Mortgage Brokers Professional Indemnity

ENDEAVOUR INSURANCE
BROKING GROUP PTY LTD
ACN: 003196601 / ABN: 50 003 196 601 / AFS Licence No: 241469
MORTGAGE BROKERS PROFESSIONAL
INDEMNITY PROPOSAL FORM
302, 16-18 Cambridge Street, Epping NSW 2121
PO Box 548, Epping NSW 1710 • E-Mail: alexia@endeavourinsurance.com.au
Telephone: (02) 9876 8199 • Facsimile: (02) 9876 4077

Important Notice

Claims-Made and Notified Insurance
This policy is issued on a claims-made and notified basis. This means that the policy only covers Claims (as defined) first made against you during the Policy Period (as defined) and notified to the insurer in writing during the Policy Period. The policy does not provide cover for any Claims made against you during the Policy Period if at any time prior to the commencement of the Policy Period you became aware of facts which might give rise to those Claims being made against you. Section 40(3) of the Insurance Contracts Act 1984 provides that where you give notice in writing to the insurer of facts that might give rise to a Claim against you as soon as is reasonably practicable after you become aware of those facts but during the Policy Period, the insurer cannot refuse to pay a Claim which arises out of those facts, when made, because it is made after the Policy Period has expired. This policy contains a “Prior Claims/Circumstances” Exclusion for loss in connection with any claim:

(a) made prior to or pending at the inception of this policy; or

(b) arising out of, based upon or attributable to any circumstance that, as of the inception of this policy, may reasonably have been expected by any Insured to give rise to a Claim.

This policy does not provide cover for Claims arising from any Wrongful Acts which take place before the Retroactive Date

Your Duty of Disclosure

Section 21 of the Insurance Contracts Act 1984 provides that before you enter into a contract of general insurance with an insurer, you have a duty to disclose to the insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk of the insurance and, if so, upon what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance. However, your duty of disclosure does not require you to disclose matters:

(a) that diminish the risk to be undertaken by the insurer;
(b) that are of common knowledge;
(c) that your insurer knows, or in the ordinary course of its business, ought to know;
(d) as to which compliance with your duty of disclosure is waived by the insurer.

Your duty of disclosure continues after the proposal form has been completed up until the Policy Period commences.

Consequences of Non-Disclosure

If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under the contract in respect of a Claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning.

Subrogation
This policy contains provisions which have the effect of excluding or limiting the insurer’s liability in respect of a loss where you have prejudiced the insurer’s rights of subrogation where you are a party to an agreement which excludes or limits insurer’s rights to recover the loss from another party. You are hereby notified of the effect of these provisions.

Details of Proposer

1)

a) Firm Name*

b) Trading Name

c) ABN

d) Contact Person

e) Aggregator (if any)

f) If you intend to claim an Input Tax Credit for the premium paid for this policy, please specify the percentage of the premium you will be claiming:

g) Situation Address Office

Postal Address

Address*

Postcode*

Suburb

State

Telephone

Facsimile

Website

Email Address

2) Is any acquisition, tender offer or merger pending or under consideration by the firm?*

Yes
No

If “Yes” Please provide full details*

3) Please provide details of the current partners/principals/directors of the firm:

List

Name of Partner/ Principal/ Director	Qualification(s)	Year Qualified	This Practice	Previous Practice

4) Please provide details of current staff numbers:

a) Partners/principals/directors*

b) Other qualified/technical personnel*

c) Administration & clerical personnel*

d) Consultants (other than employees) to be noted on the policy

Total*

e) Please name each Consultant to be noted on the Certificate of Currency

5.

a) Is the Firm a full member of the Mortgage & Finance Association of Australia (MFAA)?*

Yes
No

b) Has the Firm read and complied with all the MFAA Guidelines and Compliance requirements?*

Yes
No

c) I/We declare that the firm has carried out and documented an assessment with the client of their borrowing capacity.

Yes
No

d) I/We declare we document our discussions with the client the impact that rate increases will have on repayments?

Yes
No

6. If not a member of the MFAA what Professional associations do you belong?*

7. Is any Partner, Principal or Director of the Firm connected or associated (financially or otherwise) with any other practice or business?*

Yes
No

If “Yes”, please give details of the nature of the connection/association*

Details of the Business

8. Please provide the total amount of the firm’s gross income/fees for the following periods:

a) Previous financial year*

b) Current financial year*

c) If you are an Aggregator what percentage of the above income is retained by the insured Company?

