Professional Indemnity Insurance (Lawyers)

Professional Indemnity Insurance (Lawyers)

Proposal Form

ADNIC is a Public Joint Stock Company incorporated in the United Arab Emirates

by Law No. (4) of 1972, and it is governed by the provisions of the UAE Federal

Law No. (6) of 2007 “Establishment of the Insurance Authority & Organization of its

Operations”, with Registration No. (1).

Completing this form

In order to apply for this insurance, please complete all parts of this proposal form and

the annexures, if any.

If you are in any doubt about what you should disclose, please do not hesitate

to contact us. A material fact is one that would influence our decision whether to offer

you insurance or the terms which we offer.

If the space provided is inadequate, please provide details using an additional

information sheet, signed and dated.

Your insurance does not commence when you sign the proposal. Your cover will only

commence once we have reviewed the proposal form and confirmed cover in writing.

You must provide full, accurate, and true answers to all questions listed below. Material

facts which you know or ought to know should be fully and accurately disclosed.

Failure to do so may result in rejecting your claim and/or terminating the insurance

policy from inception.

1. General information a. Name of the firm:

b. Address of head office: (Please show the address required on the policy)

P.O. Box: City:

Country: Mobile number:

Phone number: Email address:

Fax number: Website address:

c. Address of branch office(s) and name(s) of resident partner(s):

d. When was the firm established?

e. During the past five years, has the name of the firm been changed or has any other firm purchased or any merger or consolidation taken place? Yes No

If so, please give full details:

f. Member of Association? Yes No g. Details of all practicing principals or partners

Names Qualifications, dates

qualified/total duration of professional experience

Position held in company and how long

1. General information (continued)

2. Nature and volume of your present and foreseeable future activities

h.

i. Does your firm, any partner, principal or staff manage, own or have financial control of any bank, trust company, mortgage or loan association, title guarantee or real estate company or undertake work as executor, trustee, director or company secretary? Yes No

If so, please give full details:

a. Describe your firm by showing the percentage of gross fees to be received from the following activities during the current fiscal year

i) Litigation %

ii) Real estate conveyancing %

iii) Estate work %

iv) Corporation Law %

v) Patents %

Total number of principals, partners and staff Number

Technical:

Principals, partners or officers Lawyers and legal assistants

Staff other than typists and office staff (please specify)

Typists and office staff

2. Nature and volume of your present and foreseeable future activities (continued)

b. Does the firm’s practice extend or has it ever extended to activities abroad? Yes No If so, please indicate:

i) In which countries and the respective share of total business:

ii) Method of handling such business:

c. Fees

Please indicate your fiscal year:

What are the gross fees for: i) Last fiscal year?

ii) Current fiscal year (estimate)? iii) Next fiscal year (estimate)?

3. Previous insurance/Previous claims

a. Have you previously been insured? Yes No If so, please specify:

Name of Insurer Policy Period Limit of Indemnity

b. Has your previous application been declined? Yes No Has your previous insurance

i) Required increased premium? Yes No ii) Required special restrictions? Yes No iii) Been terminated/not been renewed by an insurer? Yes No

If so, please give detailed information:

c. Have any claims been made during the past five years against your firm? Yes No

If so, please give details of paid claims including quantum and background of each claims:

d. Is your firm aware of any circumstances or incidents which may result in a claim against your firm?

Yes No

If so, please give details:

4. Indemnity required

3. Previous insurance/Previous claims (continued)

5. Endorsements to basic cover

a. Extended claims reporting period Yes No b. Loss of documents Yes No If so, up to what amount?

c. Incoming/Outgoing partners

i) Incoming partners Yes No

ii) Outgoing partners Yes No

If this extension is required, please advise the names of the partners and incoming/outgoing dates:

d. TPL Yes No

If so, up to which limit of indemnity?

I/We hereby declare that the statements/information given by me/us in the Proposal Form are full, accurate and true. It is hereby understood and agreed that the statements, answers and particulars provided in this Proposal Form and as per the attachments are the basis on which the insurance policy is being issued/effected. If after the insurance policy is effected, it is found that any fact in the statements, answers or particulars in this Proposal Form is incorrect, untrue, inaccurate, misrepresented or non-disclosed in any material respect, ADNIC shall have no liability under the insurance policy and/or shall have the right to terminate the insurance policy from inception.

Name of Proposer:

Title:

Signature:

Stamp:

Date:

Note: Please note that each page of the proposal form should be signed by the Proposer or its legal representative Declaration