1
Solicitors Professional Indemnity Insurance Application Form
Please provide a full answer to every question. A Principal/Member of the Practice must sign and date this form and any separate sheets. Please include with this form a sheet of your current LETTERHEAD PAPER, which can also be used to supplement areas where you may have insufficient space to answer a question.
1. Name and address details
Practice name Main Office Solicitors Regulation Authority Registration
Number
Please include all other names under which you practice and any other entities for which you are seeking cover including Trustee and/or nominee companies and/or incorporated principals.
Main office address Preferred mailing address if different from main office address
Postcode
Postcode
Main office telephone number Main office fax number
Practice website Contact e-mail address
Date established Primary contact
1.1 Is the practice a Limited Liability Partnership or a company registered at Companies House? Yes No 1.2 Do you have any other offices, other than the main office listed above, for which you are seeking cover? Yes No
If ‘Yes’, please list the addresses on a separate sheet. If there is no resident Principal, please identify the office concerned and indicate how it is supervised
1.3 Is the practice planning any merger or consolidation with another
Practice within the next twelve months? Yes No
2. Prior Practices
List the names of all prior Practices to which the practice has become a Successor Practice in the last fifteen years (as defined in the SRA Solicitors Indemnity Insurance Rules). Use a separate sheet if necessary.
Practice name Date established Date of succession
Have any of the listed Practices reported any circumstances or claims in the last five years? Yes No
If ‘Yes’, please provide copies of claims information from other Qualifying Insurers or the Assigned Risks Pool for all circumstances and claims reported since 01/10/2003.
Is the Practice planning any succession or merger with another Practice within the next 12 months? Yes No
If ‘Yes’, please provide full details:
3. Staff details
Please provide all information requested for every Principal, Member, Director, Assistant and Consultant who will be employed by the practice as at the inception date of the Policy. If anyone listed is a Registered Foreign Lawyer of Registered European Lawyer, please note RFL or REL alongside Solicitor’s status. If you are a newly established Practice, please enclose Curriculum Vitae for every Principal/Member in the practice, your Business Plan and a Cash Flow Statement.
(a) Solicitors details Title
(Mr/Mrs etc)
Solicitors full name Date of birth (DD/MM/YYYY) Solicitors status (Principal/Member/Assistant) Full or part time Role number (As shown on practising certificate) Year of admission in England and Wales
Title (Mr/Mrs etc)
Full Name Date of birth
(DD/MM/YYYY)
Role (eg. HR/IT, Finance Director, Barrister, Legal Executive, Licensed Conveyancer etc) Fee earner Yes/No Full or part time Regulatory body
Work for other Practices
Are any Principals or other fee earners also Principals, fee earners or employees of other Law Practices or any other business ?
If ‘Yes’, please provide full details:
4. Other Staff
Number of non solicitor fee earning staff (please state if none):
Number of all other staff, including secretarial (please state if none):
5. Practice fees
Please provide gross fee income for the last three completed accounting periods and an estimate of gross fee income for the current accounting period, from your clients in the following territories.
Date UK USA/Canada Elsewhere Total
Estimated current year Last completed year Prior completed year – (1)
Prior completed year – (2)
5.1 Do you or have you carried out the work for any client domiciled outside the UK?
Yes No
If ‘Yes’, please provide details including the amount of the total gross fees for the last accounting period paid by clients domiciled in the USA and Canada
Please state if none
5.2 Does any one client or group of clients or referral source generate 20% or greater of your annual fees?
Yes No
6. Practising certificate
In the last ten years has any fee-earner in the Practice:
6.1 Ever been refused a practising certificate? Yes No
6.2 Ever been granted a conditional practising certificate? Yes No
6.3 Been reprimanded fined or otherwise sanctioned by the Disciplinary Tribunal? Yes No
6.4 Practised in a firm subject to an investigation or an intervention by the Law Society or Solicitors Regulation Authority?
Yes No
6.5 Had an award for inadequate professional service made against him or her by the legal complaints service or the former CCS or the former OSS or entered into any regulatory settlement agreement with the SRA?
Yes No
6.6 Had a civil or criminal judgement against him or her? Yes No
6.7 Has the practice been the subject of a monitoring visit from the Law Society or Solicitors Regulation Authority in the last three years?
Yes No
6.8 Has the practice been the subject of any visit or enquiry from the Forensic Investigation Unit of the Law Society or Solicitors Regulation Authority in the past three years or has notice of any proposed visit or enquiry been given?
Yes No
6.9 Been investigated by any regulatory body other than the Law Society or Solicitors Regulation Authority (e.g. FSA, Council of Licensed Conveyancers, ILEX) ?
Yes No
If you have answered ‘Yes’ to any of the above questions, please provide full details on a separate sheet and include a copy of all reports and relevant correspondence issued by the LCS, former CCS or OSS, Forensic Investigation Unit, Disciplinary Tribunal and, or any other regulatory body.
7. Claims and circumstances
7.1 Has the practice or any prior Practice, reported any circumstances or claims to the Assigned Risks Pool or to Qualifying Insurers?
Insurance Year 2003/04 Yes No
Insurance Year 2004/05 Yes No
Insurance Year 2005/06 Yes No
Insurance Year 2006/07 Yes No
Insurance Year 2007/08 Yes No
Insurance Year 2008/09 Yes No
Insurance Year 2009/10 Yes No
Insurance Year 2010/11 Yes No
If ‘Yes’ to any of the above insurance years, please provide with this form claims information from other Qualifying Insurers or the Assigned Risks Pool for all circumstances or claims reported since 01/09/2003 by the practice or any Practice to which you are a successor Practice.
7.2 Have any circumstances or claims reported by the practice or any prior Practice in the last five
years arisen as a result of the dishonesty of any Principal, Member or employee of the Practice? Yes No If ‘Yes’, please provide full details on a separate sheet including how each matter was resolved and
the
procedures/processes in place to avoid re-occurrence.
7.3 After making a full enquiry of all Principals, Members and employees in the practice, are you aware of
any circumstances or claims that have not been reported to your current or any prior insurers? Yes No If ‘Yes’, please explain on a separate sheet.
Please note that you have an obligation under your current Professional Indemnity insurance policy to notify these matters to your insurer and we shall ask you to confirm that you have done so before cover can be put in place.
Please provide detailed answers to this section otherwise we will be unable to offer terms.
7.4 Has the Practice been involved in any fee dispute actions within the past five years? Yes No If ‘Yes’, please provide details:
fees
8. Area of practice
Please provide the percentage of gross fees allocated to each area of practice or, if you are a new Practice, estimated percentage for the coming year for guidance
Last completed year Prior completed year (-1) Prior completed year (-2)
Administration oaths, taking affidavits and notary public
%
%
%
Agency advocacy
%
%
%
Acting as an arbitrator, adjudicator or mediator
%
%
%
Children, mental health tribunal and welfare
%
%
%
Commercial litigation
%
%
%
Commercial/corporate work (excluding work related to public companies) please complete section 8 (a)
%
%
%
Conveyancing (commercial) please complete section 8 (b)
%
%
%
Conveyancing (residential) please complete section 8 (b)
%
%
%
Criminal law
%
%
%
Debt collection
%
%
%
insurers, including defendant personal injury work
Employment - contentious
%
%
%
Last completed year Prior completed year (-1) Prior completed year (-2)
Employment – non contentious
%
%
%
Financial advice and services regulated by the Solicitors Regulation Authority
%
%
%
Immigration
%
%
%
Landlord and tenant
%
%
%
Lecturing and related activities and expert witness work
%
%
%
Litigious work other than given in any other category (please provide a breakdown on separate sheet)
%
%
%
Matrimonial/Family
%
%
%
Non-litigious work other than given in any other category (please provide a breakdown on separate sheet)
%
%
%
Offices and appointments
%
%
%
Parliamentary agency
%
%
%
Personal injury claimant please complete section 8 (c)
%
%
%
Probate and estate administration
%
%
%
Property management,
valuations and real estate agency
%
%
%
Town and country planning
%
%
%
Wills, trust and tax planning
%
%
%
Commercial/corporate work for public companies please complete section 8 (a)
%
%
%
Financial advice and services where the practice has opted into regulation by the FSA (please completed FSA questionnaire)
%
%
%
Intellectual property including patent, trademark and copyright
(please provide full details on a separate sheet)
Total must equal 100%
8.1 Are any substantial changes in the percentage amounts shown above anticipated during the next
12 months? Yes No
If ‘Yes’, please provide details:
8.2 Please split the Practice business between the following market sectors:
Private Client % Entertainment & Sport %
Financial Institutions/ Banking
% Privately Held Companies (other than
above) %
Government
% Publicly Held Companies (other than
above) %
Construction % Insurance %
Other (please specify)
%
8 (a) Commercial
In respect of commercial work, please provide gross fee income for the last accounting period from:
Area Gross fees non – public companies Gross Fees - public companies
Mergers and acquisitions Debt issuance/securitisation Project financing Pension schemes Tax Insolvency Regulation/compliance Other (please specify) Other (please specify) Other (please specify)
Please list the five largest matters over the last three years and fees earned in each case. Area of work Public or non-public
company (please state)
Contract value Fees earned Year completed
8 (b) Conveyancing
Please state the number of fee earners in the practice who undertake or have undertaken conveyancing work.
Last completed year Prior completed year (-1) Prior completed year (-2) Solicitors
Other qualified fee earners Non-qualified fee earners
Please complete the below table in relation to residential conveyancing.
Last completed year Prior completed year (-1) Prior completed year (-2) Gross fees
Number of transactions Highest capital value Average typical capital value Percentage of total relating to remortgage work
Please complete the below table in relation to commercial conveyancing.
Last completed year Prior completed year (-1) Prior completed year (-2) Gross fees
Number of transactions Highest capital value Average typical capital value
In any year in the last three, have more than 10% of your conveyancing instructions originated from any one development or from any one client or referrer e.g. mortgage broker, developer, financial adviser, estate agent?
If Yes, please provide full details
Estimate what percentage of all your conveyancing instructions in each of the last three complete financial years relates to the purchase of buy-to-let properties.
% Last completed year % Prior completed year (-1) % Prior completed year (-2)
What identity checks do you carry out on conveyancing clients?
How do you comply with the lender requirements on verification of identity?
If you do not meet a client prior to a transaction how do you establish identity?
Over the last three years what safeguards have you had in place to ensure that any information indicative of mortgage fraud, e.g. back- to- back transactions, discounts, incentives is:
b) Reported to lender clients?
Does anybody other than a Principal sign reports and/or certificates of title addressed to lenders?
If Yes, please provide full details.
On approximately how many occasions in the last 12 months have you received requests for conveyancing files from lenders? Please provide full details including name(s) of the lender(s)
Has the Practice of any prior Practice in the last twelve months:
Yes/No Number
a) undertaken residential or commercial surveys/valuations for lending purposes? b) advised on Equity Release Plans
Does the Practice plan to do any of the above in the next twelve months?
If Yes, please provide full details.
8. (c) Personal Injury
Please advise your current personal injury work by percentage.
Clinical negligence %
Occupational disease %
All other personal injury (eg. RTA, Employers/Public Liability etc.) %
How many open claimant personal injury cases does the practice currently have? What was your average personal injury settlement over the last twelve months?
What was your highest personal injury settlement over the last twelve months?
Please estimate the percentage of personal injury work (claimant) you currently have in each of the following categories:
Small Claims % Fast Track % Multi Track %
Please estimate the number of personal injury cases you currently have where the expected settlement exceeds £250,000
Please state the number of fee earners in the Practice who undertake or have undertaken personal injury work.
Last completed year Prior completed year (-1) Prior completed year (-2) Solicitors
Other qualified fee earners Non-qualified fee earners
Do you undertake work or accept any referrals from Claims Management Companies or referral networks?
If Yes, please provide name(s) and full details.
Does the Practice vet personal injury cases for a third party?
If Yes, please provide full details.
What percentage of your current cases have ATE insurance? %
Please provide full details.
