Please complete and tick boxes as appropriate. If there is insufficient space to provide answers to the proposal form questions,
please use the ADDITIONAL INFORMATION section at the end of the form.
In this proposal we use the term ‘Principal’ to mean any sole Principal, Partner, Director or member of a Limited Liability Partnership.
Reference to ‘Proposer, ‘You’ or ‘Your’ in this proposal shall include all names included under question 1 who will be the Insured in the
insurance Policy.
Please ensure that all relevant sections of the Proposal Form are completed. Please attach additional sheets if necessary.
Section 1 – All questions to be completed
1 Name of business (‘The Proposer)
2 Address of your main office and location of all other offices
3 Describe fully the activities for which professional indemnity cover is required. Any Policy issued will only cover activities which
have been declared by You and accepted by Us (The Insurer).
4 Date commenced
5a. Give details of Your five largest contracts undertaken in the past three years
Client Client’s business Nature of contract Duration of Contract Contract value
5b. Give details of Your three largest contracts expected to be undertaken in the forthcoming year
Client Client’s business Nature of contract Duration of Contract Contract value
Postcode: Website: www.
6 a. How many current customers do you have?
b. What is the value of your average contract?
c. What is the length of your average contract?
7 Give details below of Your Principals (Partners, Directors and Members of LLPs)
Name Age
Qualifications and
dates obtained
How long a
Principal of the firm
If less than 5 years as a Principal,
provide details of previous experience
8 State your number of permanent staff
a Technical Staff (including Analysts, System b Administration
Designers and/or Programmers)
and Support staff
9 Is Your business represented in any way in the USA, its territories and possessions, or Canada?
Yes No
If ‘Yes’, state how (e.g. by subsidiary company, local ofce, local representative or by any other person or concern holding a
power of attorney on behalf of the business)
10 State Your gross income (including fees paid to subcontractors) payable by clients for work undertaken
Last year Previous year
Forthcoming year (estimated)
for new and existing practices
a in the UK (excluding c and e below)
£ £ £
b in the USA, its territories and possessions and Canada
subject to non USA/Canada law
£ £ £
c in the USA its territories and possessions and Canada
subject to USA/Canada law
£ £ £
d in the UK and elsewhere (excluding USA and
Canada) for clients domiciled in the USA its
territories and possessions or Canada, including work
for USA companies, subsidiaries of USA companies or
USA subsidiaries of companies based elsewhere £ £ £
e elsewhere* (excluding USA and Canada)
£ £ £
f in the UK for clients domiciled elsewhere*
(excluding USA and Canada) £ £ £
Total of a b c d e and f above £ £ £
* State countries and amounts involved below
11 a Please state last year’s income (fees or turnover) You derived from
Fees £
Turnover £
i Supply of Third Party Shrink-Wrapped Software* (Not customisable)
ii Supply of own Shrink-Wrapped Software*
iii Supply of other software (including bespoke and customised software)
iv Customisation of software
v Installation and Maintenance
i Installation and Maintenance
ii Supply of own hardware
iii Supply of Third Party hardware
i Consultancy and advice
ii Co-location (storage, surge protection, security, utilities including light, heat and
iii Supply of contract staff
iv Training
v Project management
vi Data processing
Internet Services (Please answer additional questions in Section 2)
i Design of Websites
ii Hosting of Websites
iii Domain name registration and renewal
iv Application Hosting (hosting client data and systems on your site utilising
your own hardware)
Other Services not listed above (Please specify)
Shrink-Wrapped Software: software for standard use on CD or DVDs that are boxed, shrink-wrapped and sold in stores (or
purchased and downloaded from manufacturer’s website)
Income derived from the following
Fees £
i Financial stocks or derivatives trading systems
ii Investment performance / prediction software
iii Engineering software e.g. structural design, production line control, mechanical
iv Fire or Security systems / software
v Medical software or systems
vi Computer games
Please provide further details in respect of i-v above
If applicable, what percentage of products developed are:
1 year old or less
Between 1 and 2 years old
Between 2 and 5 years old
Over 5 years old
12 Subcontracted work
i. Do contracts with subcontractors always provide a hold harmless or indemnity to you from
the subcontractor for claims arising from the work or content supplied by the subcontractor?
