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[null,null," "]
[null,"Please complete Declaration on screen to obtain premium indication, print, sign and return to Marsh via email conveyancingsa@marsh.com"]
[null,"If insufficient space for your replies, please provide separately and return with signed Declaration"]
[]
[null,"SECTION 1 - Details of the Insured"]
[]
[null,"Marsh Client Number "]
[null,"Name of all entities to be Insured"]
[]
[" ","Primary Contact "]
[null,"Postal Address"]
[null,"Suburb / State / Postcode"]
[null,"Telephone"]
[null,"Mobile "]
[]
[null,"Email Communication","Email Address: "]
[]
[null,"By providing your email address you are agreeable to Marsh communicating with you by electronic means, including sending renewal applications forms, renewal notices, all policy documentation and correspondence when required."]
[]
[null,"SECTION 2 - Staff Numbers"]
[]
[null,"Number of Registered Conveyancers to be covered by this policy:",null,null,"    Support Staff:        Full Time",null,"   Part Time "]
[]
[]
[null,null,null,null,{"$f":"IF(F22>(D22*2),1.1,1)","v":1}]
[null,"All Firms and Conveyancing Companies must provide details of all Registered Conveyancers for the period 1 April 2017 to 31 March 2018"]
[]
[null,"Registerd Conveyancers: Partners / Directors / Sole Conveyancers",null," Registered Conveyancers:  Employees or Contractors / Locums"]
[]
[null,"Name of Registered Conveyancer","Registration Expiry Date","Name all  Registered Conveyancers employed or contracting for you during the policy period","Position within your firm:             Employee / Contractor / Locum","If contractor / locum, do they work solely for your company?"]
[]
[]
[{"$f":"IF(AND(B33=\"\",D33=\"\"),0,IF(AND(B33<>\"\",D33<>\"\"),2,1))","v":0}]
[0]
[0]
[0]
[0]
[0]
[0]
[0]
[0]
[]
[null,"SECTION 3 - Risk Information"]
[{"$f":"SUM(A33:A41)","v":0},{"$f":"IF(OR(A44=D22,A44>D22),\"\",\"Number of registered conveyancers is less than the total you input above\")","v":""}]
[null,"Estimated number of conveyancing transactions carried out for the period 1 April 2017 to 31 March 2018"]
[null,null,null,null,null,null,null,{"$f":"IF(H45/A44>560,110%,100%)","v":{"$error":"#DIV/0!"}}]
[null,"Do you conduct conveyancing activities in States/Territories other than South Australia?"]
[null,{"$f":"IF(H47=\"yes\",\"Activites conducted outside of South Australia are not covered by this policy\",\"\")","v":""}]
[null,"Do you engage in professional activities other than conveyancing work in South Australia?"]
[null,{"$f":"IF(H49=\"yes\",\"Claims arising from non-conveyancing work are not covered by this policy\",\"\")","v":""}]
[null,"Do you conduct conveyancing where you act for both parties (including private transactions)?"]
[null,{"$f":"IF(H51=\"yes\",\"Higher deductible/excess may apply in the event of a claim - refer to Section 6 Deductible in the Professional Indemnity Contract of Insurance \",\"\")","v":""}]
[null,{"$f":"IF(H51=\"yes\",\"Estimated number of conveyancing transactions that involved acting for both parties for the period 1 April 2017 to 31 March 2018:\",\"\")","v":""}]
[{"$f":"IF(H53=\"yes\",\"Please be advised that activites conducted outside of South Australia are not covered by this policy\",\"\")","v":""}]
[null,"SECTION 4 - Transaction Types and Revenue"]
[null,"Advise the percentage breakdown into the following transaction types:"]
[null,null,"Residential ",null,null,"  %"]
[null,null,"Division ",null,null,"  %"]
[null,null,"Commercial ",null,null,"  %"]
[null,null,"Business ",null,null,"  %"]
[null,null,"Other ",null,null,"  %"]
[null,null,"Total",null,{"$f":"SUM(E57:E61)","v":0},"  %"]
[null,null,null,null,{"$f":"IF(E62=0,\"\",IF(E62=100,\"\",\"Total not equal to 100%\"))","v":""}]
[null,"Estimated Total Gross Revenue* (TGR)  for the period 1 April 2017 to 31 March 2018"]
[null,{"$f":"IF(H64>750000,\"Firms with Gross Revenue* over $750,000 will be referred to the Insurer for a premium quotation\",\"\")","v":""}]
[]
[null,"* “Total Gross Revenue” is the total of all revenue received less actual reimbursement of ** “Disbursements”."]