Please name any ATE insurance provider that you place more than 20% of your business with and specify the percentage in each case.
Have your files been audited or has an audit been proposed by any underwriters or funders?
If Yes, please provide details, including copies of all correspondence relating to any audit or proposed audit.
Do you receive, or have you received, any time in the last three years, any commission or other financial incentive from any insurer?
If Yes, please provide details.
Please provide a copy of any standard letter that you have advising clients about the choice of ATE insurer and any commissions, financial incentives or similar that you receive.
If Yes, please provide full details, including identity of provider, percentage of cases and background to the level of instructions.
8.3 Please provide details of the Practices five largest clients in the past three years :
Year Name of Client Business of Client Description of work
undertaken
9. Risk management
9.1 What Legal Service Commission Quality Mark or other quality standards (e.g. LEXCEL or Investors in People) is the practice currently accredited with. (If accredited with LEXCEL, please provide date of accreditation)
9.2 Does the Practice have a management structure in place? Yes No
If the Practice is managed by either a Management Committee or Executive Committee of the like, how often do they meet?
Weekly Monthly Other (please specify)
9.3 Has there been any changes to the internal management structure
9.4 Does the Practice have written risk management procedures? Yes No
9.5 Are these regularly reviewed and circulated? Yes No
9.6 Does the Practice have a formal Money Laundering policy for which
training has been provided to all Partners and employees Yes No
9.7 Does the Practice always obtain written references preceding the
employment of employees and Partners? Yes No
9.8 Does the Practice require two signatures on monetary transactions
and drawing down on clients accounts above £25,000 Yes No
9.9 Does the Practice use or have:
9.9.1 Client and new business vetting which prohibits any individual Solicitor from accepting a new client or matter without the approval of the
Practice’s management structure? Yes No
9.9.2 A written policy specifying the conflicts of interest procedures which
include a cross check system and back up? Yes No
9.10 Does the Practice use engagement letters which
contain a scope of services? Yes No
9.11 If the scope of services are amended, are these confirmed in writing
in the form of an amendment to the original engagement letter? Yes No
9.12 Does the Practice operate a centralised diary system
with appropriate manual or electronic back up? Yes No
9.13 Please confirm that the Practice makes regular checks to ensure that all
key dates are met and that the system caters for absenteeism? Yes No
9.14 Does the Practice use a file review system which requires randomly selected files to be
audited by a Solicitor other than the Solicitor handling the file? Yes No
9.15 Does the file review system include Partner to Partner auditing? Yes No
9.16 Does the Practice designate or employ an individual with responsibility for dealing with complaints, actual or potential claims and other
such matters? Yes No
9.17 Please provide the name and status of the person responsible for risk management in the Practice?
9.18 Does the Practice undertake any professional service for any client in which any Partner or Solicitor holds a Partnership/Directorship or has any other financial interests?
Yes No
9.19 If ‘Yes’, are these service always carried out by a Partner/Solicitor other
than the Partner/Solicitor connected with the client? Yes No
9.20 Does the Practice offer and promote Solicitors’ continuing
training? Yes No
9.21 Does the Practice use a formal review system to evaluate at least
annually, the performance of all Solicitors and Legal Staff within the Practice? Yes No Who is entitled to authorise payment from the client account?
10. Current coverage
Has the Practice, or any prior Practice, ever been in the Assigned Risks pool? Yes No
If ‘Yes’, please explain on a separate sheet.
Has any qualifying insurer refused to offer the Practice, or any prior Practice, terms for Professional Indemnity insurance?
Yes No
If ‘Yes’, please explain on a separate sheet.
Please provide details of your current insurance below:
Current insurer Premium Limit Excess
£ £ £
11. Requested cover
The minimum cover required is £2million for a Partnership or £3million for LLPs and companies registered at Companies House.
Limit of Indemnity Excess
£2 million £3 million £4 million £Nil £1,000 £3,000
£5 million
£6 million £7 million £5,000 £10,000 £25,000
£8 million £9 million £10 million £50,000 £75,000
Other (please specify) £ Other (please
specify)
£
AGGREGATE EXCESS (please refer to definition for details on this coverage)
Do you require a quotation for aggregate excess: Yes No Include both options
12. Significant change
Do you expect there to be any significant change to or in the Practice in the coming year? Yes No If ‘Yes’, please explain on a separate sheet.
13. Other material information
Is there any other material information that may be relevant to this application? Yes No If ‘Yes’, please explain on a separate sheet.
14. Data protection
Please read carefully the following statements prior to signing where indicated.
All personal data collected by Vantage Professional Risks (VPR) will be held in accordance with the Data Protection Act 1998. VPR will disclose this information to our service providers and agents for policy administration purposes. In addition, VPR may exchange information with other organisations such as the Police, regulatory authorities and professional bodies by whose rules the insured is bound, through various databases to help us check information provided and to prevent fraudulent claims. By returning this form, you consent to the processing of personal data, including sensitive personal data, for these purposes and to VPR transferring such information outside the European Economic Area where necessary.
When you provide information about another person, you are confirming that they have appointed you to act for them. Such persons will have been made aware of the purposes for data collection and processing set out above and have consented to such processing. You will receive, on their behalf, any data protection notices and keep them informed about how their data will be processed and where it may be disclosed.
VPR may share personal data within Vantage Insurance Services Limited and other companies with which we have established commercial links, so we and they may contact you (by email, telephone or other appropriate means) in order to keep you informed about carefully selected products, services or offers that we believe will be of interest to you. If you do not wish us to do this please tick the box.
15. Declaration
I/We declare that to the best of my/our knowledge or belief the particulars and statements given in this application and any other documentation and information provided in connection with this application are true and complete and that no material facts have been misstated or suppressed after enquiry, and this application, declaration, documentation and information will be the basis of the contract between the Insured and the Insurer. I/We declare that I/We have informed the Insurer of all facts which are likely to influence the Insurer in the acceptance or assessment of this insurance. I/We understand that failure to do so could invalidate this insurance. I/We accept that if II/we are I am in doubt whether any fact may influence the Insurer I /We should disclose it. I/We undertake to inform the Insurers of any material alteration to those facts occurring before the completion of the contract of insurance.
The completion of this Application Form does not bind the Practice or Insurers to effect a contract of insurance, but if a policy is issued, this Application Form, together with any other information supplied prior to inception shall form the basis of any Contract of Insurance effected thereon.
Any liability of Insurers, under any policy issued, to provide insurance cover over and above the minimum limit of insurance cover required by the Law Society will be subject to the terms and conditions specifically applicable to such ‘Excess’ cover, which terms and conditions may differ from the Minimum Terms and Conditions of Professional Indemnity Insurance for Solicitors in England and Wales as specified by the Law Society of England and Wales. In particular but without limitation, in the event that the Practice fails to disclose and/or misrepresents circumstances known to it at any time prior to the inception of Excess cover (and not merely at the date that this proposal is signed) which may give rise to a claim, the Insurers reserve the right to take whatever action is deemed appropriate and necessary in accordance with the terms and conditions applicable to the Excess cover.
Number of additional sheets with this application
Signature Date
Print name Position
This form must be signed and dated by a Principal/Member of the Practice Please return this form to:
Vantage Professional Risks 41 Eastcheap
London EC3M 1DT
Telephone 020 7655 8020 Email:pi@vantageinsurance.co.uk www.vantageprofessionalrisks.co.uk
Vantage Professional Risks is a division of Vantage Insurance Services Limited (VISL) which is authorised and regulated by the Financial Services Authority. Registered Office: 41 Eastcheap, London, EC3M 1DT.Registered in England No: 3441136.
16. Document checklist
Before posting, please ensure that you have included the following documents: This form; fully completed, signed and dated
A sheet of the Practice’s current LETTERHEAD PAPER And, if applicable, please provide the following:
Claims information for all claims and circumstances reported to Qualifying Insurers or the Assigned Risks Pool, by your Practice and any Practice to which you are a successor Practice.
If you are a newly established Practice, Curriculum Vitae for every Principal/Member of the Practice and your Business Plan
and Cash Flow Statement.
