Yuchengco Tower I, 500 Quintin Paredes St.

,
Binondo, Manila
VAT Reg. TIN: 000-333-534-000
Tel. No. : 242-8888 . Fax. No. : 242-2222
Email : Malayan@malayan.com
Website : http:/www.Malayan.com

Professional Indemnity Insurance

for Specific Projects
(Design and Consult Risk)

NOTICE TO THE PROPOSED INSURED

1. Disclosure of Relevant Facts to have known had the potential to give

Your Duty of Disclosure
Before you enter into a contract of general
insurance with an insurer, you have a duty to
disclose to the insurer every matter which you
know, or could reasonably be expected to
know, is relevant to the insurer’s decision
whether to accept the risk of the insurance and
if so, on what terms.
You have the same duty to disclose those
matters to us before you renew, extend, vary or
reinstate a contract of insurance.
rise to a claim under this policy
- claims arising out of circumstances noted
on the Proposal Form for the current
period of cover or on any previous
proposal form
However, where you give notice in writing to
the insurer of any facts that might give rise to a
claim against you as reasonably practicable
after you became aware of those facts but
before the expiry of the period of cover, the
policy will, subject to the terms and conditions,
cover you notwithstanding that a claim is only
made after the expiry of the period of cover.

Comment You should familiarize yourself with our

The requirement of full and frank disclosure of
anything which may be material to the risk for
which you seek cover (e.g. claims, whether
founded or unfounded), or to the magnitude of
the risk, is of the utmost importance with this
type of insurance. It is better to err on the side
of caution by disclosing anything which might
conceivably influence the insurer’s
consideration of your proposal.
2. Claims Made Policy
standard form of policy for this type of cover
before submitting this proposal.
3. Average Provision
The policy provides that if a payment in excess
of the limit of indemnity available under the
policy has to be made to dispose of a claim,
the insurer’s liability for costs and expenses
incurred with its consent shall be such
proportion thereof as the amount of indemnity
available under this policy bears to the amount
paid to dispose of the cla

This proposal is for a “claims made” policy of

insurance. This means that the policy covers
you for claims made against you and notified to
the insurer during the period of cover. This
policy does not provide cover in relation to:

- events that occurred prior to the retroactive

date of the policy (if such a date is
specified)
- claims made after the expiry of the period
of cover even though the event giving rise
to the claim may have occurred during the
period of cover
- claims notified or arising out of facts or
circumstances notified (or which ought
reasonably to have been notified) under
any previous policy
- claims made, threatened or intimidated
against you prior to the commencement of
the period of cover
- facts or circumstances of which you first
became aware prior to the period of cover
and which you knew or ought reasonably

Malayan Insurance Co., Inc.

Professional Indemnity (DESIGN AND CONSULT) | Application Form Page 1 of 8
IMPORTANT:
 Please answer ALL questions fully. If there is insufficient space please provide details on
your letterhead.
 Where provided, tick a c appropriate box to indicate answer.
 The Applicant will be referred to in this Proposal as “You” or “Your”

1. DETAILS OF APPLICANT

a) Full name of the Applicant and their relationship to the client in respect of this Project
(e.g. Head or Principal Contractor).

FOR CORPORATE ACCOUNTS

CLIENT NAME: CHINA CONSTRUCTION THIRD ENGINEERING BUREAU CO., LTD
(SEC-Registered Corporate Name)

OFFICIAL/PRINCIPAL BUSINESS ADDRESS (SEC-Registered Corporate Address)

___________________________________________________________________________________________
Dept/Floor Bldg. Street Subdivision/Village Barangay

_____________________________________________________________________
Municipality/City Province Zip Code

FOR INDIVIDUAL ACCOUNTS

NAME OF PROPOSER: ______________________________________________
Last Name First Name Middle Name
BUSINESS ADDRESS: ___________________________________________________
Number Street Subdivision/Village Barangay
______________________________________________________________________
Municipality/City Province Zip Code

b) Please list EACH Practice in the Design and Consulting team

Full Name and
Cover required
Address of Head or Date Established Activity or Business
[Yes/No]
Principal Office

c) Please supply the following details in respect of EACH Engineer, Architect and Surveyor
in the Design and Consulting team
Names of
Engineers,
Age Qualifications Date Qualified
Architects and
Surveyors

2. DETAILS OF PROJECT
a) Please provide details of the Project to be insured
(i) Title of the Project
M PROJECT

(ii) Location
New Seaside Drive and Diosdado, Macapagal Boulevard, Paranaque, Metro Manila, Philippines