[null,"** \"Disbursements\" means actual expenses paid by the Conveyancer to third parties on behalf of the conveyancer's clients for specific services obtained for clients, ie. Title searches, Section 7 searches, registration of title costs, etc."]
[null,"** \"Disbursements\" does not include incidental administration, business or operating expenses and does not include administration costs recovered from the client for incidentals such as copying, document production etc."]
[]
[]
[]
[]
[null,"SECTION 5 - Limit of Indemnity"]
[]
[null,"Minimum Limit of Indemnity $1,500,000"]
[]
[null,"Select Limit of Indemnity required:"]
[null,{"$f":"IF(H78>5000000,\"Limits over $5,000,000 will be referred to the Insurer for a premium quotation\",\"\")","v":""}]
[null,"SECTION 6 - Claims and Circumstances"]
[]
[null,"After enquiry, are any Conveyancers / Partners / Directors / Employees / Contractors / Locums aware of any claim / circumstances which may give rise to a claim that have not been reported to Marsh or your Insurer?",null,null,null,null,null,null,null,{"$f":"VLOOKUP(H78,limits_to_columns,2)","v":2}]
[null,null,null,null,null,null,null,null,null,{"$f":"IF(H95*200>1000,1000,H95*200)","v":0}]
[null,{"$f":"IF(H82=\"yes\",\"Full details must be provided separately and attached to this Declaration\",\"\")","v":""}]
[null,null,null,null,null,null,null,{"$f":"IF(H82=\"\",\"This Question must be answered\",\"\")","v":"This Question must be answered"}]
[]
[null,"As a reminder, this policy is arranged on a \"claims made\" basis.  It will cover claims made against you (the Insured) and reported to the Insurer during the period of insurance.  You must advise Marsh or your Insurer of all claims and circumstances that may give rise to a claim against you without delay and prior to the expiration of your current policy."]
[null,{"$f":"IF(H84=\"yes\",\"Full details must be provided separately and attached to this Declaration\",\"\")","v":""}]
[null,"SECTION 7 - Premium Indication  (Do not send payment with this Declaration)"]
[null,{"$f":"IF(H88=\"yes\",\"Full details must be provided separately and attached to this Declaration\",\"\")","v":""}]
[null,"Important Note: Your Tax Invoice will be emailed to you along with your Certificate of Insurance / Policy Schedule.  A range of payment options will be offered for your convenience including Bpay. "]
[null,{"$f":"IF(H90=\"yes\",\"Full details must be provided separately and attached to this Declaration\",\"\")","v":""}]
[null,"Registered conveyancers who have attained a CPC or an Accreditation Certificate through the Australian Instititute of Conveyancing Continuing Professional Development Program are entitled to a Risk Management Premium Reduction.  Please attach copies of certificates as evidence of participation."]