9. a) For each of the activities below, indicate the percentage of gross income/fees derived from:

i) Mortgage Broking/ Origination/ Finance Broking

ii) Mortgage Administration

iii) Mortgage Management

iv) Mortgage Aggregator

v) Other (please specify)

Total 100%

b) Is the Firm authorised to:

i) Conduct Credit online check enquiries for the Lenders?*

Yes
No

ii) Instruct solicitors to prepare mortgage documentation?*

Yes
No

Please note that this policy only provides cover for the activities referred to above. The policy does NOT provide cover for any other activity including where the Firm operates under a delegated lending authority.

10. From the total of activities listed in Q9, please provide the average size loan for the previous 12 months?*

11. From the total of activities listed in Q9, please provide the maximum size loan for the previous 12 months?*

12. Please provide details of your loans for the previous 12 months, as shown in the table below:

Loan Type

Residential dwellings

Commercial / Industrial / Leasing & Equipment

Reverse Mortgages / Non-conforming or “Low-Doc” loans

Total 100%

13. Are any of the Firm’s business activities performed outside of Australia or provided to clients based outside of Australia?*

Yes
No

If “Yes”, please give details of the name of the client(s), the country they are located within and what service(s) are provided*

14. Is the Firm a member of a joint venture?*

Yes
No

If “Yes”, please give details including the nature of the joint venture, the business activities provided by the Firm and the name(s) of the joint venture partners*

Claims Information

15. After enquiry of the Partners/Principals/Directors and employees, has there been or is there now pending a claim against the Firm, it’s predecessors in business or it’s current or former Partners/ Principals/Directors or employees for a Breach of Professional Duty?*

Yes
No

If “Yes”, please give details*

16. After enquiry of the Partners/Principals/Directors and employees is the Firm aware of any circumstance or incident which may give rise to a claim against the Firm or it’s Partners/Principals/Directors or employees?*

Yes
No

If “Yes”, please give details

17. After enquiry of the Partners/Principals/Directors and employees is the Firm aware of any prosecution or investigation (actual or pending) of the Firm or any Partner / Principal/Director or employees under any International, Commonwealth, State or Local statute, legislation, regulation or By Law?*

Yes
No

If “Yes”, please give details*

18. After enquiry of the Partners/Principals/Directors and employees, has the Firm or any Partner/Principal/Director or employee ever been subject to any disciplinary action, been fined or penalised, or been the subject of an inquiry investigating or alleging professional misconduct?*

Yes
No

If “Yes”, please give details*

Details of Insurance

19. As at today’s date does the Firm have Professional Indemnity Insurance currently in force that has been paid for?*

Yes
No

If “Yes”, please state

a) Insurer
b) Indemnity Limit
c) Expiry Date
d) Retroactive Date

20. Has the Firm ever had any Insurer decline a proposal, imposed any special terms, cancelled or refused to renew a Professional Indemnity Insurance Policy?*

Yes
No

If “Yes”, please give details*

21. What limit(s) of liability do you require quotations for?*

$1,000,000
$2,000,000

22. What self insured retention are you prepared to carry?*

$2,000
$5,000

23. For the purpose of calculating Stamp Duty please state the number of current staff (including directors/partners, full/part time and casual employees) located in each state. (Note the total should equal the answer in Question 4):

NSW	VIC	QLD	SA	WA	TAS	ACT	NT	Overseas

Total of all employees above:*

24 Do you require Public Liability Insurance?

Yes
No

If “Yes” please indicate the Limit required

$5,000,000
$10,000,000
$20,000,000

25 After enquiry of the Partners/Principles/Directors and employees, has there been or is there now pending a claim against your firm for Public Liability?*

Yes
No

Endeavour Insurance Broking Group P/L Suite 302, 16-18 Cambridge St, Epping. NSW. 2121 Ph: 61 2 9876 8199 Fax: 61 2 9876 4077 Mobile: 0417 707202 Email: dwayne@endeavourinsurance.com.au Privacy Statement

Important Notice

Your Duty of Disclosure

Consequences of Non-Disclosure

Details of Proposer

Postal Address

Details of the Business

Claims Information

Details of Insurance

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