B. Please provide details onassociates who have left your company in the last 5 years (attach a separate sheet if required).
List the name ofassociate, date they left the brokerage and why their employment ended. (i.e., associate resigned,associate was dismissed, etc.). If theassociate was dismissed, indicate if any disciplinary actions were taken.
5. Has the brokerage arranged the purchase or sale of an existing mortgage on behalf of a lender in the past 24 months? Yes No
6. Please provide the following information on Brokering Activities and Gross Revenues
Please complete all fields and write $0 if your brokerage does not perform the specified mortgage type or use the specified funding source
A. Average annual gross revenues earned by the brokerage over the last 5 year period: $
(Question A does not relate to mortgage volumes)
B. Please estimate for the current fiscal year only if the brokerage has been in operation for less than 12 months.
Mortgage Activities
Prior Year Fees/ Commissions Earned
Forecast Current Fiscal Year Fees/Commissions Earned
% of Total (Current Year)
A) Types of Mortgages Arranged (Do not enter mortgage volumes arranged in fields provided; only enter fees / commissions) (NOTE: all fields must be filled in enter numbers only , no commas)
Residential mortgages
$
$
Construction mortgages
$
$
Commercial or Industrial Mortgages
$
$
Totals for Section A) * NOTE - Construction mortgages should include all types of lending for construction projects. Do NOT include Residential or Commercial construction mortgages in the Residential or Commercial categories under section A.
$
$
B)Mortgage Funding Sources
(NOTE: If No Revenues Enter 0)
Mortgages placed with Institutional Lenders (Banks, Trusts and others)
Mortgages funded "In-house" with own and/or related company sources
$
$
Totals for Section B)
$
$
Totals of Section B) MUST match this total
$
$
7. Is your brokerage involved in arranging second or third mortgages: Yes No
A) Estimate the volume (i.e., total number of mortgages) of second/third mortgages arranged as a percentage of the total number of mortgages arranged over the past 12 months: %
B. Do you arrange second or third mortgages with private lenders? Yes No
If "No", please list the institutional lenders with whom you arranged second or third mortgages in the past 12 months:
C) Complete the following table with respect to second/third mortgages arranged:
Estimated number of second/third mortgages Arranged
The insurer is seeking an estimated total number that should be within 20% of the actual number
Estimated Average Value of the second/third mortgages arranged
Largest second/third mortgage arranged
% of Total revenue Generated from Arranging second/third mortgages
Last year
$
$
Estimated for current fiscal year
$
$
8. Please provide the following information on Construction Mortgages :
Not Applicable
A) If your brokerage arranged construction mortgages then please provide the funding sources utilized as an
approximate percentage of the total construction mortgage volume for the brokerage::
Construction Mortgage Funding Sources
% of Volume (by number)
Institutional lenders (banks, credit unions etc.)
%
Private lenders (individuals, M.I.C.s, etc.)
%
In-house private funds (broker/ssociates funded)
%
(Total must be 100%)
%
B) If your brokerage arranged construction mortgages then please provide the types of construction projects
funded as an approximate percentage of the total construction mortgage volume for the brokerage:
Construction Project Type Being Funded
% of Volume (by number)
Individual mortgagors for their own occupancy or property development purposes
%
Property Developers for Marketing Purposes - Individual residential units
%
Property Developers for Marketing Purposes - Multiple unit residential (i.e., subdivisions or condos) or commercial
%
(Total must be 100%)
%
C) Is the lender always responsible for making the decision to advance funds to the borrower? Yes No
If no, please explain who has the authority to advance funds on behalf of the lender?
D) Are you responsible for the site visits before releasing the funds or advising the lender to release the funds? Yes No
If "Yes", please complete the following:
i) Provide the details on how the site visits are conducted:
ii) Do you keep a record of all the correspondence with the Lender regarding your site visits? ?Yes No
iii) If "No", give us the reasons why records are not maintained:
9. Please provide the following information on Private Mortgages. Questions 9 - 12 - Not Applicable
Is your brokerage or any Mortgage broker/ssociate involved in the arrangement of Investors into a mortgage fund (i.e., Mortgage Investment Corporation, trust or syndicate) managed by the brokerage? Yes No
(A) If "Yes", provide the revenues generated from managing/administering the fund: $
(B) If "Yes", please also provide the total asset size of the mortgage fund: $
Please Note: Arranging or placing investors into a mortgage fund is NOT a Professional Service covered under this policy.
10. Please provide the details on how mortgages are placed with third party private lenders through your brokerage:
Do you ever represent individual private lenders when arranging mortgages? Yes No
(Answering "No" means you only represent the borrowers in the transaction)
If you answered "Yes" to question A, please answer the following:
A. Do you solicit the private lenders for arranging funds for the borrower? Yes No
B. Do private lenders approach the mortgage brokerage for the placement of their funds into mortgages? Yes No
C. Are all applications verified for accuracy and correctness when arranging mortgages through individual private lenders? Yes No
If "No", please give us the reasons for not verifying:
D. Are the risks associated with lending explained to the private lender, if the mortgage broker/ssociate approaches the private lender to fund mortgages? Yes No
11. Have you or any of your mortgage brokers/ssociates been granted authority by any lender to fund mortgages on their behalf without receiving prior approval from the lender? Yes No Please provide the details:
12. Do you conduct any in-house appraisals of property?Yes No
If "Yes", explain under what circumstances you conduct an in-house appraisal instead of using a third party appraiser?
13. Is the private lender always responsible for making the decision to advance funds to the borrower? Yes No
If "No", please give us the full details on the due diligence you perform prior to advising the private lender to release their funds to the borrower:
14. Please provide the following details about your business:
A) Does your company have any business operations in the USA? Yes No
Please note that US operations are not covered under this policy. Please contact LMS PROLINK if you wish to further discuss your US operations.
