Architeam Runoff Insurance

IMPORTANT NOTICE TO THE APPLICANT

ArchiTeam MEMBERSHIP DETAILS
Membership runs from 31 May until 31 May each year.
Annual Membership $308.00 (incl. GST)
Joining Fee $60.50 (incl. GST)
ArchiTeam Share $1 (one off payment)
All Applicants must be a registered Architect or graduate in Architecture or a registered practitioner in an allied profession.

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 insurance. The Policy does not provide cover in relation to:

events that occurred prior to the retroactive date, if any, specified in the Policy;
claims notified or arising out of circumstances notified under any previous policy (whether made or issued by the Insurer or any other insurer);
claims made against you prior to commencement of the period of insurance;
claims arising out of claims and circumstances noted on the proposal form for the current period of insurance or on any previous proposal form;
subject to what is said in the next paragraph, claims made after expiry of the period of insurance even though the event giving rise to the claim may have occurred during the period of insurance.

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 insurance, the policy will, subject to its terms and conditions, cover you notwithstanding that a claim is only made after expiry of the period of insurance.

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 1984, to disclose to the insurer every matter which 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 us before you renew, extend, vary or reinstate a contract of insurance.

Your duty however does not require disclosure of a matter:

that diminishes the risk to be undertaken by the insurer
that is common knowledge
that the insurer knows or, in the ordinary course of business as an insurer, 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 it’s beginning.

1. Applicant Details

Membership Number*

Are you a....*

Sole Trader
Company
Partnership

Full legal name of each current incorporated company, unincorporated business, trading name or entity to be insured:

Sole Trader Principals Name*

Company Name*

Partnership Business Name*

Commencement date of business*

ABN/ACN

Additional Company Details

Tick to add Company

Company Name*

Commencement date of business*

ABN/ACN

Registered architect/s to appear on the Certificate of Currency

Business Name (If you want included on Certificate of currency

Registered ArchItect Name*

Additional Registered Architect Name

2. Main Contact Person Details

Contact Name (PLEASE ALSO INCLUDE IN SECTION 4 IF PARTNER/DIRECTOR)*

Phone*

Mobile*

Contact Email*

Website

Fax

Office Street Address*

Suburb*

State*

Postcode*

3. Staff

Number of principal(s)/partner(s)/director(s):

Total Staff (Including principals, partners, directors)*

4. Details of Principal(s)/Partner(s)/Director(s)

Name of Principal/ Director/Partner*

Age*

Architect Registration Number*

Email*

Phone Number*

Name of Principal/ Director/Partner*

Age*

Architect Registration Number*

Email*

Phone Number*

Name of Principal/ Director/Partner*

Age*

Architect Registration Number*

Email*

Phone Number*

Name of Principal/ Director/Partner*

Age*

Architect Registration Number*

Email*

Phone Number*

Please Note: To be covered all Principal(s)/Partner(s)/Director(s) need to be current members of Architeam.

5. Retirement / Non Practicing details:

I confirm that as a retired / non practicing architect I do not undertake any work whatsoever as an architect and/or practicing under my own business and that the professional indemnity policy does not cover me for any current work as an architect under my own registered business name during the policy period. If my application is accepted I will be covered by the policy only for all past work, that is, all work conducted prior to the date that I ceased to practice as an architect and/or under my own business.*

Yes
No

I confirm that I am listed as a ‘retired/non practicing’ architect with the relevant registration board*

Yes
No

Please confirm the year that you went into retirement / ceased practicing under my business name.*

Retired members and members who cease trading under registered business name, who held insurance through ArchiTeam for three consecutive years prior to retiring are eligible for the special ArchiTeam Run Off Cover.

I confirm that I have held insurance through ArchiTeam at least for the past 3 consecutive years.*

Yes
No

Please provide details for the practice turnover for the last two years prior to retirement / business ceased operation was:

Last Year:*

Last Year Income AUD$

Second Last Year:*

Second Last Year Income AUD$

Is your practice continuing to trade*

Yes
No

Please confirm the date that you resigned as director and attach resignation letter*

Are you aware of being involved in/working on any projects where Aluminium Composite Panelling (ACP) was installed?*

Yes
No

Name and Address of Project

Your Role

Total Contract Value ($)

Cost of Cladding Component ($)

Additional details..

