1. Proposed date of inception of insurance
the inception date of any policy commences at 4:00pm EST on the date the policy begins
the inception date cannot be a date either prior to or more than 6 weeks after the current date
Please note if the below proposed Insured is a Credit Licensee, cover will only extend to its Credit Representatives (whether incorporated or not):
(i) where the Total Gross Income /Fees of such Credit Representatives have been included in response to question 6 of this Proposal Form (Total Gross Income / Fees); and
(ii) where such Credit Representatives have been individually nominated to be covered in response to question 4 of this Proposal Form (Credit Licensee / Credit Representatives); and
(iii) in relation to the Professional Services performed for and on behalf of the below proposed Insured (subject to policy terms and conditions).
a) Full legal & trading name of each entity to be insured:
(if you are a Credit Licensee do not include your Credit Representatives. For a proposer who is a company please include 'Pty Ltd', and any associated trusts and trading name i.e. ABC Pty Ltd ATF ABC Trust T/as ABC.)
g) Please nominate if you are attached to any of the following Aggregators :-
1300 Home Loans
Australian Loan Company
Australian Mortgage Brokers
Centrepoint Lending Solutions
Custom Equity Group
Finance & Mortgage
Liberty Network Services
Mortgage Loans Australia
My Local Broker
Refund Home Loans
Smartline Home Loans
Specialist Finance Group
Please provide total number of current staff numbers (include any credit representatives and their staff)
4. Credit Licensee, Credit Representatives
In response to the below request please:
only name Principals (which includes a natural person who is a sole trader, director or partner) of the legal entity noted under Question 2(a) above; and
only name Credit Representatives to be covered by this insurance who perform Professional Services for and on behalf of the legal entity noted under Question 2(a) above.
do not include employees if either of the above
note, cover will not extend to any Credit Representative where the Total Gross Income /Fees of such Credit Representatives has not been included in response to question 6 of this Proposal Form (Total Gross Income / Fees)
Please name any Principals or Credit Representatives (other than employees) to be covered by this insurance and noted on the Certificate of Currency
5. Risk Management Questions
Of your Credit Licensees/Credit Representatives to be insured by this insurance, have at least 50% either enrolled or completed one of the following Diploma courses?
6. Total Gross Income / Fees
Please provide the total amount of the proposed Insured's gross income and fees (not the value of loans processed) for the following periods:
Important Note: If the proposed Insured is a Credit Licensee, gross income and fees must include gross income and fees earned by any Credit Representatives of the proposed Insured to be covered by this insurance
7. Breakdown of professional services
For each of the activities below, indicate the percentage of gross income / fees (noted in 6(a) above derived from:
Please note cover will NOT be provided in relation to a Delegated Lending Authority held by or on behalf of the Insured.
From the total activities noted in Question 7 above, please detail the % of loans for the last 12 months for the following loan types
Total (Loan Types must amount to 100%)
Please enquire within your organisation to ensure that all known claims and/or circumstances likely to
become a claim, are identified and reported to your insurer prior
to your current expiry date.
Failure to do so may result in cover being denied for such incidents
as this is a CLAIMS MADE policy.
11. Professional Indemnity Insurance
Please note to comply with new legislation your minimum Policy limit should be $2,000,000 anyone claim and $6,000,000 in the Aggregate.
c) Please select your preferred Policy Limit
$2,000,000 any one claim, $6,000,000 in the aggregate
$5,000,000 any one claim, $15,000,000 in the aggregate
For the purpose of calculating Stamp Duty , please state the % loans processed for each state in the last 12 months (or 100% in your state of domicile if a new broker)
13. Public Liability Insurance
This Broadform Liability policy includes public/products/advertising liability insurance (this is a separate policy)
Important Note: The Policy Limit under the Broadform Liability Insurance is $20,000,000 any one occurrence (for public liability) and in the aggregate (for products liability and advertising liability).
14. Cyber Cover Extension
This extension provides cover for privacy breach claims, system damage losses, computer virus transmission and hacking claims, multimedia claims, cyber extortion costs, privacy fines & investigations and rewards expenses cover (cover subject to the terms and conditions of the Cyber Cover Extension).
Important Note: This is an Extension to the professional indemnity policy. The total aggregate Specific Cover Limit under this Extension is $250,000, which amount is inclusive of the Policy Limit under the Professional Indemnity policy.
Declaration & Important Information
I/We hereby declare that:
My/Our attention has been drawn to the Important Notice accompanying this Proposal form and further
I/we have read these notices carefully and acknowledge my/our understanding of their content by my/our signature/s below.
The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this Proposal form and the inception date of the insurance to which this Proposal relates I/we shall give immediately notice thereof.
I/We authorize CGU Professional Risks, Insurance Australia Limited trading as CGU Insurance, to collect or disclose any personal information relating to this insurance to/from any other insurers or insurance reference service. Where I/we have provided information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the section in the Policy on “The way we handle your personal information”.I/We also confirm that the undersigned is/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this Proposal form and I/we complete this Proposal form on their behalf.
To be signed by the Chairman/President/Managing Partner/Managing Director/Principal of the association/partnership/company/practice/business.
Once you have answered all the questions above, please click on the submit button below and the Proposal will be saved.
If your Proposal contains errors, you will be taken to the beginning of the form where the fields will be highlighted in red.
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