Fidelity Insurance

Proposal Form - Addendum

When engaging employees does the proposed Insured always use a process to obtain references from former employers?	No ☐	Yes ☐
Are employees who are responsible for financial and accounting functions and computer programming operations required to take two weeks uninterrupted leave each year?	No ☐	Yes ☐
Are duties segregated so that no one person can issue and draw cheques, withdraw funds or transfer funds in excess of $1,000 in value without approval by another person?	No ☐	Yes ☐
Are bank accounts independently reconciled on a monthly basis by persons not authorised to deposit or withdraw funds from the accounts?	No ☐	Yes ☐

If no to any questions above, please provide full details in the space below.