Tick to add additional ACP project

Name and Address of Project

Your Role

Total Contract Value ($)

Cost of Cladding Component ($)

Additional details..

Tick to add additional ACP project

Name and Address of Project

Your Role

Total Contract Value ($)

Cost of Cladding Component ($)

For any additional projects with ACP please complete using seperate document and attach pdf here.

Drop files here or

6. Risk Management

Did the applicant use a standard agreement or form of contract outlining your terms of engagement?*

Note: ArchiTeam can provide a legally reviewed and formatted Client Architect Agreement, alternatively you must have your own agreement or contract legally reviewed at your own cost.

Yes
No

When acting as the lead architect (under this business name) please state the value of the largest project undertaken in the last five years ($)*

7. Claims History

Has any Principal or staff member ever been subject to disciplinary proceedings for professional misconduct?*

Yes
No

Please provide details:*

During the past 10 years has any Claim been made, or has negligence been alleged, against any entity or individual to be insured by this insurance (including any prior corporate entity and any of the present or former Principals), or have any circumstances which may give rise to a claim against any of these been notified to insurers?*

Yes
No

Name of Claimant or Potential Claimant*

Name of Insurer*

Date*

Description of Problem*

Amount Paid or Outstanding ($)*

Finalised or Outstanding*

Additional details..

Tick to add additional details

Name of Claimant or Potential Claimant*

Name of Insurer*

Date*

Description of Problem*

Amount Paid or Outstanding ($)*

Finalised or Outstanding*

Additional details..

Tick to add additional details

Name of Claimant or Potential Claimant*

Name of Insurer*

Date*

Description of Problem*

Amount Paid or Outstanding ($)*

Finalised or Outstanding*

Are there any circumstances not already notified to insurers which may give rise to a Claim against any entity or individual to be insured by this insurance (including any prior corporate entity and any of the present or former Principals).*

Yes
No

Name of Claimant or Potential Claimant*

Name of Insurer*

Date*

Description of Problem*

Amount Paid or Outstanding ($)*

Finalised or Outstanding*

Additional details..

Tick to add additional details

Name of Claimant or Potential Claimant*

Name of Insurer*

Date*

Description of Problem*

Amount Paid or Outstanding ($)*

Finalised or Outstanding*

Additional details..

Tick to add additional details

Name of Claimant or Potential Claimant*

Name of Insurer*

Date*

Description of Problem*

Amount Paid or Outstanding ($)*

Finalised or Outstanding*

8. Insurance History

Has the applicant or any proposed person or entity ever had a professional indemnity insurer:

Decline a proposal?*

Yes
No

Impose special or unusual terms?*

Yes
No

Declined to continue your insurance/offer renewal terms?*

Yes
No

Cancel a professional indemnity insurance policy?*

Yes
No

Please provide details:*

9. Any Additional Information you Wish to Provide

Is there any additional information you wish to provide*

Yes
No

Use as much space as required)*

10. DECLARATION

I/We declare and acknowledge that:

I/we have made due inquiry of our principals, partners, directors and employees concerning the questions asked within this proposal and have authority to sign this proposal on their behalf;
I/we have read and understood the Important Information of this proposal;
the statements and particulars in this proposal are true and correct;
this proposal along with any other information supplied by me/us shall form the basis of any policy entered into;
I/we understand that up until the policy is entered into, we must notify any change in the matters disclosed in this proposal; and
I/we will notify any material alteration to the matters disclosed in this proposal occurring after completion of the proposal.

You must agree to the form to proceed*

Agreeing to the form does not bind the practice or Insurers to complete the insurance.

I AGREE

Please be patient when clicking SUBMIT. It may take up to 10 seconds to process.

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Joining Fee

Joining Fee Total

Next 12 Months Total

Last 12 Months Total

Partners 2

Partners 3

Partners 4

Paid

Membership Total

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Insurance Price

Total Due

Total Due New Member

Total Above 3 stories

Professional Indemnity Proposal Form for run off cover

IMPORTANT NOTICE TO THE APPLICANT

1. Applicant Details

2. Main Contact Person Details

3. Staff

4. Details of Principal(s)/Partner(s)/Director(s)

5. Retirement / Non Practicing details:

6. Risk Management

7. Claims History

8. Insurance History

9. Any Additional Information you Wish to Provide

10. DECLARATION

Please be patient when clicking SUBMIT. It may take up to 10 seconds to process.

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