DIRECTORS AND OFFICERS LIABILITY AND COMPANY REIMBURSEMENT INSURANCE PROPOSAL FORM

NOTE: THE POLICY PROVIDES THAT THE LIMIT OF LIABILITY AVAILABLE TO PAY JUDGEMENTS OR
SETTLEMENTS SHALL BE REDUCED BY AMOUNTS INCURRED FOR LEGAL DEFENCE. FURTHER
NOTE THAT AMOUNTS INCURRED FOR LEGAL DEFENCE SHALL BE APPLIED AGAINST THE
RETENTION AMOUNT. IF A POLICY IS ISSUED, THE PROPOSAL WILL BECOME PART OF THE
POLICY, THEREFORE IT IS NECESSARY THAT ALL QUESTIONS BE ANSWERED ACCURATELY AND
COMPLETELY.
IF A POLICY IS ISSUED, IT WILL BE ON A CLAIMS-MADE BASIS.

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