Employment Practices Liability Insurance

Proposal Form - Addendum

Does the proposed Insured expect there to be any redundancies or other reductions amongst its employees in the next 24 months?	No ☐	Yes ☐
Has there been more than 10% of the employees of the proposed Insured resign, or been made redundant, or dismissed during the last 24 months?	No ☐	Yes ☐
Does the proposed Insured plan to make any amendments to the employee benefits package in the next 24 months or has it already done so during in the last 24 months?	No ☐	Yes ☐
Has the proposed Insured or any principals or directors of the proposed Insured had any claims made against them for wrongful termination, discrimination intimidation or sexual harassment within the last five years?	No ☐	Yes ☐

If yes to any questions above, please provide full details in the space below.

Does the proposed Insured have written procedures, contracts of employment, personnel files, and an employee handbook?	No ☐	Yes ☐
Does the proposed Insured minute all grievance and disciplinary hearings?	No ☐	Yes ☐

If no to either question above, please provide full details in the space below.