Mortgage & General Insurance Brokers Professional Indemnity
Proposal Form
Once completed please return this form to:
Scott Clay (CeMAP, CeFA)
If you would like to discuss Professional Indemnity Insurance prior to completing this form,
please contact Scott who will be happy to answer any questions. The more information you
can provide about your business, the better. A former mortgage broker who is CeMAP
qualified and has worked in the mortgage industry, Scott has a deep understanding for the
work of Mortgage Brokers and the industry at large. Scott regularly provides commentary in
industry press and trade journals.
Email
[email protected]
Tel:
Post
Broadstone Mill, Broadstone Road, Stockport, Cheshire, SK5 7DL
0161 348 7390
If you have any questions whilst completing this form, please contact us anytime.
ABOUT US:
Profile PI is a specialist intermediary for Mortgage Brokers Professional Indemnity Insurance. We offer cover which is compliant
with FCA regulations for Mortgage Brokers on behalf of underwriters and offer A+ (Superior) A M Best Rated security.
ADDITIONAL COVER:
Profile PI can also quote for:


Commercial Combined Insurance: (Employers Liability, Public Liability & Office Insurance)
Estate & Letting Agents: Combined Commercial Insurance Scheme
To download a proposal form please visit: www.profilepi.co.uk
IMPORTANT NOTICE:
The Insurance Act 2015 requires that you make a fair presentation of your risk.
The questions in this proposal are designed to guide you so that you know what information we are likely to need when your risk is
underwritten. It is not an exhaustive questionnaire and cannot cater for every possible combination of circumstances. Where we have
not asked a direct question about a business activity that you undertake, which is relevant to this insurance, then providing you give us
sufficient information so that we can make further enquiries of you then the information you have provided to us will still represent a
fair presentation of your risk.
Mortgage & GI Proposal Form v2 9.1.17
ABOUT YOU / YOUR FIRM
Name of Firm / Individual:
Trading Address:
Post Code:
Date Firm Established:
Company Status:
Is this a New Start-up Business?
☐ Yes
☐ No
CONTACT DETAILS
Key Contact Person:
Title:
Telephone:
Mobile:
Fax:
Website:
Email:
BUSINESS STRUCTURE
Please state the total number (including part time staff) of:
Directors / Partners
Number of Self Employed Advisers
Admin / Other
Advisers / Sales Consultants
Number of staff NOT permanently based at main
office address (if any)
Number of Appointed Representatives (if any)
Registered Introducers
Which case tracking system do you use?
Please provide names of any other businesses including AR’s for which cover is required under this policy:
Click here to enter text.
FINANCIAL CONDUCT AUTHORITY (FCA)
Please provide your FCA Firm Reference Number:
(please insert TBA if you are currently applying for authorisation)
Please confirm you are directly authorised by the FCA
Appointed Representative
Appointed Representative (if applied to leave please provide details below)
☐ Yes
☐ Yes
☐ Yes
☐ No
☐ No
☐ No
☐ Yes
☐ Yes
☐ Yes
☐ No
☐ No
☐ No
Please state name of Network or Principal
Mortgage Packager
Not Currently Authorised / Other
Please confirm all Directors / Partners have over 3 years’ experience
Please provide additional information here:
Click here to enter additional information.
Mortgage & GI Proposal Form v2 9.1.17
FINANCIALS AND WORK SPLIT
Last Complete Financial Year
Past
Present
Estimate
Please state your firms GROSS INCOME for the following years
£
£
£
Please confirm your firms GROSS INCOME is 100% UK
☐ Yes
☐ No
Please provide an approximate percentage split of your income for the following activities for the last complete business year:
Full Status Regulated Mortgages
Interest Only Mortgages
Sub-Prime Mortgages
Self-Certification Mortgages
Secured Loans
Unsecured Loans
Buy-to-Let Mortgages
Islamic / Faith Compliance Mortgages
Commercial Mortgages (please also supply largest/average below)
Pure Protection (i.e. life, critical illness, income protection)
Residential Buildings & Contents (i.e. home cover)
Commercial Insurance (i.e. insurance for businesses – please provide details below)
Equity Release
Lifetime Mortgages
Packager Mortgages
Referral Income (please provide details below)
Other (please provide details below)
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
%
Click here to enter additional information
GENERAL QUESTIONS
a)
Has any employee, or authorised representative ever been convicted, or have any prosecutions
pending, or been given an official police caution in respect of fraud or dishonesty?
☐ Yes
☐ No
b)
Does the business operate as a Network Principal?
☐ Yes
☐ No
c)
Does the business, or its appointed representatives, operate any delegated or binding authority on
behalf of mortgage lenders, insurers or any other business?
☐ Yes
☐ No
d)
In respect of mortgage and secured lending only, does the business hold client money or assets?
☐ Yes
☐ No
Is it your practice to always provide key fact illustrations that are clear and comprehensive and to
retain these on your file for at least six years?
Do you always ensure that your clients are fully and clearly informed as to the risks and suitability of
any mortgage product you transact on their behalf?
In respect of Interest Only mortgages, do you always ensure that the client is aware of the need for a
repayment vehicle and can you confirm that this information is always recorded in writing and
retained on file?
Have any mortgages been arranged on behalf of any client with terms that extend past the client’s
planned retirement age?
If YES to above:

Can you confirm both client and lender are aware mortgages extends into clients
retirement?
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
☐ Yes
☐ Yes
☐ No
☐ No
☐ Yes
☐ No
☐ Yes
☐ No
e)
f)
g)
h)
i)
j)

Can you confirm the affordability has been assessed?

