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Menu
Types of Insurance
Business Packages
Public Liability
Work Injury Compensation
Professional Indemnity
Commercial Property
Directors and Officers Liability
Marine Cargo
Commercial Vehicle Insurance
Business Interruption
Cyber
Covid and Dengue Insurance
Employee Health Benefits
Contractors All Risk Insurance
Foreign Worker Medical Insurance
More Insurance
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IT Companies Insurance
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Accountants Insurance
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Renovation Contractors Insurance
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+65 8874 7011
Chubb Professional Indemnity Misc
Professional Indemnity Misc Proposal Form
Step
1
of
6
- Application for Insurance Cover
0%
Application for Insurance Cover
Application for Insurance Cover
Period of Insurance from
MM slash DD slash YYYY
To
MM slash DD slash YYYY
Limit of Insurance Required in SGD
Excess / Deductible Requested in SGD
Are you requesting cover for Fraud & Dishonesty?
Yes
No
Are you requesting cover for Principals’ Previous Business?
Yes
No
Details of Applicant
Names and Company Registration Numbers of all firms applying to be covered under this insurance (Referred to as “You” in the rest of this form)
Has your name ever been changed, or have you purchased or merged with any other practice or business?
If Yes, please attach details.
Yes
No
Please attach details
Max. file size: 512 MB.
What is your address?
Postal code
Which year was your firm established?
What is the breakdown of the number of your staff by nature of work?
Principals, partners or directors
Other professionally qualified staff
Non-technical administrative staff
Other staff
Total
Details of Business
What professional licences do you, your Principals, Partners or Directors hold?
What professional societies and associations are you, your Principals, Partners or Directors members of?
Please provide the percentage breakdown of each type of professional service or advice that you provide to clients.
Type of Work
%
Do you engage in any other professional or business activities other than what is described in this section 2?
Yes
No
Are you or any of your Principals, Partners or Directors connected or associated with any other practice or business?
Yes
No
Financial Details
When does your Financial Year end?
What is your total turnover or fee income for the:
Year
SGD
Total
What percentage of your fee income is derived from work in:
Singapore (%)
Other Asia (%)
Australia (%)
Europe (%)
USA (%)
Others (%)
Please list the foreign countries you provide services in and the number of staff located in each:
Country
Number of Staff
What are your five largest projects or contracts during the past five years?
Client name
Service performed
Location
Start and End Date
Fees (SGD)
Risk Management
Do you execute a written contract, agreement or engagement letter for services with every client?
Yes
No
Do you execute a written contract, agreement or engagement letter for services with every client?
Yes
No
Do these contracts contain specific description of services that you provide?
Yes
No
Do these contracts contain guarantees or warranties of your services?
Yes
No
Do these contracts contain limitation of your liability to your clients?
Yes
No
Do these contracts hold harmless or indemnity agreements to your benefit?
Yes
No
Do these contracts hold harmless or indemnity agreements to your client’s benefit?
Yes
No
Do these contracts contain disclosure of actual or potential conflicts of interest?
Yes
No
Are all changes to your contracts confirmed in writing?
Yes
No
Are verbal reports or advice always confirmed in writing?
Yes
No
Are written disclaimers included in any advice that you give?
Yes
No
What percentage of your professional services is subcontracted to others?
Please state the services which are subcontracted.
Does your subcontractor contractually agree to hold you harmless for liability caused by the subcontractor’s acts?
Yes
No
Do you contractually agree to waive any legal rights you may have against your subcontractors, consultants or agents?
Yes
No
Do you ask for verification that the subcontractor carries professional liability or media liability insurance?
Yes
No
Insurance History
Do you currently have similar insurance?
Yes
No
Has any application for similar insurance been refused, or has any similar insurance ever been rescinded or cancelled?
Yes
No
Types of Insurance
Business Packages
Public Liability
Work Injury Compensation
Professional Indemnity
Commercial Property
Directors and Officers Liability
Marine Cargo
Commercial Vehicle Insurance
Business Interruption
Cyber
Covid and Dengue Insurance
Employee Health Benefits
Contractors All Risk Insurance
Foreign Worker Medical Insurance
More Insurance
Industries
IT Companies Insurance
Retail Shops Insurance
F&B Insurance
Beauty Services Insurance
Consultants Insurance
Accountants Insurance
Architects Insurance
Engineers Insurance
Renovation Contractors Insurance
More Industries
FAQ
Business Package FAQ
Public Liability FAQ
Professional Indemnity FAQ
Work Injury Compensation FAQ
Marine Cargo FAQ
Directors & Officers FAQ
Inland Transit FAQ
Cyber FAQ
Money FAQ
Fidelity Guarantee FAQ
Product Liability FAQ
Trade Credit FAQ
Customer FAQ
About
Login
Account
+65 8874 7011
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