Skip to content
1.888.822.2646|policy@mangoinsurance.ca
LinkedInFacebook
Mango Insurance Logo Mango Insurance Logo Mango Insurance Logo
  • Home
    • Business Insurance Quote
    • Commercial Auto & Trucking Insurance Quote
    • Personal Auto Insurance Quote
    • Home Insurance Quote
    • Restaurant Insurance Quote
    • Cannabis Insurance Quote
  • Business Insurance
    • Accountants Insurance
    • Apartments Insurance
    • Architects Insurance
    • Banks Insurance
    • Barber Shops Insurance
    • Beauty Shops Insurance
    • Breweries Insurance
    • Camps Insurance
    • Carpenters Insurance
    • Civil Engineers Insurance
    • Confectioners Insurance
    • Convenience Stores Insurance
    • Dentists Insurance
    • Engineers Insurance
    • Garages Insurance
    • Golf Course Insurance
    • Jewellers Insurance
    • Libraries Insurance
    • Medi Spas Insurance
    • Municipalities Insurance
    • Paving Contractors Insurance
    • Property Managers Insurance
    • Theatres Insurance
    • Automobile Dealer Insurance
    • Automobile Repairs Insurance
    • Bars Insurance
    • Caterers Insurance
    • Electrical Contractors
    • Excavating Contractors
    • Hotels Insurance
    • Janitorial Services Insurance
    • Kindergartens Insurance
    • Landscape Contractors Insurance
    • Logging Operations Insurance
    • Painters Insurance
    • Parking Lots
    • Pizzerias Insurance
    • Plumber Insurance
    • Printers Insurance
    • Road Contractors Insurance
    • Roofing Contractors Insurance
    • Universities Insurance
    • Wineries Insurance
    • Construction Equipment Insurance
    • Dairies Insurance
    • General Contractors Insurance
    • Radio Stations
    • Refineries Insurance
    • Restaurants Insurance
    • Supermarkets Insurance
    • Carpenters Insurance
    • Condominium/homeowners Insurance
  • Quotes
    • Alternative Workmen Compensation – Buy Online
    • Truckers Downtime Protection – Buy Online
    • Professional Liability or Errors and Omissions ( E&O ) Insurance
    • Commercial Vehicle Insurance
    • Directors and Officers Liability Insurance
    • Cyber Insurance
    • Builder Risk or Course of Construction ( COC ) Insaurance
    • Property and Casualty Insurance
    • Trucking Insurance
  • Products
    • Alternative Workmen Compensation
    • Truckers Downtime Protection
    • Automobile Insurance
    • Business Interruption Insurance
    • Commercial Auto Insurance
    • Commercial General Liability Insurance
    • Contractor-controlled Insurance Programs (Ccip)
    • Crime Insurance
    • Cyber Liability Insurance
    • D&O Insurance
    • Equipment Breakdown Insurance
    • Overland Flood Insurance
    • Owner-Controlled Insurance Programs
    • Product Liability Insurance
    • Trade Credit Insurance
    • Homeowners Insurance
  • Contact Us
    • Certificate Request
    • Policy Change
    • Jobs at Mango Insurance
Directors and Officers Liability Insurancelaxmikant2020-08-19T07:09:01+00:00

Directors and Officers Liability Insurance

This form enables users to input data for getting Commercial Vehicle Insurance.

Step 1 of 8

12%
  • MANAGEMENT LIABILITY INSURANCE

    APPLICATION FORM

    INTRODUCTION

    The purpose of this application form is for us to find out who you are and to obtain information relevant to the cover provided by the ML policy. Completion of this application form does not oblige either party to enter into a contract of insurance.
    Insurance is a contract of utmost good faith. This means that the information you provide in this application form must be complete, accurate and not misleading. It also means that you must tell us about all facts and matters which may be relevant to our consideration of your proposal for insurance. Any failure by you in this regard may entitle us to treat this insurance as if it never existed. If a contract of insurance is agreed between you and us this application form will form the basis of the contract.
    Important: Insuring clauses 1, 2, 3 and 4 (SECTIONS A and B only) provide cover on a claims made and reported basis. Under these insuring clauses, a claim must be first made against the Insured and notified to us during the period of the policy and a claim will not be covered if it arises out of any prior or pending litigation before the Prior and Pending Date.

