Anchorman Insurance Consultants Limited

ILM Scheme
Anchorman House
19 East Street
Okehampton
Devon
EX20 1AT

Telephone:
01837 65 00 30

Fax:
01837 55277

Email:
> click here

GET AN INSTANT QUOTE

Insurance proposal form for Members of the Institute of Leadership and Management

Please complete the following short proposal form which will automatically generate your quotation. Assuming that our quotation is acceptable to you and you wish to proceed with the insurance, simply submit the completed document to us with your payment instruction. You will receive an acknowledgement confirming that your application has been received and that temporary cover has been bound pending payment of the premium.

Section 1 - Your Details


Name (or trading title if a company):
Office Address:
Post Code:
Telephone:
Email:
Date Established: (dd/mm/yyyy)
Is your office address also your home address?		Yes No
Please provide your current ILM membership number:
Are you an Individual or Corporate member?		Individual Corporate
What were your total fees for your last complete financial year: (If you are newly established and/or have not yet traded for 12 months, please provide an estimate of fees for your current year.)		£
How many staff do you employ? (Include yourself if a Limited Company)
Please enter your total annual wageroll (Include yourself if a Limited Company)		£
Please indicate which of the following descriptions most accurately reflects your business activities:
Assessment and/or verification of ILM courses, exams and accreditation centres
Coaching or Mentoring
Health & Safety Training/Consultancy
Human Resources
Leadership, Management or Business Coaching
Management Training
Organisational Development
Training & Development
Other
If you have checked OTHER we regret that we are unable to offer you a quotation at this time. However, we may still be able to offer you a competitive quotation. Please telephone us on 01837 650030.
Do you have less than 3 years experience in the business activities identified above?		Yes No
Are the premises from which you trade of non-standard construction? (i.e. built from materials other than brick, stone, slate and tile)		Yes No
Are more than 25% of your fees derived from work undertaken outside of the UK?		Yes No
In the last 3 years, have you had any claims or incidents which could give rise to a claim?		Yes No
Has any insurer ever:
i) Declined to offer insurance to you or any Partner, Principal or Director?		Yes No
ii) Imposed any special terms on your Company or any Partner, Principal or Director?		Yes No
iii) Cancelled or voided an insurance for you or any Partner, Principal or Director?		Yes No

Section 2 - Cover Required

The basic cover is for Professional Indemnity Insurance only. Please indicate the Limit of Indemnity which you require by checking the appropriate box. Once you have done this, please select which of the optional covers you require, again by checking the relevant boxes. Your Quotation will then be shown once you have confirmed your agreement to the Declaration by checking the box in Section 3.

PLEASE NOTE that Employer's Liability can only be taken with Public/Products Liability or as part of one of the Office Package Options


Professional Indemnity (Mandatory)	YES

Limit of Indemnity required	£ 250,000 £ 500,000 £ 1,000,000

OPTIONAL COVERS
i) Liability Only	No Separate Liability Cover Public / Products Liability Employer's & Public/Products Liability

ii) Office Package View Rating Table for options	Option 1 (including Liability Cover) Option 2 (including Liability Cover) Option 3 (including Liability Cover) None

iii) Legal Expenses	Yes No

Please enter the date from which cover is required (dd/mm/yy)
PLEASE NOTE: Cover cannot be backdated or have a commencement date which is more than 30 days in advance.

Section 3 - Declaration

Please use this space to provide additional information in support of the answers given within the proposal form or simply to provide further details about you or your activities which you feel would be of interest to us. Please clearly show the question number to which the information relates.

IMPORTANT NOTICE CONCERNING DISCLOSURE It is your duty to disclose all material facts to Underwriters. A material fact is one which may influence an Underwriter's judgement in the consideration of your proposal. If you are in any doubt as to whether a fact is material you should disclose it.

FAILURE TO DISCLOSE could prejudice your rights to recover in the event of a claim or allow Underwriters to void the policy

By checking this box, I/we confirm that I/we have read the Policy Summary. I/we further declare that the statements and particulars contained in the proposal are true and that I/we have not mis-stated or suppressed any material facts. l/we agree that this proposal together with any other information supplied by me/us shall form the basis of any contract of insurance effected thereon. I/we undertake to inform Underwriters of any material alteration to these facts occurring before completion of the contract of insurance.