This declaration must be accepted by at least one principal, partner or director of the Proposer (preferably the Managing Principal, Partner or Director). The completion of this declaration does not oblige the Proposer or any insurer to enter into a contract of insurance.

• I have made due inquiry of the Proposer and their principals, partners, directors, managers and appropriate staff members in respect of all questions in this proposal form and have the authority to sign this proposal form on their behalf.
• I declare that all statements and responses are true and accurate, and no fact or matter has been misstated, misrepresented or omitted.
• I agree that this proposal form and all additional information provided by me shall be incorporated into and shall form part of any contract of insurance.
• I acknowledge that until a contract of insurance is entered into, I must notify any material change to the facts and/ or matters disclosed in this proposal form.
• I/ we consent to:
  • the use of personal information about me/ us in accordance with the respective privacy policies of Chase Underwriting Solutions ; and
  • the disclosure of personal information in accordance with the respective privacy policies of Chase Underwriting Solutions.
  • If I have disclosed personal information about any other person, I confirm that I/ we are authorised to:
  • disclose to Chase Underwriting Solutions such personal information and consent to its use in accordance with the respective privacy policies of Chase Underwriting Solutions; and
  • the disclosure of such personal information in accordance with the respective privacy policies of Chase Underwriting Solutions.
• I confirm that:
  • No more than 40% of our services are provided outside of Australia;
  • We do not engage in any consulting relating to: insolvency; mergers & acquisitions; auditing of publicly listed companies; business valuations.

If you are applying for the NSW stamp duty exemption, you confirm the following:

You are a small business if you are an individual, partnership, company or trust that:

• Is carrying on a business, and
• The business has an Aggregated Turnover of less than $2 million.

Aggregated Turnover is your annual turnover plus the annual turnovers of any business entities that are your affiliates or are connected with you.

• After appropriate inquiry, has the Proposer, or any of their current or former principals, partners, directors or staff members, or any of the Proposer’s predecessors, or any prior practice of any present or former partners, principals, or directors ever been subject to disciplinary proceedings or action for any kind for professional misconduct?
• After appropriate inquiry, has the Proposer, or any of their current or former principals, partners, directors or staff members, or any of the Proposer’s predecessors, or any prior practice or business of any present or former partners, principals, or directors ever;
  • been subject to any claim made against them arising from any actual or alleged breach of professional duty, dishonesty or breach of any statutory provision?
  • notified any circumstance to an insurer that may give rise to such a claim?
• After appropriate inquiry, has the Proposer, or any of its current or former principals, partners, directors or staff members, or any of the Proposer’s predecessors, or any prior practice or business of any present or former partners, principals, or directors ever notified any claim or circumstance which may give rise to a claim under a previous Professional Indemnity insurance policy after such policy had expired?