The Professional Indemnity Proposal Form is a crucial document in the South African insurance landscape, designed to facilitate the arrangement of professional indemnity coverage for businesses and individuals providing professional services. This document is required when seeking new coverage or renewing existing professional indemnity insurance policies, in accordance with South African insurance regulations, including the Short-term Insurance Act and FAIS Act. The form collects comprehensive information about the applicant's business operations, professional activities, risk management procedures, and claims history, enabling insurers to accurately assess the risk exposure and determine appropriate coverage terms and premiums. It serves as the foundation for the insurance contract and must include all material facts that could influence the underwriter's decision to provide coverage.
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1. 1. General Information: Basic details about the business/professional including registered name, trading names, registration numbers, VAT number, and contact details
2. 2. Business Details: Nature of business, professional activities, years in operation, qualifications, and professional memberships
3. 3. Staff Information: Details of partners, directors, qualified staff, and other employees, including their qualifications and experience
4. 4. Financial Information: Annual revenue, fee income, largest contracts, geographical spread of activities
5. 5. Risk Management: Quality control procedures, risk management protocols, and internal review processes
6. 6. Claims History: Details of any past claims, circumstances that might give rise to claims, and previous insurance coverage
7. 7. Coverage Requirements: Desired limit of indemnity, excess/deductible preferences, and specific coverage needs
8. 8. Declaration: Statutory declarations about the truth of information provided and understanding of obligations under POPIA
1. Professional Services Breakdown: Detailed section for firms offering multiple professional services, breaking down revenue and activities by service type
2. Overseas Operations: Additional section for firms operating internationally, including jurisdictional exposures and overseas revenue
3. Specialized Project History: For firms involved in high-risk or specialized projects requiring detailed risk assessment
4. Subcontractor Information: For businesses that regularly employ subcontractors, detailing their use and management
5. Cyber Risk Assessment: For firms handling sensitive data or providing technology services, detailing cyber security measures
6. Environmental Risk: For professionals whose work may impact environmental matters, such as architects or environmental consultants
1. Schedule A - Revenue Breakdown: Detailed breakdown of revenue by service type, client industry, and geographical location
2. Schedule B - Staff Schedule: Comprehensive list of professional staff, their qualifications, and roles
3. Schedule C - Claims Experience: Detailed history of claims and circumstances for the past 5 years
4. Appendix 1 - Risk Management Procedures: Copies of quality control documents and risk management protocols
5. Appendix 2 - Professional Qualifications: Copies of relevant professional certifications and memberships
6. Appendix 3 - Corporate Structure: Organization chart and details of any subsidiary or associated companies
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