PROFESSIONAL INDEMNITY
INSURANCE PROPOSAL FORM FOR
MISCELLANEOUS PROFESSIONS
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CONTENTS
A. ADVICE ON COMPLETING THE PROPOSAL FORM
B. PROPOSAL FORM
C. OTHER INSURANCE REQUIREMENTS
A. ADVICE ON COMPLETING THE PROPOSAL FORM
To allow us sufficient time to time negotiate with Insurers, please ensure you return this proposal form
as soon as possible. It is essential that you allow sufficient time to complete the proposal form and
provide accurate information. Insurers regard the proposal form as a reflection of the quality of the
business seeking insurance; a poorly completed, untidy or inaccurate form can reflect badly on a
business and will not assist us in securing terms.
1. Definitions of terms used in this proposal form
• ‘Principal’ means: Any Partner(s), Director(s), Member(s)
• ‘Employee’ means: Any person who is or has been under a contract of service for or on behalf
of the Firm.
• ‘Senior Management’ means, in accordance with the Insurance Act 2015: those individuals
who play significant roles in the making of decisions about how the Insured’s activities are to be
managed or organised. Under Section 4 of the Insurance Act 2015 an Insured must disclose all
material circumstances known to its ‘senior management’ and those persons responsible for the
Insured’s insurance. Please see question15. in this proposal form.
2. Duty of fair presentation
Under English law, you owe a duty of disclosure to the insurer which includes your duty to make a fair
presentation of the risk. A ‘fair presentation’ is one:
• which clearly discloses all material circumstances which the Insured’s Senior Management,
including persons responsible for the Insured’s insurance, know or ought to know following a
reasonable search or which is sufficient to make the insurer ask questions about the risk. A
circumstance is material if it would influence an insurer’s judgment in determining whether to take
the risk and, if so, on what terms. If you are in any doubt whether a circumstance is material we
recommend that it should be disclosed;
• which discloses information in a manner which is clear and accessible to a prudent insurer (i.e. no
‘data dumping’);
• in which every material representation as to a matter of fact is substantially correct and every
material representation as to a matter of expectation or belief is made in good faith.
Failure to disclose a material circumstance may entitle an insurer to:
• in some circumstances, avoid the policy from inception and in this event any claims under the
policy would not be paid;
• impose different terms on your cover; and/or
• proportionately reduce the amount of any claim payable.
This duty applies:
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• before your cover is placed;
• when it is renewed; and
• at any time that it is varied.
Your policy wording may also provide that this duty continues for the duration of the policy.
You should contact us immediately for assistance if you are unsure whether information may be
material, or if it comes to your attention that you may have not disclosed full and accurate
information.
3. General instructions relating to completion of the form
• Please ensure this proposal form is completed by a Principal of the business.
• A response to all questions must be entered. Where a question is not relevant to your business,
please respond N/A.
• If the proposal form is completed by just one of the Principals, please ensure that full
consultation is made with the Senior Management, prior to submission of this form and that
they, in turn, have consulted those for whom they are responsible.
• If you are completing this Proposal Form by hand, it should be completed in black ink and
preferably in block capitals.
• If you have completed the form electronically, please print and sign it before returning it to us,
either electronically or by post.
• A number of questions request YES or NO answers. Please place an x in the appropriate box
or underline the appropriate response.
• If there is insufficient space to answer any questions please provide full details on your headed
paper. Please ensure that any additional information is signed, dated and makes clear
reference to the question(s) on the Proposal Form, to which it refers.
• Depending upon the qualifications and/or experience of the Principal(s), Insurers reserve the
right to request a Curriculum Vitae and details of any circumstances or claims pertaining, in the
past 5 years, irrespective of whether they were employed by the business at the time.
• Completion of this proposal form does not automatically bind the Principal, the Firm or Insurers
to effect a contract of insurance.
• Wherever the word ‘Employee’ appears herein, this is deemed to read ‘Any person who is or
has been under a contract of service for or on behalf of the Firm’.
• If you have any questions about completing this form please contact us on 0207 133 1300.
• A copy of this proposal should be retained for your own records.