Yes No
ii. Do you ensure all subcontractors maintain their own Professional Indemnity Insurance?
Yes No
iii. What percentage of your income is subcontracted? %
If no to 12d i. or 12d ii. please provide details:
13 Is the failure of any of Your services likely to result in the following:
a Injury or death to any person?
Yes No
b Physical damage to or destruction of property?
Yes No
c Significant financial losses to Your client(s)?
Yes No
If the answer is ‘Yes’ to any of the above please give details below
14 What percentage of jobs/contracts with clients are subject to:
a Your terms and conditions
b Your terms and conditions with negotiated amendments
c Your clients’ terms and conditions
d Bespoke terms and conditions
e No written contracts
15 Are You able to confirm that
a contracts are always drafted by legal professionals or vetted by legal advisors?
Yes No
b contracts exclude liability for loss of sales/profits, consequential, special, liquidated or
indirect damages?
Yes No
c work undertaken by Your staff is regularly reviewed by a senior technical manager?
Yes No
d written procedures or checklists are used for the professional services provided?
Yes No
e contracts, letters of engagement or terms of acceptance including subsequent amendments are
evidenced in writing, specify the work to be undertaken, the extent of your responsibility
and are retained for at least 3 years?
Yes No
f contracts always cap overall liability at a reasonable level?
Yes No
g contracts always warrant that the performance standard is no greater than reasonable care and skill?
Yes No
h. contractual indemnities are only provided in respect of bodily injury, death,
intellectual property rights and property damage?
Yes No
i. contracts include a dispute resolution procedure?
Yes No
j. You have a disaster recovery plan?
Yes No
k diary systems, registers or other procedures are in operation to ensure that deadlines are met?
Yes No
l a formal review of working procedures is undertaken at least annually?
Yes No
m satisfactory written references are always obtained for new employees?
Yes No
If ‘No’ to any of the above, give details below
16 Do You have procedures in place to ensure that prior to any contract being agreed or amended:
a the contract specifications can be met, and
Yes No
b all customer requirements can be satisfied?
Yes No
17 Are You accredited to or in the process of becoming accredited to ISO 9001, Cyber Essentials or
subject to any other form of external assessment?
Yes No
18 Are You a member of any professional association or trading body?
Yes No
If ‘Yes’, which?
19 Do you
a take steps to ensure compliance with the latest data privacy legislation?
Yes No
b operate commercially licenced and purchased anti-virus software across your network and
regularly apply patches & updates in accordance with the suppliers’ recommendations?
Yes No
c back up your critical/sensitive data at least weekly to a secure location (i.e. offsite, cloud)?
Yes No
d have a Business Continuity Plan or Disaster Recovery Plan and does it address cyber risks
including back up of data?
Yes No
20 Have You any existing Professional Indemnity insurance in force?
Yes No
If ‘Yes’, state
a name of insurer
b renewal date
21 Has any insurer in respect of the risks to which this Proposal relates ever
a declined a proposal, refused renewal or terminated an insurance?
Yes No
b required an increased premium or imposed special conditions?
Yes No
If ‘Yes’, in either case give details
22 a Has any claim been made against You or any predecessors in business or any Partner,
Director, Member, Consultant or employee for neglect, error or omission in relation to
professional duties?
Yes No
b Have You or any predecessors in business or any Partner, Director, Member, Consultant
or employee incurred any other loss or expense which might be within the terms of cover?
Yes No
If ‘Yes’, in either case give details below or attach a separate note if preferred
Date of claim or loss Brief details of each claim or loss
Cost (if any) of claim paid
or loss incurred
outstanding cost
c What action has been taken to prevent a recurrence of the situation which gave rise to each claim or loss?
23 Is any Partner, Principal, Director, Member, Consultant or employee of Yours, after enquiry, aware of any circumstances which
a give rise to a claim against You or any predecessors in business or any of the present or former
Partners or Principals?
Yes No
b result in You or any predecessors in business or any of the present or former Partners or
Principals incurring any losses or expenses which might be within the terms of this cover?
Yes No
c otherwise affect the Insurer’s consideration of this insurance?
