Fields marked with an * are required

Please carefully review the Statement of Fact below and advise if you do not agree with ALL of the statements:

  1. You have you been trading for at least 12 months and made a profit (that is, a net profit after tax) in the last 12 months
  2. You have not made any redundancies in the last 6 months and do not plan to make any redundancies in the next 12 months
  3. There have been no: merger; TUPE arrangements; change of ownership; acquisitions; and/or disposals of any company(ies) in the last 12 months and none are planned in the next 12 months
  4. You are not regulated by the Financial Conduct Authority
  5. You do not have assets in the United States of America (USA) and your turnover or income does not include any turnover or income from the USA
  6. Your latest report and accounts to Companies House were submitted within the required statutory time frame, with an unqualified auditor's report (clean report)
  7. You reported a positive net worth in your last completed financial year and will, in the forthcoming 12 months be able to pay debts as they fall due
  8. In the last 5 years, there have been no claims or investigations made against you, or against any directors, trustees, officers or employees, that this policy might have covered if it had been in force – force – including, but not limited to, Shareholder Disputes, HSE Fee For Intervention etc
  9.  After full enquiry, neither you or any of your directors, trustees, officers or employees are aware of any fact or circumstance that may lead to a claim under the proposed policy
  10.  In respect of Fidelity cover - if cover is required:
    • Other than directors, all duties are segregated so that dual controls exist on signing cheques above £2,500 and issuing instructions for disbursement of assets or funds
  11. In respect of Employment Practices Liability - if cover is required:
    • You use external Human Resources consultants or legal advisers to review all employment terminations
    • You communicate written employment and grievance policies to all new and existing employees
    • There have been no Employment Tribunals in the past 5 years
  12. All Material Facts have been disclosed