4. Providing additional information
If you feel there is additional information required in order to make a fair presentation of the risk
which is not requested by this form, such information should be set out clearly and attached to this
proposal form.
Additional information, where not requested by the proposal form, could include:
• Corporate brochure(s);
• Organisation chart(s);
• An overview of risk management;
• CV’s of the Principal(s);
• A description of any services provided in the past 6 years which are no longer provided and/or
any new services the business intends to provide in the future;
• An overview of the client base;
• Standard Terms of Engagement.
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5. Claims and circumstances
Whilst every question on the proposal form is important and constitutes material information upon
which Insurers rely, Insurers will be particularly interested in your history of claims and/or
circumstances. Details of all claims and circumstances notified to previous Insurers must be
declared on the proposal form, accompanied by a brief description which should include:
• Overview of the job/instruction being undertaken
• Date the work, to which the allegation relates, was undertaken
• Policy year in which the notification was made to Insurers
• Alleged wrong doing
• The firm’s own view on the matter
• Insurers’ view on the matter (clearly differentiated from the above)
• Details of any amounts:
o Paid by Insurers
o Reserved by Insurers
o Legal fees incurred by Insurers
In order to ensure that all notifiable matters are declared, the recommended practice would be for
each Principal including all members of the Senior Management and other senior members of staff
to sign a declaration to the effect that he/she has investigated the areas for which he/she is
responsible and can confirm that there are no claims or circumstances other than those declared in
the proposal form.
After completion of the proposal form and prior to the expiry of the firm’s current insurance, a
check should be undertaken within the Business to ensure that there are no claims or
circumstances of which anyone is aware other than those already notified in the proposal form.
If any new matters are discovered, these should be immediately notified to Howden if we are your
current Broker. If we are not your current Broker, then you should notify your current
Broker/Insurers and Howden. Such notifications should reach your current Broker/Insurers and
Howden prior to the expiry date of the firm’s current insurance.
Data Protection Act
Any information provided on this form, which may include sensitive data (e.g. medical history, criminal
convictions, age), will be processed by Howden UK Group Limited in compliance with the Data Protection
Act 1998 and will only be used for the purposes of providing insurance cover and handling claims arising.
In the course of our duty as insurance brokers we may be required to provide such data to limited third
parties including Insurers and/or circumstance required by law.
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B. PROFESSIONAL INDEMNITY INSURANCE
MISCELLANEOUS PROFESSIONS PROPOSAL FORM
1. NAME AND ADDRESS DETAILS
1.1 Name of Firm (including any subsidiaries for whom cover is required).
Establishment Date(s)
IFC GLOBAL TEKNİK KONTROL SERTİFİKASYON ANONİM ŞİRKETİ 16.12.2021
1.2 Name of all predecessors of the Firm for whom cover is required.
Date of Establishment Cessation
Deniz Alya Eryılmaz 16.12.2021
1.3 Principal Address and location of all other offices.
Adalet Mh. 2132/2 sk. No:3/28 Bayraklı/İzmir
Main office telephone number Firm’s Website address
08503044500
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2. PARTNERS/DIRECTORS AND CONSULTANTS DETAILS
Name Status: (Partner/Director/ Age Qualifications How long in this
Consultant) capacity in the Firm
3. STAFF DETAILS
Please state numbers of:
Partners/Directors Qualified staff Other staff Self-employed
persons
4
4. BUSINESS ACTIVITIES
4.1 Please provide a full description of your Firm’s activities
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Within the scope of ISO/IEC 17021, we provide certification services under ISO 13485 accreditation
from TURKAK. We also provide CE certification services within the scope of (EU) 2017/745 Medical
Device Regulation.
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4. BUSINESS ACTIVITIES continued
4.2 Please categorise the activities outlined above and indicate the percentage of the gross fees
this represents
Activity UK % USA/Canada % Elsewhere %
ISO 13485 Certification %100
4.3 Are you involved in any process of manufacture, construction, alteration,
repair, installation or sale or supply of products, other than in a pure
consultancy capacity as described above? YES NO
If YES please give details.
5. FEE INCOME
5.1 Please state for the whole Firm the total annual gross fees received in each of the last three
financial years ending 31th (day) December (month) and an estimate for the current year.
Year: - Year: - Year:2024 Current Year:2025
UK
USA/Canada
Elsewhere 6070 €
Total
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5.2 Reimbursable Costs
5.3 Estimated gross fees for the following financial year
6. SPECIALIST SUB-CONSULTANTS
6.1 If any of the fees for the last financial year are paid by your Firm to any independent and/or
specialist consultants please provide the following:
Name of Firm/Individual Professional Discipline Fees paid (Last Financial
Year)
6.2 Do you require them to carry Professional Indemnity Insurance for a limit
not less than the amount of cover requested by this proposal? YES NO
N.B. If they do not carry PI Insurance and you require them to be indemnified under your policy for
work done on behalf of your Firm, special arrangements must be made with Insurers. In such cases
a copy of the individuals CV will be required.
7. CLIENTS
7.1 Please state your 5 largest clients where services have been provided/rendered in the past 5
years:
Date work Completion Services provided
Client Firm’s Fee
commenced date
TEKSERVİS TEKNİK 02.07.2024 14.11.2027 1000 € ISO 13485
VE TIBBI ÜRÜNLERİ CERTIFICATION
PAZARLAMA
SANAYİ VE TİCARET
LİMİTED ŞİRKETİ
DENTİMPLANT 03.12.2024 25.02.2028 850 € ISO 13485
MEDİKAL SAĞLIK İÇ CERTIFICATION
DIŞ TİCARET
SANAYİ LİMİTED
ŞİRKETİ
KONFORT ÖZEL 22.02.2024 14.06.2027 1100 € ISO 13485
SAĞLIK HİZMETLERİ CERTIFICATION
TIBBİ MALZEMELER
SANAYİ VE TİCARET
LİMİTED ŞİRKETİ
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«LYTECH» Co. Ltd 24.10.2024 10.12.2027 750 € ISO 13485
CERTIFICATION
ARDEN MEDİKAL 14.06.2024 12.08.2027 700 € ISO 13485
SAĞLIK İÇ VE DIŞ CERTIFICATION
TİCARET ANONİM
ŞİRKETİ
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8. CONTRACTS OUTSIDE THE UNITED KINGDOM
8.1 Does the Firm undertake or has it undertaken any work for clients
where the “end product” of such work is outside the United Kingdom? YES NO
If YES please give details.
Total
Completion Extent of service
Country Start date Client contract Fee
date provided
value
Türkiye 02.07.2024 TEKSERVİS 1000 € 1000 14.11.2027
TEKNİK VE €
TIBBI ÜRÜNLERİ
PAZARLAMA
SANAYİ VE
TİCARET
LİMİTED
ŞİRKETİ
Türkiye 03.12.2024 DENTİMPLANT 850 € 850 25.02.2028
MEDİKAL €
SAĞLIK İÇ DIŞ
TİCARET
SANAYİ LİMİTED
ŞİRKETİ
Türkiye 22.02.2024 KONFORT ÖZEL 1100 € 1100 14.06.2027
SAĞLIK €
HİZMETLERİ
TIBBİ
MALZEMELER
SANAYİ VE
TİCARET
LİMİTED
ŞİRKETİ
Russia 24.10.2024 «LYTECH» Co. 750 € 750 10.12.2027
Ltd €
Türkiye 14.06.2024 ARDEN 700 € 700 12.08.2027
MEDİKAL €
SAĞLIK İÇ VE
DIŞ TİCARET
ANONİM
ŞİRKETİ
8.2 Does the Firm work or has it worked other than from its UK office? YES NO
8.3 Does the Firm enter into agreements where the jurisdiction is other than
UK courts? YES NO
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If the answer to any of the above is YES, full details are required - i.e. list the jurisdictions and the
gross fees derived from each and provide a copy of the relevant contracts.
Certification activities were carried out in Turkey and Russia.
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9. OTHER FINANCIAL INTEREST
Does the Firm or any Partner have any association with, or financial interest
in any other firm or organisation (other than a share or stockholder in a Publicly
Quoted Company)? YES NO
If YES give full details of the nature of the association or interest together with the name and business
of the firm or organisation.
There are 2 other companies, 100% owned by Deniz Alya Eryılmaz, providing certification services
in ISO/IEC 17021 and ISO/IEC 17065.
Name: IFC Global Sertifikasyon Muayene ve Eğitim Hizmetleri Anonim Şirketi: Under ISO/IEC
17021&17065 certification
Name: IFC Global HALAL Sertifikasyon Anonim Şirketi: Halal Product Certification (OIC/SMIIC 2)
10. INTERNAL CONTROL PROCEDURES
10.1 Does your Firm insist on satisfactory written references from former
employers for the three years immediately preceding the engagement
of any employee responsible for money, accounts or goods? YES NO
10.2 Will any Director, Partner or Employee be authorised to sign cheques
on their sole signature in respect of the Firm’s or Clients’ accounts. YES NO
If YES please state name, position and limit
Name:Deniz Alya Eryılmaz
Title: General Manager
No limit
10.3 Does the Firm have compliance and procedure manuals related to all
aspects of its operation? YES NO
If NO what system of quality control is in place to ensure that professional
standards are achieved and maintained?
10.4 Does the Firm use standard terms and conditions of business or letter
of appointment? YES NO
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If YES, please enclose copies
10.5 Does the Firm issue any brochure, leaflet etc. describing the Firm’s
Services? YES NO
If YES, please enclose copies
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11. CURRENT INSURANCE ARRANGEMENTS
If the Firm currently has Professional Indemnity Insurance please provide the following details. (This
information is not required where the policy is currently arranged by Howden UK Group
Limited.)
-
Name of Insurers
-
Limit of Indemnity
-
Excess
-
Premium
-
Retroactive date
-
Policy Expiry date
12. PREVIOUS APPLICATIONS FOR INSURANCE
Has an Insurer ever:
a) Declined to insure this Firm or any Partner? YES NO
b) Imposed special terms? YES NO
c) Cancelled or voided an insurance? YES NO
If any answer is YES please give full details
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13. NEW INSURANCE ARRANGEMENTS
13.1 For what Limit of Indemnity do you require a quotation?
1.000.000 €
13.2 What level of excess are you prepared to carry?
100%
13.3 If you have any specific requirements with regard to your Professional Indemnity Insurance
please state these in the space provided below
None
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14. CLAIMS
14.1 Have any claims alleging professional negligence, error or omission (successful or otherwise) been made against the Firm or its present or
former Partners/Directors and/or predecessors in business during the past 10 years? YES/NO
If YES, please give full details including amounts
Date of Defence costs Insurers’ Reserve
Details Amount claimed Amount Paid
Claim (if known) (if known)
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14. CLAIMS continued
14.2 Are any of the Partners/Directors AFTER ENQUIRY of all staff and consultants aware of any
circumstances or events which may give rise to a claim against the Firm or it’s present or former
Partners/Directors and/or predecessors in business?
YES NO
If YES please give full details
15. KNOWLEDGE OF THE INSURED
Under Section 4 of the Insurance Act 2015 an Insured must disclose all material circumstances known
to its Senior Management and those persons responsible for the Insured’s insurance. The Act defines
Senior Management as those individuals who play significant roles in the making of decisions about
how the Insured’s activities are to be managed or organised.
For these purposes please list below the positions / roles within your firm that you consider to be your
Firm’s Senior Management and include the roles of those persons responsible for the Firm’s
insurances.
Position Role
Deniz Alya Eryılmaz General Manager
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DECLARATION
Before signing this declaration please familiarise yourself with your ‘Duty of fair presentation’
which is outlined under section A. 2. at the beginning of this form.
Please read the declaration carefully and sign at the bottom.
I/We declare that I/We have made a fair presentation of the risk, by disclosing all material
circumstances which I/we know or ought to know or, failing that, by giving the Insurer sufficient
information to put a prudent Insurer on notice that it needs to make further enquiries in order to reveal
material circumstances.
Completing this Proposal Form does not bind the Proposer or Insurers to complete this insurance.
Signature of Principal
Name (IN CAPITALS) Date
17.04.2025
DENIZ ALYA ERYILMAZ
A copy of this proposal should be retained by you for your own records
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