(iii) Estimate contract value

(iv) Estimate gross fee income to be received by the Design and Consulting team
(v) Brief description and type of contract (including number of buildings)

b) Please complete the time chart below

(i) Pre-Design Phase
Pre-Design Phase
(Including Feasibility Studies)
Contract Value ($)
From To Fees ($)
(If applicable)

(ii) Design Phase

Design Phase
Contract Value ($)
From To Fees ($)
(If applicable)

(iii) Construction Phase

Construction Phase
Contract Value ($)
From To Fees ($)
(If applicable)
JUNE JUNE
2020 2023

(iv) Maintenance Phase

Construction Phase
Fees Contract Value ($)
From To
($) (If applicable)
c) Please detail below the activities of the Practices to be covered in respect
of this project
Total Amount including
Amount Sub-Contracted
Activity Any Amount Sub-Contracted
Contract Value (USD) Fee (USD) Contract Value (USD) Fee (USD)
i) Civil Engineering 15%
ii) Mechanical Engineering 3.5%
iii) Electrical Engineering 3.5%
iv) Structural Engineering 50%
v) Heating and Ventilating 6%
/Air Conditioning Engineering
vi) Acoustic Engineering %
vii) Chemical Engineering %
viii) Geotechnical/ %
Soil Engineering
ix) Hydraulic/ 3.5%
Fire Engineering
x) Plumbing Engineering 3.5%
xi) Environmental Engineering %
xii) Mining Engineering %
xiii) Nuclear Engineering %
xiv) Marine Engineering %
xv) Architecture 15%
xvi) Drafting %
xvii)Town Planning %
xviii) Surveying
(1) Land %
(2) Quantity %
(3) Building %
(4) Marine %
xix) Interior Designing %
xx) Project Management %
xxi) Construction Management %
xxii) Others (please specify) %
Total for this Project %

d) Which of the following professional duties are required to be performed by

or on behalf of the proposer within the provisions of the contract?

Feasibility studies Yes No

Cost Estimates Yes No

Cash flow forecasts Yes No

Geotechnical services Yes No

Design criteria Yes No

Working drawings Yes No

 Flow sheets Yes No

Drafting contract conditions Yes No

Quantity estimates Yes No

Instructions to Tenderers Yes No

Tender adjudications Yes No

Approval of detailed design/ drawings Yes No

Co-ordination/ expenditing Yes No

Quality control and assurance Yes No

Arranging site insurance Yes No

Inspection of installation works Yes No

Measurement Yes No

Authorizing progress payments Yes No

Administrating retention fund Yes No

Supervison of commissioning Yes No

Issuing variation orders Yes No

Settling contractual claims Yes No

Certifying final payment/completion Yes No

Agreeing clearing, forwarding and customs dues Yes No

Others (please specify) Yes No

Note: The Policy does not provide cover for claims arising out of the supervisory activities which under a
traditional form of contract would be the responsibility of the contractor and not the professional
team.

3. CLAIM DETAILS
 (a) Have any claims for negligence or breach of professional duty been made in the last ten
(10) years against the applicant or any Practice to be covered or have circumstances
been notified to insurers that might give rise to a claim? (Yes/No)
If yes, please specify the following details in respect to each matter
Amount
Name of
Name of Brief Paid or Is Matter
Date Matter Claimant of
Insurer Description Estimate of Finalized or
Notified Potential
(If Any) of Matter Potential Outstanding
Claimant
Liability

(b) Is the Applicant or any Practice to be covered, AFTER ENQUIRY, aware if any claim or
circumstances that might give rise to a claim against the Applicant or any Practice to be
covered which matter is not referred to in Question 6 above? (Yes/No)
If yes, please specify the following details in respect to each matter
Name of Claimant or Brief Description of the Estimate of Potential
Potential Claimant Matter Liability

(c) Is the Applicant or any Practice to be covered, AFTER ENQUIRY, aware if any claim or
circumstances that might give rise to a claim in respect of this Project? (Yes/No)
If yes, please specify the following details in respect to each matter

4. INSURANCE COVER
(a) Does the Applicant or any Practice to be covered presently carry, or have they ever
carried Professional Indemnity Insurance? (Yes/No)
If yes, please supply details:
Amount of
Name of Name of Limit of
Deductible/ Expiry Date
Practice Insurer Indemnity
Excess
 (b) Has the Applicant or any Practice to be covered ever been refused Professional
Indemnity Insurance, or had similar insurance cancelled, or had an application of
renewal declined, or had special terms imposed? (Yes/No)
If yes, please supply details:

