INSURED DETAILS
Proposer(s), please list all legal entities to be Insured
ABN(s):
Trading Name:
Postal Address:
Street Address(s):
Contact Name: Phone:
Facsimile: Mobile :
Email Address:
Web Site:
Date firm established:
Are you, or the firm, or principal of the firm, a current member of the API and/or REI? YES NO
Are the Directors or Principals Licensed Valuers and/or Real Estate Agents? YES NO

PARTNERS / PRINCIPALS / DIRECTORS EXPERIENCE

Name/s

Qualifications and/or Licenses

Date Qualification License or Obtained

Years at this firm

Years at previous firm

Total Experience


DIRECTORS, STAFF & CONTRACTORS
TYPE NUMBER

NOTE: If you wish to ensure the liabilities of contractors and/or sub-contractors they must be named as a proposer in Question 1.

Partners, Principals, Directors
Sales Staff
Contractors, Sub contractors etc.
Property Management Staff  
Office, Administration Staff  
TOTAL  

STAMP DUTY SPLIT
For the purposes of calculating Stamp Duty as it is different in each State, please state the number of current staff (including directors/partners, full-time, part-time and casual employees) located in each State.

NSW

VIC

QLD

SA

WA

TAS

ACT

NT

TOTAL


BUSINESS ACTIVITIES
Please state the amount of Gross Fee Income earned in the last 12 months:
REAL ESTATE ACTIVITIES
Sales – Residential / Rural $
Sales – Commercial / Industrial $
Property Management – Residential $
Property Management – Commercial / Industrial $
Commerical Leasing $
Strata Title Management – Residential $
Strata Title Management – Commercial $
Stock & Station Agents $
Auctioneering $
Business Sales / Business Broking $
Insurance Agency $
Other (please describe): $
This Financial Year - TOTAL $
Estimate Next Financial Year - TOTAL $
Actual Previous Financial Year - TOTAL $
 
VALUATION ACTIVITIES
Residential $
Commercial / Industrial $
Tourism $
Rural $
Asset / GST / Stamp Duty $
Government $
Strata Title $
Municipal $
Plant & Equipment $
Hotels / Licensed Premises $
Issuance of Prospectus' $
Other (please describe): $
This Financial Year - TOTAL $
Estimate Next Financial Year - TOTAL $
Actual Previous Financial Year - TOTAL $

MORTGAGE VALUATION WORK
Please state the percentage of valuations conducted for mortgage purposes %
Please provide a percentage breakdown of the following lender types for whom you conduct mortgage valuations: Banks / Building Societies / Credit Unions %
Solicitor Lenders %
Private Lenders %
Other %

VALUATION VALUES OF THE INSURED
Of the valuations conducted, please state the following:
Average value of all properties valued over the last 12 months $

Maximum value of any properties valued in the last 36 months

 $

Type (e.g. Residential / Commercial etc):
Purpose (e.g. Mortgage / Asset / Stamp Duty etc):
If any valuations conducted in the last 12 months exceed $2mil please complete the attached addendum.

REAL ESTATE AGENCY QUESTIONS

Do you sell “off the plan” residential property in buildings of 4 storey or more?

 YES NO
If YES, please provide full details including relevant brochures / additional information regarding off the plan sales.

How many Residential Properties do you manage?

How many Commercial / Industrial Properties do you manage?

How many Strata Title Properties do you manage?
Are there more than 10 shops managed in any one retail shopping centre? YES NO

RISK MANAGEMENT PROCEDURES
Do the Directors / Partners and qualified employees of the insured regularly attend continuing education programmes conducted by the API and/or REI? YES NO

Does the proposer provide Property Management and/or Strata Title Management services?
(If YES , complete next two questions)

 YES NO
Do you use the standard Property Management and/or Strata Title Management agreements as recommended by the Real Estate Institute? YES NO
If NO, please provide a copy of your Property Management Agreement for review and approval
Do you maintain a Complaints / Repairs Register to record all reports it received about problems with the properties the insured is managing? YES NO
Do you engage Contractors and/or Sub-contractors? YES NO
If YES, Do you ensure that they carry their own Public Liability Insurance YES NO
Do you always request that landlords obtain Public Liability Insurance for properties that you manage? YES NO
If NO , Why not?  

CLAIMS / CIRCUMSTANCES DETAILS
Failure to provide this information may result in lengthy delays in obtaining a quotation.
Have ANY claims EVER been made against You, the Proponent, or any of your present Partners, Principals, Staff, and/or Sales Representatives or your predecessors in business or former Partners or Principals? YES NO
Have these claims been advised to an insurer? YES NO
If NO, please advise why?  
Have you, the proponent, or any present or former Partners, Principals, Staff and/or Sales Representatives ever been the subject of any investigation or inquiry or on behalf of any industry, regulatory or investigatory body? YES NO
Are You, the Proponent, or any present or former Partners, Principals, Staff and/or Sales Representatives aware of any circumstance(s) that could give rise to any claims? YES NO
Has any insurer ever declined, cancelled or imposed special conditions in relation to Professional Indemnity Insurance? YES NO

INSURANCE DETAILS
BROKER INSURER SUM INSURED EXCESS DUE DATE PREMIUM

COVER REQUIRED
$1,000,000 $2,000,000 $5,000,000 $10,000,000 Automatic Reinstatement

