1. D&O and Corporate Liability Statements of fact

THE APPLICANT CAN CONFIRM THAT
Its shares are privately held (i.e. they are not publicly traded on any stock exchange) and are expected to remain so for the next 18 months.
It has no mergers or acquisitions planned.
It has been in continuous operation for more than 12 months.

IN RESPECT OF THE APPLICANTS FINANCIAL STATEMENTS THE APPLICANT CAN CONFIRM THAT
It's latest financial statements are audited or if not required to be audited, are prepared by a qualified accountant and are less that 18 months old.
It's latest financial statements are not qualified.
It's latest financial statements show a profit before tax.
It has not acquired any companies or concerns since it's last financial year end which have increased it's total assets by 50% or more.

IN RESPECT OF THE APPLICANTS BUSINESS THE APPLICANT CAN CONFIRM THAT
No business or other activities under it's past, present or planned future management or ownership involve any activities in:
• Commercial Airlines
• Pharmaceuticals
• Banking or Fund Management
• Private Equity or Venture Capital
• Building and or Friendly Societies
• National or Local Government
• Financial Fund Management
• Stock Broking
• Insurance Broking in Lloyd's
• Sports Agencies
• Insurance or Reinsurance*
• Telecommunications
• Pension Schemes - Final Salary
• Tobacco
*other than intermediaries or service provider
All of it's turnover is derived from the UK or other EU member countries.

WITH REGARD TO CLAIMS AGAINST THE APPLICANT THE APPLICANT CAN CONFIRM THAT
The Applicant, or its Directors, Officers or Managers, are not aware of any claim(s) that have been made in the past or any circumstance(s) that could give rise to a claim being made in the future, against the Applicant Company, or its Directors, Officers or Managers involving the following:
• its employees (including but not limited to Employment Tribunals)
• its customers
• its shareholders
• its former or current Directors or Shareholders
• Government authorities; e.g. HM Revenue & Customs, Department of Trade and Industry
• accountants, liquidators or receivers
or, any other person or entity not mentioned above.
This is regardless of whether or not the claim(s) or, circumstance(s) has been notified to the Applicant's current or previous Insurer.

IN RESPECT OF THE APPLICANTS EMPLOYEES THE APPLICANT CAN CONFIRM THAT
All it's employees* are based in the UK.
None of it's employees* are permanently based in the London postcodes EC or WC.
It's total annual wages divided by it's total number of employees* is £50,000 or less.
It's total number of employees* is not expected to exceed 100 in the next 12 months.
All it's existing and new employees* have a signed contract of employment.
It has a written grievance procedure in place which is communicated to all employees*.
It is not currently undergoing or contemplating any involuntary redundancies or terminations.
None of it's employees* is engaged in any activities involving news, media or broadcasting, private members clubs, night clubs, bars, doctors surgeries, cosmetic surgeries, or dental practices.
*Employees includes part time and seasonal workers

WARRANTY STATEMENT
All material facts must be disclosed, including any which might arise or change prior to the inception date of any contract of insurance based on the information provided. Failure to do so may cause the contract of insurance to be void. A material fact is one likely to influence acceptance or assessment by Insurers. If the applicant is in any doubt as to what constitutes a material fact they should consult their insurance adviser.

DATA PROTECTION
By completing this electronic Application Form the Applicant consents to the Insurer or its representatives using the information Insurers may hold about the Applicant for the purpose of providing insurance and handling claims and to process sensitive personal data about the Insured where this is necessary, in compliance with the Data Protection Act 1998. This may necessitate providing such information to third parties.

2. Starter Directors & Officers Liability Statements of fact

Company Information - THE APPLICANT CAN CONFIRM THAT

Its shares (if any) are privately held (i.e. not publicly traded on any stock exchange) and are expected to remain so for the next 18 months.
Its annual financial statements are not overdue to Companies House.
Its annual financial statements have been prepared by a qualified accountant and are less than 18 months old.

Loss Experience - THE APPLICANT CAN CONFIRM THAT

It, or its Directors, Officers or Managers, are not aware of any claim(s) that have been made in the past, or any circumstance(s) that could give rise to a claim being made in the future, against the Applicant, or its Directors, Officers or Managers involving the following:
its employees
its customers
its shareholders
its former or current Directors or Shareholders
Government authorities; e.g. HM Revenue & Customs, Department of Trade and Industry
accountants, liquidators or receivers
or, any other person or entity not mentioned above

This is regardless of whether or not the claim(s) or, circumstance(s) has been notified to the Applicant's current or previous Insurer.

No business(es) or other activities under its past, present or planned future management or ownership involve any involvement in Aviation, Banking, Telecommunications, National or Local Government or as an Insurance Company (rather than merely an intermediary or service provider).

Material Facts Warranty - WARRANTY STATEMENT

All material facts must be disclosed, including any which might arise or change prior to the inception date of any contract of insurance based on the information provided. Failure to do so may cause the contract of insurance to be void. A material fact is one likely to influence acceptance or assessment by Insurers. If the applicant is in any doubt as to what constitutes a material fact they should consult their insurance adviser.

DATA PROTECTION

By completing this electronic Application Form the Applicant consents to the Insurer or its representatives using the information Insurers may hold about the Applicant for the purpose of providing insurance and handling claims and to process sensitive personal data about the Insured where this is necessary, in compliance with the Data Protection Act 1998. This may necessitate providing such information to third parties.

1. D&O and Corporate Liability Statements of fact

2. Starter Directors & Officers Liability Statements of fact

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