5. Application for Cover

(a) Limit of Indemnity required: ____________________________________
(b) Deductible/Excess requested: (Each and Every Claim)________________
(c) Extensions:
(i) Automatic Extensions
 Consultants, Sub-contractors and Agents Automatically Included
 Run-Off Cover Insured Entity or Subsidiary Automatically Included
 Project Management Automatically Included
 Outgoing Principals Automatically Included
 Mitigation/Rectification Action/Prior to Hand-over Costs Automatically Included

(ii) Please indicate if you seek cover for the following Optional
Extensions
Yes No
Fraud and Dishonesty
Increased Aggregate Limit of Indemnity (Reinstatement)
Loss of Documents

6. DECLARATION
To be signed by a Partner, Principal or Director of the Applicant and each Practice to be covered under this Proposal

We the undersigned, after enquiry declare as follows:

(1) We have read and understood the Notice to the Proposed Insured on the front of this Proposal.
(2) We have read this Proposal and the accompanying documents and acknowledge the contents of same to be
true and complete
(3) We understand that, up until a contract of insurance is entire into, we are under a continuing obligation to
immediately inform you of any change in the particulars or statements contained in this Proposal or in the
accompanying documents.

Although the signing of this Proposal does not bind the Applicants to effect insurance, the Applicants acknowledge that the
particulars and statements contained in this Proposal and in the accompanying documents shall be the basis of the
contract should a Policy be issued; and further, the Applicants acknowledge that the Proposal and the accompanying
documents will be incorporated in the Policy.

(a) The Applicant

Name of the Applicant:

Signed:
Partner, Principal or Director: Date:
Name and Title:
(b) Practices to be covered
(i)

(ii)
Name of the Applicant:
Signed: (iii)
Name of the Applicant:
Name ofPrincipal
Partner, the Applicant:
or Director: Date:
Signed:
Signed:
Name and Title: or Director:
Partner, Principal Date:
Partner, Principal or Director: Date:
Name and Title:
Name and Title:
DATA PRIVACY I acknowledge that Malayan Insurance Company, Inc. (Malayan) may collect, use, process and share my personal
information to its employees, duly authorized representatives, other insurers, reinsurers, adjusters, investigators, and other third
party providers for purposes such as underwriting, administration, claims adjudication and management, investment, data analytics,
statistical analysis, risk analysis/ assessment/management, financial and tax monitoring/review/reporting, protection against fraud,
errors, or misrepresentations, profiling, research, due diligence, company evaluation, studies/customer satisfaction surveys, and
compliance with legal, regulatory or contractual requirements. Further, I agree that Malayan may notify and offer me any of its
products and services that may be useful to me. In furtherance of these purposes, my personal information, unless prohibited, may
be processed outside the Philippines and be subject to different data protection standards.
AUTHORITY TO VERIFY INFORMATION I also authorize Malayan to verify and investigate the information given by me, including
submitted documents from whatever source it may consider appropriate.
RIGHTS OF THE DATA SUBJECT I acknowledge that I have the right to access the given information and I undertake to correct,
rectify or supplement the same should any information be found to be inaccurate or incomplete. I shall notify Malayan in writing of
any changes in the information given above.
UNDERTAKING I hereby warrant that all personal information given by me are true, correct, updated to the best of my knowledge,
and freely and voluntarily given to Malayan. I agree and consent that the above information are being collected, used, processed
and recorded for purposes of securing insurance protection or any other business transaction(s) with Malayan and for other purpose
as indicated herein.
If purchasing, transacting and/or acting in behalf of other person(s), I hereby warrant that I have been duly authorized to perform
such acts and permitted to give their information to Malayan. I hereby bind myself to advise all other persons in whose behalf I have
acted, transacted with and/or purchased any product or services from Malayan of all the terms and conditions herein. I will hold
Malayan, directors, officers, employees, agents, successors and assigns free and harmless from any liability that may arise as a
result of the authorization given above.
By signing this form, I hereby certify that I have read and understood the foregoing and this consent remains valid and binding
unless I submit a written notice to Malayan revoking or altering the same.
AUTHORITY TO DISCLOSE By ticking the box, I hereby authorize Malayan to grant the members of the Yuchengco Group of
Companies (YGC), their and Malayan’s affiliates, subsidiaries, contractors, partners, agents and representatives,
intermediaries, industry associations, and other third parties access to my personal information, including this form, for purposes of
marketing, sales or promotional information campaigns, and provision of any products, services, or offers through
mail/email/SMS/telephone, or any type of electronic facility.

CAS-B037-0919-4