SECTION 4 Insurance/claims history – Are you currently insured against the risks covered by ITIC? Yes No If answer the following. (If please give details of most “Yes”, “No” recent insurance) Name of insurer Limit of indemnity Excess/Deductible Premium Expiry date Retroactive date Has any insurer Declined to insure you Yes No Cancelled your insurance Yes No Refused to renew your insurance Yes No Imposed penalties or special terms Yes No If please give details: “Yes” Have any claims for professional negligence, successful or not, ever Yes No been made against your company or its present Directors? If please give details: “Yes”
SECTION 4 – Insurance/claims history Are you currently insured against the risks covered by ITIC? If “Yes”, answer the following. (If “No” please give details of most recent insurance) Yes No Name of insurer Limit of indemnity Excess/Deductible Premium Expiry date Retroactive date Has any insurer Declined to insure you Yes No Cancelled your insurance Yes No Refused to renew your insurance Yes No Imposed penalties or special terms If “Yes” please give details: Yes No Have any claims for professional negligence, successful or not, ever been made against your company or its present Directors? If “Yes” please give details: Yes No
ITIM_rail_proposal_form.docx