MANAGEMENT LIABILITY INSURANCE APPLICATION

Revenue Details

 Total Annual Revenue $

Employee Numbers

                                                           
Please state the total number of employees including self: Yes  No
Do you have written employment practices procedures that are available to each employee?

PLEASE NOTE: EPL DEDUCTIBLE OF $25,000 WILL APPLY

Main Business Activity


In respect of income earned for the current financial year, please provide a breakdown by State:
NSW ACT QLD VIC TAS SA WA NT Overseas
% % % % % % % % %    Total must be 100%   %

Crime / Fidelity Controls

 		Yes No N/A
1) Are countersignatures required on all cheques?
2) Are dual authorities required for all funds transfers?
3) Is dual authorisation required for any changes to your master creditors list?
4) Is an inventory check undertaken and reconciled by a person who does not participate in the inventory check?

Social Engineering Fraud

Yes No
1) Do you verify new customer or supplier bank account information (including name, address and bank account number) prior to initiating any financial transaction with such supplier or customer?
2) Do you have callback procedures with customers or suppliers to authenticate any fund transfer instructions greater than $50,000 prior to transfer?
3) Do you upon receipt of any email requests to change supplier or customer bank account details (including account number, email address, contact information, bank routing number) have direct callback procedures in place (i.e. other than responding via email) to the contact phone number in place prior to receipt of the change request?

Promotional Code (if relevant):