OTHER INSURANCES

Do you require cover for other MANAGEMENT LIABILITIES such as:
a) Employment related liability - covers claims for Sexual Harassment, Unfair Dismissal etc
b) Directors & Officers liability - covers the personal liabilities of the Directors against breach of State Real Estate Legislation etc
c) Fidelity Guarantee - covers the misappropriation of Money or Property by employees, e.g. Trust & Trading Accounts

 YES NO

Do you require cover for BUSINESS PROPERTY & LIABILITY?
(This covers your office equipment against Fire & Perils, Burglary, Accidental Damage, Liability and many more)

 YES NO

CLAIMS and CIRCUMSTANCE
Please complete this form for each matter referred to on the proposal form. If there is sufficient space, please attach further information on a sheet of your letterhead. If more than one matter, copy this form as required before proceeding.
1. Date the circumstance was notified
2. Name of Insurer (if any)
3. Name of Claimant or Potential Claimant
4. Brief Description of the circumstance
5. Amount Paid or Estimated / Potential Liability
6. Is the matter finalised or outstanding

BUSINESS SALES / BROKER ADDENDUM
(1.) Number of Business sold in the last 12 months?
(2.) Average Sale Price?
(3.) Largest Sale Price?
(4.) Specialty of Business sold
(5.) Do you ensure that the business sold secure their own independent valuation YES NO
(6.) Are any Financial forecasts prepared for the business being sold? YES NO
(7.) Do you value any Plant & Machinery and if so is this undertaken by an external contractor? YES NO

NOTICE TO PROPOSED INSURED
(Pursuant to the Insurance Contracts Act 1984)

1. DISCLOSURE OF RELEVANT FACTS

YOUR DUTY OF DISCLOSURE

Before you enter into a contract of general insurance with an insurer, you have a duty, under the Insurance Contracts Act of 1984, to disclose to the insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk of the insurance and if so, on what terms.
You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance. Your duty however does not require disclosure of any matter:

  • that diminishes the risk to be undertaken by the insurer;
  • this is of common knowledge;
  • that your insurer knows or, in the ordinary course of business, ought to know;
  • as to which compliance with your duty is waived by the insurer.

NON-DISCLOSURE

If you fail to comply with your Duty of Disclosure, the insurer may be entitled to reduce its liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning.

(COMMENT - The requirement of full and frank disclosure of anything which may be material to the risk for which you seek cover (e.g.: claims, whether founded or unfounded), or to the magnitude of the risk, is of the utmost importance with this type of insurance. It is better to err on the side of caution by disclosing anything which might conceivably influence the insurer’s consideration of your proposal. )

2. CLAIMS MADE POLICY
This policy is a “claims made” policy of insurance. This means that the policy covers you for claims made against you and notified to the insurer during the period of cover. The policy does not provide cover in relation to:

  • events that occurred prior to the retroactive date, if any, specified in the Policy;
  • claims made after expiry of the period of cover even though the event giving rise to the claim may have occurred during the period of cover;
  • claims notified or arising out of circumstances notified, or which ought to have been notified, under any previous policy;
  • claims made, threatened or intimated against you prior to the commencement of the period of cover;
  • facts or circumstances which you became aware of prior to the period of cover and which you knew or ought reasonably to have known had to potential to give rise to a claim under this policy.
  • claims made against you prior to commencement of the period of cover
  • claims arising out of claims and circumstances noted on the proposal form for the current period of cover or on any previous proposal form

However, where you give notice in writing to the insurer of facts that might give rise to a claim against you as soon as reasonably practicable after you become aware of those facts but before expiry of the period of cover, the policy will, subject to its terms and conditions, cover you notwithstanding that a claim is only made after expiry of the period of cover.

AVERAGE PROVISION

The policy provides that if a payment in excess of the limit of indemnity available under the policy has to be made to dispose of a claim, the insurer’s liability for costs and expenses incurred with its consent shall be such proportion thereof as the amount of indemnity available under this policy bears to the amount paid to dispose of the claim.

DECLARATION

We declare we have made all necessary enquiries into the accuracy of the responses given in this proposal and confirm the statements and particulars given in this proposal are true and complete and that no material facts have been omitted, misstated or suppressed. We agree that should any of the information given by us alter between the date of this proposal and the commencement of the insurance to which the proposal related, we will give immediate notice thereof to the insurer. We acknowledge receipt of the “Notice to the Proposed Insured” contained in this proposal and that we have read and understood the contents of that notice. I confirm that I am authorised by the insured to complete, sign and submit this proposal on behalf of the insured.

I/We the undersigned have read and I understand this Duty of Disclosure & Declaration

Signature of Director/Principal   _____________________________     Date _________________

VALUERS - ADDENDUM
This is required for all valuations conducted in excess of $2million in the last 12 months

Please provide details for all valuations in excess of $ 2million:

Please advise which individual/s undertook the valuation/s and confirm their relevant experience:

When was the valuation/s undertaken?

What was the purpose/s of the valuation?

What was the value/s involved?

Please nominate the sold properties and their selling prices.

What was the type and purpose of the buildings involved?
Has the file been revisited since the valuation/s took place? YES NO

SIGNATURE OF DIRECTOR / APPLICANT DATE
NAME OF FIRM: