position: / Enter your position /
Signature: / Date: / Click here to enter a date /
Mortgage & GI Proposal Form v1.2 May 16