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 fees/income in each of the financial years derived from clients located in:
Last Financial Year Ended	Current Financial Year Ending	Next Financial Year Ending
_ _ / _ _	_ _ / _ _	_ _ / _ _
Australia
Overseas (specify)
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 fees/income split between activities undertaken for the last complete financial year:
Australia	Elsewhere	Total
Structural Engineering
Civil Engineering
Project Management (not construction management/supervision)
Construction Management/Supervision
Electrical Engineering
Mechanical Engineering
Chemical/Petrochemical Engineering
Architecture
Quantity Surveying
Marine Engineering
Nuclear Engineering
Geotechnical
Project Co-Ordination
Town Planning
Setting Out
Interior Design – structural
Interior Design – not structural
Planning Supervision
Structural Surveying
Draughting
Client / Employer Representative
Heating/Ventilation/Air Conditioning
Feasibility Studies
Soil Analysis
Other (Specify)
100%
Please allocate below, as a percentage (to a total of 100%) the fees/income for the last financial year between contracts where the activities relate to:
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 (specify is above or below ground)
Foundations, Underpinning
Sewerage, Water Systems (housing)
Sewerage, Water Systems (other)
Environmental Appraisals, Assessments, Audits
Waste Disposal, Treatment
Oil & Gas Pipelines
Inspection, testing and certification
Other (specify)
100%
Is indemnity required for any other activity, now ceased, which is different to those declared in (2) and (3) above?	Yes No
If ‘Yes’, please provide details of the activity, fees/ income and when the activity was conducted.
What percentage of fees over the last 3 years have been paid to outside consultants?	%

Does or has the proposer’s work involved repetitive construction of the same or similar design or constructions?	Yes No
If ‘Yes’, please provide details
Does or has the proposer undertaken any contract which involves direct or contractual responsibility for
Manufacture, construction, erection or installation?	Yes No
Supervision of manufacture, construction, erection or installation?	Yes No
Supply materials, plant, goods or equipment?	Yes No
Provision of computer software or hardware	Yes No
If ‘Yes’ to any of the above, please provide details

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: