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IITP

Recruitment Liability Application

LET'S GET TO KNOW YOU

Name of Recruitment Agency

Contact Person completing this Declaration

Your Email Address

Postal 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?

Yes

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?

Yes

Please submit a copy of the contract/s applicable

CONFESSION TIME

Are you aware of any circumstances (prior or pending) that could eventuate into a claim against an employee or the company?

Yes

Please Explain

Have you had any past claims or disputes in fees?

Yes

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.

Accepted