[]
[null,"Total Number of Registered Conveyancers in your firm who have obtained CPC or Accreditation certificates"]
[]
[null,"Total number of CPC and or Accreditation Certificates attached"]
[]
[null,{"$f":"IF(H95=H97,\"\",\"If certificates are not attached, Marsh will obtain confirmation of accreditation from the AICSA on your behalf.\")","v":""}]
[]
[null,"Premium Indication",null,null,null,"2018 PROFESSIONAL INDEMNITY "]
[null,"Total Premium Amount  ",null,null,null,{"$f":"IF(OR(H45<1,H78<1),\"Input Revenue and Limit of Indemnity\",J107)","v":"Input Revenue and Limit of Indemnity"},null,null,null,{"$f":"IF(H85=\"\",VLOOKUP(H64,Min._Prem,J82)*E25*H46,\"x\")","v":"x"}]
[null,"GST (10%)",null,null,null,{"$f":"F102*10%","v":{"$error":"#VALUE!"}},null,null,null,{"$f":"0-J83","v":0}]
[null,"Stamp Duty (11%)",null,null,null,{"$f":"(F103+F102)*11%","v":{"$error":"#VALUE!"}}]
[null,"Broker Fee",null,null,null,150]
[null,"Broker Fee GST",null,null,null,15]
[null,"Total Premium including Risk Management Premium Reduction where applicable",null,null,null,{"$f":"SUM(F102:F106)","v":{"$error":"#VALUE!"}},null,null,null,{"$f":"IF(J102=\"x\",\"Please go back and complete Section 6 \",IF(SUM(J102:J106)<2098,2098,SUM(J102:J106)))","v":"Please go back and complete Section 6 "}]
[null,null,null,null,null,null,null,null,null,{"$f":"IF(H95>D22,\"Error in Numbers of Certificates\",J11)","v":0}]
[null,"Please note this indicative quotation is non-binding and subject to insurer acceptance of all of the information disclosed in this form. If the premium changes from that indicated or claim loading is to be applied, Marsh will advise you before issuing Tax Invoice for payment.  "]
[]
[null,"SECTION 8 - Declaration"]
[]
[null,"Permissive Statements"]
[null,"To verify placement for your registration requirements we may be required to forward copies of your Certificate of Insurance to Consumer and Business Services (CBS) which will include the following:  Policy Number, Principal Address, Names of Conveyancers, Premium breakdown, Period of Insurance, Limit of Indemnity, Excess, Sub-Limits and Retroactive Date. However, to enable us to do this we will require your prior permission to comply with Privacy Act requirements."]
[]
[null,"I / We hereby confirm our agreement for Marsh Pty Ltd to release past, present and future Professional Indemnity policy details to Consumer and Business Services."]
[]
[null,null,null,"YES"]
[]
[]
[null,"Declaration"]
[null,"By completing this insurance declaration for insurance you confirm that you have read the  Privacy Notice and/or the Marsh Privacy Policy available on our website www.marsh.com.au and you authorise and consent to Marsh collecting, holding, using and disclosing any personal information related to your application for insurance in accordance with those terms, including for the purposes explained and to the persons and authorised third parties identified. You may modify or withdraw your consent at any time by contacting our Privacy Officer (whose details are outlined in the Privacy Policy and Notices). If you do not give us consent or subsequently modify or withdraw your consent, we may not be able to provide you with the products or services you want."]
[null,"I / We confirm that I / We have read the Important Notices provided. I / We declare that the contents of this form are true and correct."]
[null,"I / We confirm that I am / We are not aware of any claims or circumstances other than as previously reported or as noted in and attached to this Declaration."]
[null,"Signature: …………………………………………………………..…….……….…………………………..  Date: …………………………………………………………….."]
[null,"Title and Authority of Signatory / Sole Practitioner: …………………………………...……………………….…………………………….………………………………….."]
[]
[]
[null,"Payment options will be provided including BPay facility with your Tax Invoice when issued."]
[null,"For assistance, please call Marsh on 1300 136 929"]
[]
[]
[null,"Marsh Pty Ltd",null,"ABN 86 004 651 512",null,"     Phone:     1300 136 929"]
[null,"Level 6, 70 Franklin Street",null,"GPO Box 2637",null,"      Fax:         (08) 8385 3650"]
[null,"ADELAIDE  SA  5000",null,"ADELAIDE  SA  5001"]
[]
[]
[]
[null,"Please print, sign and return completed Declaration via email to conveyancingsa@marsh.com   "]
[]
[null,"If insufficient space for your replies, please provide separately and return with Declaration"]

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{"sheet":"Rates 15-16 ","index":2,"n_rows":32,"n_cols":17,"rows_kept":32,"cut":false,"hidden":false,"merged":[]}
["Institute of Conveyancers"]
["Premium 31 May 2015 to 31 May 2016"]
["Fee Level","$1.5m","$2m","$3m","$4m","$5m"]
[0,2198,2686,3011,3255,3825]
[15001,2604,3134,3379,4089,4599]
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[]
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[null,null,null,null,null,null,null,null,null,null,"Expiring Rates 2012"]
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