Chubb FI Folio New line app

If yes to any of these attach details o yes o no

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Unformatted text preview: or other representative proceeding? If “Yes” to any of these, attach details. o Yes o No Other than those identified in the response to Section 8(a), are there now pending or has any claim been brought at any time during the last 5 years against (i) any Applicant or any entity proposed for coverage or (ii) any individual proposed for coverage in his or her capacity as a director or officer of any entity? If “Yes”, attach details. o Yes o No Pertaining to question 8, it is agreed that any claim arising from such suits, investigation, claim or proceeding is excluded from the proposed coverage. 9. Current Insurance – MISSOURI APPLICANTS/AGENTS: DO NOT ANSWER QUESTIONS 9 (b) a. Provide the following information with respect to any executive/directors and officers liability or other securities liability insurance coverage currently maintained by any Applicant or by any individual or entity proposed for coverage: Insurer Limits Retention $ $ $ b. $ $ $ Has any carrier refused or cancelled any executive/directors and officers liability coverage? 14-03-0715 (Ed. 07/2005) Policy Period 4 of 7 o Yes o No Financial Institution Portfolio SM Chubb Group of Insurance Companies Executive Liability and Entity Securities Liability Coverage Non-Bank Application 15 Mountain View Road Warren, New Jersey 07059 c. Provide the following information with respect to any other Bond, Trust Department E&O, and General Liability coverages currently maintained by any Applicant or by any individual or entity proposed for coverage. Coverage Insurer Limits Retention Blanket Bond $ $ Trust Depart E&O $ $ General Liability $ Policy Period $ _ It is represented and agreed that above coverages, referenced in Question 9 (c), in current amounts will be maintained by the Applicant during the policy period of the proposed insurance and that the Company is relying upon such representation when issuing a Coverage Section. 10. Is the Applicant currently offering or planning to offer any of the following services? o o o o o o o o o o o Actuarial services Appraisal services Data processing services Discount brokerage services Insurance agent/agency Investment advisor/counselor Real estate agent/agency Real estate investment trust advisory services Security broker/dealer Travel agent/agency Underwriting of securities Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes o o o o o o o o o o o 11. How often are Board of Directors meetings held? __________________________ 12. List the Board of Directors committees which are in existence and indicate the frequency of meetings: Committee 13. Indicate the areas in which formal written policies and/or procedures have been implemented by the Board of Directors to address the following: Asset-Liability Management Policy Audit Policy Conflicts of Interest Policy Duties of Directors and Officers Investment Policy Loan Policy 14. Meeting Frequency Merger or Tender Offers Operating Procedures Personnel Policy Risk Management Policy Selection Process for New Directors How often does the Board of Directors review the follow...
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This document was uploaded on 03/30/2014.

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