Can you confirm this is not a pension mortgage?
Are all recommended providers of Equity Release / Home Reversion / Home Income Plans members
of SHIP Ltd (Safe Home Income Plans)?
Can you confirm all Commercial Mortgage advice / sales (other than Buy-To-Let) are conducted in
accordance with the National Association of Commercial Finance Brokers (NACFB) regulations and
files are kept in similar manner to regulated business?
Mortgage & GI Proposal Form v2 9.1.17
k)
If you have ever transacted Commercial Mortgages, have any of these ever been over
£500,000?
☐ Yes
☐ No
l)
Is all mortgage business placed with UK lenders and secured on UK properties?
☐ Yes
☐ No
m)
Do you regularly audit mortgage advisors from all offices for whom you are responsible to ensure
compliance with regulatory requirements governing the sale and arrangement of mortgages?
☐ Yes
☐ No
n)
Do you have any financial association to any estate agency practice?
☐ Yes
☐ No
o)
During the last 5 years, have you had any Claims, or Circumstances which may give rise to a claim,
against the business principal, or partners, or directors or employee, or appointed representatives, or
predecessor in the business in respect of the type of liabilities to which this proposal relates?
☐ Yes
☐ No
PI INSURANCE REQUIREMENTS
Please select the Limit of Indemnity you require. All limits of indemnity below are sufficient for mortgage advisers and meet minimum FCA
requirements. However, please note if you undertake insurance intermediation you must select £1.75m coverage to comply with the FCA
regulations as a minimum.
Suitable for Mortgage Brokers only
Suitable for Mortgage, Pure Protection
& General Insurance Brokers
£500,000 in the aggregate
☐
£1,000,000 in the aggregate
☐
£1,750,000 in the aggregate
☐
EXISTING PI INSURANCE
How many years have you held continuous PI cover?
If not applicable, enter N/A
Please provide details of your current insurer (if applicable):
Name of Insurer
Limit of Indemnity
£
Excess
£
Retro-active date (if known)
Renewal Date (date existing cover expires)
Annual Premium
£
DATA PROTECTION:
By signing this proposal form you consent to Gamstad No.1 t/a Profile PI using the information we hold about you for the purposes of
providing insurance contracts and where appropriate, assistance in relation to handling claims, if any, and to process sensitive personal
data about you where this is necessary. This may mean that we have to give some details to third parties involved in providing insurance
cover. These third parties may include insurance carriers, third party claims adjusters, fraud detection and prevention service, reinsurance
companies and regulatory authorities. In the course of performing our obligations to you, this information may be disclosed to agents or
service providers appointed by us, insurers (including their reinsurers, legal advisers, loss adjusters or agents). Where such information
relates to anyone other than you, you must obtain explicit consent of the person to whom the information relates both to the disclosure
of such information to us and by its use by us as set out above. The information provided will be treated in the strictest confidence and
where relevant, in compliance with the Data Protection Act 1998. You have the right to apply for a copy of your information (for which we
may charge a small fee) and to have any inaccuracies corrected.
Mortgage & GI Proposal Form v2 9.1.17
DECLARATION:
I / We hereby warrant that all advice has been / is / will be given in strict accordance with the terms & provisions of the Financial
Conduct Authority and where appropriate any prior regulator(s). I / We also warrant that if cover is required for non-regulated products
I / We operate good practice and compliance procedures for non-regulated products similar to that for regulated products when providing
advice and throughout the sales process.
I / We declare that I / We have answered this questionnaire honestly and to the best of my / our knowledge and after full enquiry of all
Principals, Partners, Directors, Employees, Consultants and Appointed Representatives, I / We declare that I / We are not aware of any
circumstance or matter that may give rise to a claim.
I / We declare that I / We have not withheld any material information that would affect the underwriters judgment of this insurance and
I / We undertake to inform Gamstad No.1 Ltd t/as Profile PI of any material alteration to these facts occurring before the completion of the
contract of insurance.
I / We declare that I / We have never:
a)
b)
c)
d)
e)
Been declared bankrupt
Been disqualified from being a company director
Been convicted, or have any prosecutions pending, or been given an official caution in respect of fraud or dishonesty
Had a company go into liquidation or become insolvent
Had any insurance proposal declined, renewal refused, had special or increased terms applied or had insurance cancelled or
avoided by underwriters
I / We agree that this proposal together with any other supporting information supplied by us shall form the basis of any contract of
insurance effected thereon.
Signing this proposal form does not bind the proposing entity or Gamstad No.1 Ltd t/as Profile PI to complete this Insurance.
Full Name:
Position:
Signature:
Date:
Mortgage & GI Proposal Form v2 9.1.17