Important Notice to the Proposer on Completion of This Proposal Form

May, 2016

Professional Indemnity Insurance Architects Proposal Form Important Notice to the Proposer on Completion of this Proposal Form

1. Disclosure All material facts must be disclosed to Insurers as part of the proposal before the insurance commences and throughout the period of Insurance. A “material fact” is any fact which the Insurer may reasonably wish to know in relation to their assessment of the risk, the exposure and in calculation of any appropriate premium. You must disclose all such facts whether or not a specific question has been included in this Declaration.

Please discuss with us if you have any doubts about what is material or have any concerns that Insurers have not been made aware of material information.

2. Consequences of Non-Disclosure Any failure to disclose material information which may influence Insurers will not entitle the Insurers to avoid all cover and claims (Clause 4.1 “No avoidance or repudiation” of the Solicitors Regulation Authority (SRA) Minimum Terms and Conditions (MT&C’s)) for any element of the compulsory cover.

Insurers are entitled to seek reimbursement if you either omit or misrepresent any information (Clause 7.2 “Reimbursement” of the MT&C’s). The Reimbursement Clause shall also apply should you either commit or condone any breach of the policy conditions or where there is dishonesty or fraud.

The MT&C’s apply to the compulsory level of cover only, with Insurers being entitled to avoid cover and decline to pay claims for non-disclosure or misrepresentation of all material facts for any limits of indemnity arranged in excess of this unless you are advised to the contrary.

3. Presentation This Declaration must be completed in ink by an authorised individual, a Partner, Principal, Member or Director of the Proposer. All questions must be answered. If not applicable, state “N/A”, or if none state “None”.

4. Guidance If you have any queries about the contents of this Notice, the remainder of this Declaration or any documents which you need to provide, you should seek advice from an insurance advisor in the first instance.

5. Material Change of Risk Many policies require you to notify the Insurer in writing of any material change to the insured risk during the period of insurance and, in some cases, in the period between finalising the insurance contract (or renewal of it) and the commencement of the period of insurance. The Insurer can then decide whether to cover the new risk. Some examples of material changes are if you:

■ change your business activities; ■ acquire or merge with another business; ■ commence manufacturing a new kind of product; ■ are unable to pay your debts as they fall due and you enter into an arrangement with your creditors. ■ if you fail to comply with such a policy requirement, the remedies open to the Insurer will be set out in the policy and may be severe.

We therefore recommend that you notify us immediately of any changes to material facts as soon as they arise.

If you are in any doubt as to whether the Insurer should be told about any particular change.

Architects’ Proposal Form – April 2016 Willis Limited, Registered number: 181116 England and Wales. Registered address: 51 Lime Street, London, EC3M 7DQ. A Lloyd’s Broker. Authorised and regulated by the Financial Conduct Authority for its general insurance mediation activities only.

of 14 6. Your duty of fair presentation The following applies if your policy is subject to the laws of England & Wales, Scotland or Northern Ireland.

You are under a duty to make a fair presentation of the risk, which requires you to disclose all material facts when seeking insurance (including when renewing any insurance) and when making a subsequent variation to the insurance. You must also advise the Insurer of any changes that occur between receipt of a quotation and finalising placement or renewal. The disclosures referred to above must be presented in a reasonably clear and accessible way.

If you fail to make a fair presentation of the risk, then subject to the terms of the policy, the Insurer may cancel the policy (i.e. treat it as if it had never existed) or amend the terms that apply and/or reduce the amount it pays in the event of a claim. If any such failure is deliberate or reckless, the Insurer may cancel the policy, refuse the claim and keep the premium.

A material fact is one that would influence a prudent insurer in deciding whether to accept a proposed insurance or not and, if they accept, on what terms, conditions and cost. If you are in any doubt as to whether a fact may be material or not you are advised in your own interest to disclose all known facts or seek our advice.

If you require further information concerning a fair presentation of the risk please contact your Account Director.

of 14 Additional information should be provided on your own separate HEADED paper clearly identifiable as forming part of the proposal form.

GENERAL DETAILS

1. Insured/Proposer name:

2. Address of the principal office:

Postcode:

Telephone No: Fax No: Email: Website:

3. In what year was the business established?

4. a) Please list all additional business entities (whether or not currently trading):

Insured name Year established Year of cessation

b) Do you require cover in respect of all past activities of the business included in 4 a)? Yes No

of 14 5. Please list addresses of all other offices currently trading:

Address Postcode

6. Is/are the firm(s) or any principal, partner or director a member of a consortium, joint venture, single project partnership or group practice? Yes No

If ‘YES’, please supply details:

7. Does the firm(s) or any principal, partner or director carry out any work on behalf of any other business in which they have a controlling or financial interest (other than as a shareholder in a public quoted company)? Yes No

of 14 8. a) Has the firm previously been insured for professional indemnity? Yes No

Renewal date Limit of indemnity Premium Excess Insurer name

/ / / /

b) In respect of professional indemnity insurance, has any Insurer ever declined a proposal, declined to pay a claim, refused renewal, cancelled such insurance or imposed special conditions? Yes No

of 14 STAFF AND PARTNERS

1. Please give details of any principal, partners or directors:

Date of birth Year became Name Relevant qualifications (dd/mm/yy) Partner/Director / / / / / / / / / / / /

2. Is cover required for the professional activities of any principal, partner or director prior to joining the business? Yes No

Name of previous Name Activities Start date Leave date business / / / / / / / / / / / / / / / /

3. Please give details of number of permanent staff in current business:

Full-time Part-time Principal/Partners/Directors Professionally qualified All others

of 14 ACTIVITIES

1. Please state your total gross income for the last 3 years plus an estimate for the current and forthcoming years: Year Ending UK USA/Canada Elsewhere Total

2. Please specify the nature of any earnings declared in Question 1 from:

a) Territories subject to the law of the USA or Canada:

b) Elsewhere (excluding UK, USA or Canada):

of 14 3. Please give the percentage split of total gross fees received in the last complete financial year: Architectural Services as defined in Work stages C-L of RIBA Architects Appointment %

Town planning/Consultancy %

Feasibility Studies %

Interior Design %

Landscape %

Non Structural Refurbishment %

Structural surveys/Reports/Valuations %

Building Surveying %

Quantity Surveying and Surveying not listed above %

Consulting Engineers %

Planning Supervisor %

Construction Project Management (please refer to additional questionnaire) %

Construction Project Co-ordination (please refer to additional questionnaire) %

Adjudicator/Arbitrator %

Expert Witness %

Fees paid away to Independent Specialist Consultants (please also refer to question 7) %

Other Work, please supply details: %

TOTAL 100 %

of 14 4. Please give the percentage split of the firm’s work carried out during the last complete financial year, applicable to the following:

Individual Housing %

Multiple Housing %

Housing Associations %

Ecclesiastical %

Commercial %

Medical Facilities %

Schools/Universities %

Industrial %

Restoration Work %

Other Work, please supply details: %

TOTAL 100 %

of 14 5. a) Please give details of the 5 largest contracts where construction has commenced during the past 6 years:

Location and Description of Contract Total Contract Your fee Date Estimated value commenced completion date

b) Please give details of the three largest new projects where construction is likely to commence in the coming 12 months: Location and Description of Contract Total Contract Your fee Date Estimated value commenced completion date

6. a) Do you use independent specialist consultants? Yes No

Name Discipline

b) Do you require them to carry a minimum level of professional indemnity cover? Yes No

of 14 7. Do you envisage any material change in your activities in the next 12 months? Yes No

8. Are you in any way involved in Building Information Modeling (BIM) Yes No

If ‘YES’, please supply full details:

of 14 CLAIMS INFORMATION

1. Please provide details of any professional indemnity claims made against and/or circumstances involving the firm(s) and/or predecessors of the firm(s) and/or your current and/or retired partners, directors or principle, either individually or otherwise for any Yes No negligence, errors, omissions, breach of professional duty or the like weather successful or not:

Date of Claim Claimant Details of claim/circumstance Open/Closed including any payments made

2. After enquiry, are any of the partners, directors or principal aware of any pending claims and/or circumstances existing which may give rise to a Professional Indemnity claim against the firm(s) and/or predecessors of the firm(s) and/or your current and/or retired partners/ Yes No directors/ principal?

Date of Claim Claimant Details of Circumstance

/ / / / / / / /

of 14 Additional Questionnaire

1. CONSTRUCTION PROJECT MANAGEMENT

Term used where the Insured is responsible for appointing other professional and/or non-professional firms necessary to the contract.

Please give details of the largest five projects in which you have been involved:

Approximate Total Total fee Starting Total fees completion Type of project contract income date paid away date value retained / / / / £ £ £ / / / / £ £ £ / / / / £ £ £ / / / / £ £ £ / / / / £ £ £

2. CONSTRUCTION PROJECT CO-ORDINATION

Term used where the Insured’s principal makes the appointment of other professional and/or non- professional firms necessary to the contract whether on the Insured’s recommendation or not.

Please give details of the largest five projects in which you have been involved:

Approximate Total fee income Starting date completion Type of project Total contract value retained date / / / / £ £ / / / / £ £ / / / / £ £ / / / / £ £ / / / / £ £

of 14 DECLARATION

We will at all times treat all confidential information we hold about you (including any information that constitutes ‘personal data’ or ‘sensitive personal data’ under the Data Protection Act 1998) as private and confidential and protect it in the same way we would protect our own confidential information. We will not disclose any confidential information we hold about you to others without your prior consent except: (i) to the extent we are required to do so by law or a regulator; (ii) to insurers, surveyors, loss adjustors, and other like persons to the extent necessary to provide our services to you in a timely manner; (iii) to the CLC as the Practice’s regulator (iv) to loss assessors, lawyers, and other like persons to the extent necessary to enable such third parties to provide information or services you have requested; (v) to premium finance companies to the extent necessary to enable them to provide you with greater choice in making premium payments; and (vi) to other companies within Willis Group to the extent necessary to provide our services to you or to ensure the effective management, administration, or operation of Willis Group’s business. By signing this Proposal Form, you agree that we may use any information you provide to us to create anonymised industry or sector- wide statistics which may be shared with third parties, on the condition that unless we have obtained your consent, information specific to you will not be revealed other than on an anonymised basis and as part of an industry or sector-wide comparison.

Where you provide us with any information which constitutes ‘personal data’ (including any ‘sensitive personal data’), we will treat such information at all times in accordance with the Data Protection Act 1998, and by signing this Proposal Form you agree that we and other companies within Willis Towers Watson may hold and process such information: (i) in order to provide our services to you; (ii) to facilitate the effective management, development or operation of Willis Group’s business; and (iii) in any country – including countries outside the European Economic Area, which may not have comparable data protection laws – for the foregoing purposes (and to the extent we disclose to Willis North America Inc. (“WNA”) any such information, WNA may use and disclose such information as described in WNA’s Safe Harbor Privacy Policy, which is available at http://www.willis.com/SafeHarbor/).

By signing this Proposal Form, you agree that any information you have provided which constitutes personal data (including any sensitive personal data) has only been provided because you have ensured that you have obtained all necessary consents and provided any required notices, or that you are otherwise permitted to provide such information to us, so that such information you provide to us can be lawfully used or disclosed by us and other members of the Willis Group in the manner and for the purposes anticipated by this Proposal Form. You will also ensure that any such information you do provide to us is relevant for such purposes, and is reliable for its intended use, accurate, complete and current.

Under the Data Protection Act 1998, you (or your employees or other persons who benefit from services we provide) may have a right of access to some or all of the information we hold about you, or to have inaccurate information corrected. If you (or any relevant individual) wish to exercise either of these rights, please contact us in writing.

The undersigned person(s) declare that the statements and particulars in this proposal are true to their best knowledge and belief.

I/We understand that if my/our Practice acquires, merges with or absorbs another Practice during the period of insurance, the insurer will require similar information in relation to that Practice and may charge an additional premium.

Print name:

Signature: (Principal/Partner/Director)

On behalf of:

Please note, if you wish to submit your form via email, an indication of terms and conditions may be provided however an original signature is required before a contract of insurance can be made. Encrypted signatures are not acceptable.

Signing this form does not bind the Proposer to complete the insurance. We recommend that you should keep a record of all information supplied to us, including copies of letters and this proposal form, for the purpose of entering into this contract.

PLEASE RETURN YOUR COMPLETED PROPOSAL FORM AND ATTACHMENTS TO:

Willis Towers Watson Willis Limited, FINEX Global 9th Floor, 51 Lime Street London, EC3M 7DQ

T: +44 (0)20 3124 6000 E: [email protected]

17804/04/16