It is your duty to ensure sufficient information about your business is provided to insurers that enables them to understand the risks to be insured, or to make further enquiries. You may need to consult with others within your business that may also have relevant knowledge which should be declared to insurers. This duty continues throughout the lifetime of the policy when any change in circumstances must be notified.
Please confirm you can agree to the following:
• You have not been declared bankrupt or become insolvent or made any voluntary arrangement with creditors or been subject to enforcement of a judgement debt either in a personal capacity or as a business
• You have not been convicted of or charged with any offence, other than a motoring offence or conviction spent under the Rehabilitation of Offenders Act 1974
• You have not had any insurance or proposal cancelled, withdrawn, declined or made subject to special terms
• You are not aware of any fact, circumstance, incident, injury or illness or escalating level of complaint which may give rise to a claim. This includes a shortcoming or problem in their work which cannot reasonably be put right, a complaint about their work or anything they have supplied which cannot be immediately resolved, an escalating level of complaint on a particular project, any of your clients withholding payment to you after a complaint
Please note that cover will not commence until this form has been received and accepted by Graybrook Hallam (unless otherwise agreed)
If Yes, retroactive cover can only be considered when continuous Professional Indemnity Insurance has been held
(please submit a copy of any current policy schedule showing the retroactive date applicable)
Please acknowledge acceptance of the following:
The insurer for policies underwriting this scheme is AXA Insurance UK plc (AXA). The scheme is administered on their behalf by Graybrook Hallam.
To arrange and administer your policy AXA and Graybrook Hallam will hold and use information supplied by you, in accordance with U.K. Data Protection Laws and General Data Protection Regulation (GDPR). Full information and your rights about the personal data we collect and process can be found in our Privacy Notice which is available on request and online at www.graybrook.co.uk. A copy of the Privacy Notice will also be included in your quotation/renewal pack.
Unless you select one of these options we will not be able to send information on any of our other insurance policies or services.
We will not sell or pass your information to other organisations for marketing purposes.
CUE - Insurers pass information to the Claims and Underwriting Exchange register, run by Insurance Database Services Limited (IDS Ltd). The aim is to help us to check information provided and also to prevent fraudulent claims. When we deal with your request for insurance, we may search the register. When you tell us about an incident which may or may not give rise to a claim, we will pass information relating to it to the register. You can ask for more information about this.
IPT - Insurance Premium Tax
The Finance Act 1994 requires us to levy Insurance Premium Tax at the prevailing rate on insurance premiums. For further information, please ask us.
The parties to the policy have the right to choose the law applicable to the Policy. Unless the parties agree otherwise English Law shall apply
This insurance is administered by:
Graybrook Hallam, 8 Chandlers Way, South Woodham Ferrers, Essex, CM3 5TB
Web: www.graybrook.co.uk - Email: firstname.lastname@example.org - Tel: 01245321185 - Fax: 01245 322240
Graybrook Hallam is Authorised and regulated by the Financial Conduct Authority. Registered No. 595238
And underwritten by AXA Insurance UK plc
AXA Insurance UK plc is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority