Professional Indemnity Insurance
Scheme for Manulife Agents

Application Online

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This policy is underwritten by Chubb Insurance Hong Kong Limited (“Chubb”). Fu Hoi Insurance Management Limited is an insurance agency (license number: FA2106) authorised by Chubb.

By clicking the “Begin” button, your details will be transferred to Chubb for online insurance application.

Important Notices

Please read through the following notices which are important to this application and you should know about.

Your Duty of Disclosure

Before you enter into a contract of general insurance with Chubb Insurance Hong Kong Limited (“the insurer”), you have a duty to disclose to the Insurer every matter that 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 the Insurer before you renew, extend, vary or reinstate a contract of general insurance.

Your duty however does not require disclosure of any matter:

  • that diminishes the risk to be undertaken by the Insurer;
  • that is of common knowledge;
  • that your Insurer knows or, in the ordinary course of its business, ought to know;
  • as to which compliance with your duty is waived by the Insurer.

It is important that all information contained in this proposal is understood by you and is correct, as you will be bound by your answers and by the information provided by you in this proposal. You should obtain advice before you sign this proposal if you do not properly understand any part of it.

Your duty of disclosure continues after the proposal has been completed up until the contract of insurance is entered into.

Non-Disclosure

If you fail to comply with your duty of disclosure, the Insurer may be entitled to avoid the contract from its beginning.

If your non-disclosure is fraudulent, the Insurer may also have the option of avoiding the contract from its beginning, to retain any premium that you have paid for this contract of insurance.

Claims Made Contract

Subject to its terms and conditions the policy will cover your legal liability for any claim:

  • first made against you during the policy period;
  • resulting from any circumstance of which you become aware during the policy period which may give rise to a future claim against you provided you immediately inform us in writing of such circumstances within the policy period.

The Policy will not cover your legal liability resulting from any claim, matter, occurrence or circumstance arising from any act, error or omission committed or alleged to have been committed of which you were aware before commencement of the policy period.

Change of Risk or Circumstances

You should advise the Insurer as soon as practicable of any change to your normal business as disclosed in the proposal.

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Application for Insurance Cover

Period of Insurance :

Limit of Liability Required:

Under the “Insurance Ordinance (Cap. 41)”, the Insurance Authority (IA) has started to collect the levy on insurance premiums from policyholders through insurance companies from 1 January 2018. For more details, please refer to IA’s official website: www.ia.org.hk/en/levy

*For Agents with claim record, Chubb Insurance Hong Kong Limited reserves the right to underwrite separately on the terms and conditions.

The total aggregate Limit of Indemnity during the Period of Insurance for all Claims from all individual Insured under this Scheme is HKD100,000,000.

Please read thePolicy Wording for full version of exclusions, terms and conditions

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Details of Applicant

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Insurance History

Do you currently have similar insurance?

Yes
No
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Insurance History

Has any application for similar insurance been refused, or has any similar insurance ever been rescinded or cancelled?

Yes
No
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Claims Experience

Have any claims ever been made, or lawsuits been brought against you?

Yes
No
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Claims Experience 1

please provide full details and the status of each claim, lawsuit, allegation or matter:

*whether the status is outstanding or finalised
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Claims Experience

Are you aware, as of the date of signing this application, of any errors, omissions, offences, circumstances or allegations which might result in a claim being made against you?

Yes
No
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Claims Experience 2

please provide full details and the status of each claim, lawsuit, allegation or matter:

*whether the status is outstanding or finalised
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Claims Experience

Have you ever been the subject of disciplinary action or investigation by any authority or regulator or professional body?

Yes
No
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Claims Experience 3

please provide full details and the status of each claim, lawsuit, allegation or matter:

*whether the status is outstanding or finalised
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Declaration

  • I acknowledge that I have read and understood the Important Notices contained in this proposal.
  • I agree that this proposal, together with any other information or documents supplied, shall form the basis of any contract of insurance.
  • I acknowledge that if this proposal is accepted, the contract of insurance will be subject to the terms and conditions as set out in the policy wording as issued or as otherwise specifically varied in writing by the Insurer.
  • I declare after enquiry that the statements, particulars and information contained in this proposal and in any documents accompanying this proposal are true and correct in every detail and that no other material facts have been misstated, suppressed or omitted.
  • I undertake to inform the Insurer of any material alteration to those facts before completion of the contract of insurance/insurance policy period (if applicable).
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Personal Information Collection Statement

Chubb Insurance Hong Kong Limited & Fu Hoi Insurance Management Limited (“We/Us”) want to ensure that Our Insured Persons (“You”) are confident that any personal data collected by Us is treated with the appropriate degree of confidentiality and privacy.

This Personal Information Collection Statement sets out the purposes for which We collect and use personally identifiable information provided by You ("Personal Data"), the circumstances when Personal Data may be disclosed and information regarding Your rights to request access to and correction of Personal Data.

(a) Purposes of Collection of Personal Data

We will collect and use Personal Data for the purposes of providing competitive insurance products and services to You, including considering Your application(s) for any new insurance policies and administering policies to be taken out with Us, arranging the cover and administering and managing Your and Our rights and obligations in relation to such cover. We also collect the Personal Data to be able to develop and identify products and services that may interest You, to conduct market or customer satisfaction research, and to develop, establish and administer alliances and other arrangements with other organisations in relation to the promotion, administration and use of Our respective products and services. We may also use your Personal Data in other ways with your consent.

(b) Direct marketing

Only with your consent, We may also use your contact, demographic, policy and payment details to contact You with marketing information regarding our insurance products by mail, email, phone or SMS.

(c) Transfer of Personal Data

Personal Data will be kept confidential and We will not sell Your Personal Data to any third party. We limit the disclosure of Your Personal Data but, subject to the provisions of any applicable law, Your Personal Data may be disclosed to:

  • third parties who assist Us to achieve the purposes set out in paragraphs a and b above. For example, We provide it to Our relevant staff and contractors, agents and others involved in the above purposes such as data processors, professional advisers, loss adjudicators and claims investigators, doctors and other medical service providers, emergency assistance providers, insurance reference bureaus or credit reference bureaus, government agencies, reinsurers and reinsurance brokers (which may include third parties located outside Hong Kong);
  • Our parent and affiliated companies, or any company within Chubb local and outside Hong Kong;
  • the insurance intermediary through which You accessed the system;
  • provided to others for the purposes of public safety and law enforcement; and
  • other third parties with your consent.

With regard to the above transfers of Personal Data, where applicable, You consent to the transfer of Your Personal Data outside of Hong Kong.

(d) Access and correction of Personal Data

Under the Personal Data (Privacy) Ordinance ("PDPO"), You have the right to request access to and correction of Personal Data held by Us about You and We will grant You access to and correct Your Personal Data as requested by You unless there is an applicable exemption under the PDPO under which We may refuse to do so. You may also request Us to inform You of the type of Personal Data held by Us about You.

Requests for access or correction of Personal Data should be addressed in writing to:

Chubb Data Privacy Officer

39/F, One Taikoo Place,

979 King’s Road,

Quarry Bay, Hong Kong

O +852 3191 6222

F +852 2519 3233

E Privacy.HK@chubb.com

Fu Hoi Data Privacy Office

Room 1229, Beverley Commercial Centre,

87-105 Chatham Road,

Tsim Sha Tsui, Kowloon

O +852 2735 0086

F +852 2302 9588

E privacy.fhi@gmail.com

Your request to obtain access or correction will be considered within forty (40) days of Our receipt of Your request. We will not charge You for lodging a request for access to Your Personal Data and if We levy any charges for providing information, such charges will not be excessive. No fee is charged for data correction requests.

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Summary of Application

Option Selected
Application for Insurance Cover

Period of Insurance
September 1 2022 to August 31 2023

Option 1

Limit of Liability
HKD3,000,000 any one Claim and in Aggregate

Total Premium Due HKDIA levy inclusive

Name of Applicant

Mr XXX

District Code

123456

District Name

test

Agent Code

12345

Office Location

xxxx xxxx xxxx xxxx

IA License No.

12345

Contact No.

test

Correspondence Address

xxxx xxxx xxxx xxxx

Email Address

xxxx xxxx xxxx xxxx

Insurance History
Do you currently have similar insurance?

No

Has any application for similar insurance been refused, or has any similar insurance ever been rescinded or cancelled?

No

Claims Experience
Have any claims ever been made, or lawsuits been brought against you?

No

Are you aware, as of the date of signing this application, of any errors, omissions, offences, circumstances or allegations which might result in a claim being made against you?

No

Have you ever been the subject of disciplinary action or investigation by any authority or regulator or professional body?

No