IMPORTANT NOTICE
Failure to disclose all material information that is likely to influence the acceptance of the risk or the terms applied could invalidate the insurance. If you are in any doubt as to whether any information is material, it should be disclosed. Where the space provided is insufficient for your replies, please provide these separately and attach to this Addendum. Reference to Insured in this Addendum means: the entity or entities named in question 1 of the Proposal and this Addendum the past and/or present employees or principals of the entity or entities; and the directors of the entity or entities and all subsidiary entities for whom cover is required.
Proposed Insured:
Date that the original Proposal Form was signed and dated, with which this Addendum attaches to :
Please provide the proposer’s turnover in each of the financial years derived from clients located in:
Last Financial Year Ended	Current Financial Year Ending	Coming Financial Year Ending
_ _ / _ _	_ _ / _ _	_ _ / _ _
Australia
Overseas
Total
If fees/income has been declared as derived from clients based “Overseas” please provide details including territories involved and fees/income derived in each location
Please allocate below, as a percentage (to a total of 100%,)the turnover between activities undertaken for the last complete financial year:
Australia	Elsewhere	Total
Proposer designs and constructs from their own design & provides full technical supervision or construction
Proposer designs and/or provides technical services and subcontracts out the construction to others who are not indemnified by the proposed insurance policy
Proposer designs and/or provides technical services but has no contractual or direct involvement in construction
Proposer constructs from designs of qualified architects/engineers (who are not indemnified by the proposed insurance) performed on behalf of the proposer
Proposer constructs from designs of, and technical supervision performed by, qualified architects/engineers who are not indemnified by the proposed insurance
Proposer constructs from designs supplied by the principal or employers or client
Other Turnover not listed above: Please give details
100%
Does the Proposer require architects/engineers and others providing technical services to for and on behalf of the Proposer to arrange Professional liability insurance of a similar type and limit of indemnity as that proposed by the Proposer?	Yes No
Please allocate below, as a percentage to a total of 100%, the fees/income for the last financial year between contracts where the interest is:
Australia	Elsewhere	Total
Individual Dwellings
Low Rise Buildings
High Rise Buildings (between 4 & 10 floors)
High Rise Buildings (above 10 floors)
Schools, Hospitals, Municipal
Retail Shops, Flats, Townhouses
Modular and Industrial Buildings
Feasibility Studies, Reports
Town Planning
Domestic Surveying (pre purchase building inspections)
Industrial & Commercial Surveys/Inspections
Swimming Pools, Dams
Bridges, Tunnels, Harbours, Jetties
Roads
Mechanical Plant, Bulk Handling, Silos
Mines
Foundations, Underpinning
Sewerage, Water Systems (housing)
Sewerage, Water Systems (other)
Environmental Appraisals, Assessments, Audits
Waste Disposal, Treatment
Oil & Gas Pipelines
Other (specify)
100%

DECLARATION AND AGREEMENT I/We declare in relation to the facts, statements and particulars contained in this Addendum as follows: I/We have made all reasonable and necessary enquiries; I/We confirm that to the best of our knowledge and belief, they are true and complete; No material facts have been omitted, misstated, misrepresented or suppressed; and Should any of the information given by us alter between the date of this Addendum and inception date of the insurance to which this proposal relates, we will give immediate notice thereof to the insurer. I/we acknowledge that this Addendum forms part of the Proposal for insurance made by Us. I/We acknowledge receipt of the Important Notices on Page 1 contained on this Addendum Form and that we have read and understood the content of those Notices. I/We confirm that we are authorised by the Company and its Directors to complete, sign and submit this proposal on behalf of the Company and its Directors.
Name of Business:
Signature/s:
(This Proposal should be signed by a Principal, Partner or Director of Proposed Insured)
Title of Signatory:
Full Name of Such Person:
Date of Signing: