i2i Insurance Brokers
Recruitment Liability Application
LET'S GET TO KNOW YOU
Name of Recruitment Agency
Contact Person completing this Declaration
Your Email Address
Best Contact Number
When do you want this cover to start?
Number of Recruitment Consultants
Annual Turnover for the last 12 months is:
Do you operate outside of New Zealand?
Please advise where, how many offices and how many staff are 'on ground' at each overseas location
RIGHTO, WHAT DO YOU NEED?
Professional Indemnity is Compulsory under this programme. Please advise the Limit required
Public Liability is Compulsory under this programe. Please advise the Limit required
Please select the following complimentary covers
Just Professional Indemnity and Public Liability thanks
$500,000 Employers Liability, $500,000 Statutory Liability, $500,000 Directors and Officers Liability
$1,000,000 Employers Liability, $1,000,000 Statutory Liability, $1,000,000 Directors and Officers Liability
$500,000 Statutory Liability and $1,000,000 Directors and Officers Liability
$1,000,000 Statutory Liability and $1,000,000 Directors and Officers Liability
Have you entered into any contracts that indemnify or hold harmless your clients?
Please submit a copy of the contract/s applicable
Are you aware of any circumstances (prior or pending) that could eventuate into a claim against an employee or the company?
Have you had any past claims or disputes in fees?
Please advise when it happened, what happened and how much it was
I/We agree and accept that I/We declare and warrant that the information I/We have provided in this application is correct, truthful and complete; and that this application will form the basis of the contract between me and the Insurer.
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