Yes No
If ‘Yes’, give details including maximum potential cost (by separate note if preferred)
24 Limit of Indemnity required
£500,000 £1,000,000 Other
(please specify)
25 How much do You wish to contribute towards each and every claim?
Tick amount required £1,000
£2,500 £5,000 £10,000 Other
(please specify)
Do You wish to pay your premium by monthly instalments?
Yes No
If You provide Internet Services, please complete Section 2 overleaf, otherwise please sign the declaration on the final page
Section 2 – Internet Services – This section must be completed where Internet services are provided. Once complete please sign
Declaration And Undertaking overleaf.
1 Do You design or host websites that process financial transactions?
Design Host and Design No
Please provide details of the three websites that transact the largest online financial turnover
Client Website Online Turnover (£) Contract fee (£) Hosted on own server?
Please provide the name and address of any company providing web hosting services on Your behalf
Website or Name
2 Do Your hosting contract terms match those of the Third Party hoster?
Yes No
If ‘No’ what are the differences?
3 Do You provide hosting services for websites where messages may be posted and viewed
by other users?
Yes No
If ‘Yes’ please provide their details below
Client Website Description of users’ comments Contract fee
4 In relation to web-based message boards, forums or newsgroups, do You have procedures for
a identifying and receiving complaints arising from the content of any websites with which
You are involved?
Yes No
b removing any offending content?
Yes No
c preventing others’ unauthorised access to the site?
Yes No
5 If domain name registration and renewal services are provided
a How many domains are expected to be registered and/or renewed in the coming year?
b Do You retain responsibility for renewing domain names?
Yes No
c Do You have systems in place to ensure renewal of domains occurs on time?
Yes No
Use this space to provide further information in support of answers given to questions in this Proposal.
Please state question number clearly. Please attach additional sheets if necessary.
Royal & Sun Alliance Insurance plc (No. 93792).
Registered in England and Wales at St Mark’s Court,
Chart Way, Horsham, West Sussex RH12 1XL.
Authorised by the Prudential Regulation Authority and regulated by the
Financial Conduct Authority and the Prudential Regulation Authority.
UKC02101D PI IT Professionals January 2019
Please read the following carefully before you sign and date the Declaration And Undertaking.
Before the insurance policy takes effect the Insured have a duty to make a fair presentation of the risks to be insured under
the insurance policy.
A fair presentation of the risk is one:
discloses to the Insurer every material circumstance which you know of or ought to know of; or
gives the Insurer sufficient information to put the Insurer on notice that it will need to make further enquiries for the
purpose of revealing those material circumstances,
which makes that disclosure referred to above in a manner which is reasonably clear and accessible to the Insurer; and
in which every material representation as to a matter of fact is substantially correct, and every material representation as to
a matter of expectation or belief is made in good faith.
A material circumstance is one that would influence the Insurer’s decision as to whether or not to agree to insure you and, if so,
the terms of that insurance. If you are in any doubt as to whether a circumstance is material you should disclose it to the Insurer.
A copy of the proposal should be retained by you for your own records.
Royal & Sun Alliance Insurance plc is unable to provide insurance in circumstances where to do so would be in breach of any
financial or trade sanctions imposed by the United Nations or any government, governmental or judicial body or regulatory agency.
RSA is committed to ensuring that your privacy is protected.
For a full explanation of how we use the information we collect about you, how you can contact us if you wish
to exercise your rights and the procedure that we have in place to safeguard your privacy please visit:
I/We declare that every statement and particular contained within this proposal form:
which is a statement of fact, is substantially correct, and
which is matter of expectation or belief, is made in good faith.
If any such facts, expectations and/or beliefs materially change before the insurance policy takes effect I/we undertake to provide
details of all such changes to the Insurer in order to comply with my/our obligation to provide a fair presentation of the risk to be
insured under the insurance policy.
For the purposes of making this proposal for insurance, I/we agree that the Intermediary (which I/we have appointed to advise in
relation to this policy) is acting on my/our behalf and not as an agent of the Insurer.
Signature (Principal)
On behalf of*
*insert name of firm
This insurance will not commence until the Insurer has indicated acceptance of the Proposal. The Insurer reserves the right to
decline any Proposal.
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