    HOW TO COMPLETE THIS FORM

    Whoever fills out the form must be a director of the applicant company and should make all the necessary inquiries of their fellow directors, officers and employees to enable all the questions to be answered.
    If you require any extra space to complete the answers to questions contained within this application form please continue your response in the Additional Information section at the back of the form. Once you have completed the form please return it directly to your insurance broker.

  • SECTION 1: COMPANY DETAILS

    1.1 Please provide the following details:
  • * if less than 12 months old, please supply a copy of your business plan
  • 1.5 Please state the number of employees and business locations:
  • 1.6 Please advise the:
  • NamePercentage OwnershipRepresented on the board ( Y / N ): 
  • 1.7 Please confirm:
  • 1.8 Have you in the past 3 years, or do you during the next 12 months, have plans to:
Save and Continue Later
  • SECTION 2: EMPLOYMENT PRACTICES LIABILITY

    Only complete this section if you require employment practices liability cover
  • 2.3 Do you have written management guidelines for the following:
Save and Continue Later
  • SECTION 3: FIDUCIARY LIABILITY

    Only complete this section if you require fiduciary liability cover
  • Name of Plan:Plan assets:Type of Plan (i.e. defined contributions or defined benefits, welfare benefit, profit sharing etc): 
    Please forward the latest financial statement and a copy of the most recently filed Form 5500 (and attachments) for your largest benefit plan.
Save and Continue Later
  • SECTION 4: CYBER AND PRIVACY

    Only complete this section if you require cyber and privacy cover
Save and Continue Later
  • SECTION 5: CRIME

    Only complete this section if you require crime cover:
  • LocationSecurity 
Save and Continue Later
  • SECTION 6: KIDNAP AND RANSOM

    Only complete this section if you require kidnap and ransom cover
  • Country of destinationNumber of employees travellingDuration of visit 
    If you have more than 10 trips planned in the coming 12 months, please provide an itinerary
Save and Continue Later
  • SECTION 7: INSURANCE REQUIREMENTS

  • MM slash DD slash YYYY
Save and Continue Later
  • SECTION 8: CLAIMS EXPERIENCE AND INSURANCE HISTORY

    Regarding all of the types of insurance to which this application form relates AFTER FULL INQUIRY:
    • a) are you aware of any circumstances which may give rise to a claim against any of the companies to be insured or their directors, officers or employees, or
    • b) have any directors or officers of the companies to be insured, or the companies themselves, been found guilty of any criminal, dishonest or fraudulent activity or been investigated by any regulatory body, or
    • c) are you aware of any loss or damage, whether insured or not, that has occurred to any of the companies to be insured within the last 5 years, or
    • d) have the companies to be insured, or anyone working for the companies to be insured, experienced any kidnap, extortion, hijack, wrongful detention or a political threat, or
    • e) have you ever suffered a loss of data that has resulted in a privacy breach?
    If the answer to the above is ‘yes’ then please attach full details including an explanation of the background of events, the maximum amount involved or claimed, the status of the claims or circumstances and any reserves or payments made by you or by insurers, and the dates of all developments and payments.
  • SECTION 9: DECLARATION


    • • I declare that AFTER FULL INQUIRY the information provided in this application form is true and complete and that I have not mis-stated or suppressed any material fact.

    • • I agree that this application form, together with any other material information supplied by me, shall form the basis this contract of insurance.

    • • I undertake to inform underwriters of any material alteration to these facts occurring before the inception of the Policy.

  • MM slash DD slash YYYY
Save and Continue Later
CALL OUR EXPERTS TODAY 1.8888.222.646
© Copyright -    |   Mango Insurance
LinkedInFacebook
Page load link
Go to Top