*** If "Yes", please note that US operations are not covered under this policy.
Contact LMS PROLINK if you wish to further discuss your US operations.
B) Are you or any Mortgage broker/ssociate involved in any other professional activity other than Mortgage Brokering?
Yes No
Example: Real Estate.
If “Yes”, please note that you or any Mortgage Broker/Agent under this policy is NOT covered for any liability for any Profession other than as a licensed Mortgage broker/ssociate.
15. Please complete the following checklist by selecting either "Yes" or "No":
Mortgage Brokerage Procedures
A) Do you have an office procedural manual?
Yes No
B) Do you have a brokerage trust account?
Yes No
C) If "Yes", do mortgage funds ever go through the brokerage trust account?
Yes No
D) Do you perform a background check before hiring an associate?
Yes No
E) Do you conduct any training for the associates?
Yes No
16. What type of client file system does your brokerage utilize: Hardcopy File System (i.e., paper based) Electronic Mortgage Origination System (i.e., Filogix, MorWEB etc.) Other
17. During the past three years, are you, your employees or any of your associates aware of any circumstance, allegation, contention or incident which may potentially result in a claim for an error or omission in the performance of a professional service being made against your entity, you, any mortgage broker or associate or employee present or past associated or working with your entity? Yes No
If "Yes", please attach an additional page with full details including the date of the claim or allegation.
18. Have you or any of the Mortgage Brokers or Associates under the applicant:
A) Had their license suspended or terminated by a regulatory authority?Yes No
B) Ever been called before an investigative committee for disciplinary proceedings for professional misconduct by a professional society/board or any statutory registration board?Yes No
C) Been censured or fined by a regulatory authority? Yes No
If you've answered "Yes", to any of these questions, please attach an additional page with full details including dates.
19. Are there any E&O losses paid or outstanding in the last 3 years against the brokerage, the broker or any associate of the company? Yes No
If "Yes", please give all details along with the amount of claim:
20. Policy Limits and deductibles
Deductibles over $2500 are only available to large firms with revenues in excess of $500,000. The deductible is not applicable to defense costs (an obvious benefit in the event of a frivolous lawsuit) and only applicable to damages awarded to the claimant.
Limits Requested:
Deductible opted for
$ 500,000 per claim/ $1 million aggregate
$1000
$1 million per claim/ $1 million aggregate
$2500 (AMBA Standard)
$1 million per claim/ $2 million aggregate
$5000
$2 million per claim/ $2 million aggregate
$10,000
$2 million per claim / $4 million aggregate
Other (please specify):
SECTION 3: INSURANCE & LOSS HISTORY INFORMATION
1. A) Do you currently maintain a Commercial Office insurance policy? Yes No
By commercial office insurance we mean insurance that covers office contents and general liability or CGL. We are able to provide excellent rates through the AMBA insurance program as a bonus to members who have purchased E&O insurance.
B) Are you interested in receiving a Commercial Office insurance quote under the AMBA program? Yes No
2. Please provide the details below in order to receive a no-obligation quotation:
Current Insurer:
Premium: $
Policy #:
Basic Contents Limit: $
CGL Limit: $
Expiry Date:
3. Has any insurer ever declined, cancelled or imposed special conditions for any coverage, for you or your entity in the past? Yes No < Required If "yes" please give details:
4. Commercial Insurance Policy loss history, please provide details below (attach additional page(s) if necessary):
Year
Insurer
Loss Detail(s)
# of Loss(es)
Total Amount(s) Paid
$
$
$
Section 4. Underwriting Information for the Alberta Insurance Council E&O Insurance
Do any of your brokers/associates hold a restricted life insurance license through the Alberta Insurance Council? Yes No
1. Does the applicant have the authority to bind coverage for mortgage life insurance? Yes No
If "Yes" please explain what levels of binding authority (size of mortgage, etc) the applicant has with mortgage life insurers:
2. Please give the names of all employees who act as restricted life insurance agents and are covered under your restricted certificate of authority ("Agent(s)"). Attach a list containing additional names if more space is required:
Name of Individual
Broker/Agent/Owner
AMBA Member ( Y/N )
Life Insurance Products Sold
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
3. Please provide gross fees and/or commissions from the sale of mortgage life insurance products:
Last 12 months: $ Projected for the next 12 months: $
4. Limits Requested:
Number of Employees Acting as Mortgage Life Agents
Select
Errors & Omissions Liability Limits
1 employee
$ 500,000 per claim/ $ 500,000 aggregate
2 employees
$ 500,000 per claim/ $ 1,000,000 aggregate
3 employees
$ 500,000 per claim/ $ 1,500,000 aggregate
4 employees
$ 500,000 per claim/ $ 2,000,000 aggregate
5 or more employees
$ 500,000 per claim/ $ 2,500,000 aggregate
Optional coverage limit
$ 500,000 per claim/ $ 3,000,000 aggregate
The above limits are the minimum requirements outlined by the AIC. AMBA members may elect
to purchase the $3 MM limit for a higher premium.
Important Notice to Applicant
This is an application for insurance and the insurer is not obligated to accept the applicant for coverage. If a policy is issued, one signed copy of the application will be attached to the policy or certificate. Signature on the application form and submission of a premium payment does not bind the insurer to complete an insurance transaction with the applicant. This policy provides Errors and Omissions insurance that applies on a claims-made basis. The following provides a general description of this coverage and is subject to the terms and provisions of the actual policy.
A. The policy will not cover any losses from incidents which take place before the Retroactive Date, if any, or after the expiration of the policy period (subject to the Extended Reporting Period provision).
B. The policy will provide coverage for losses from incidents which take place on or after the Retroactive Date, if any, but before the beginning of the policy period only if the insured did not know of the incident before the beginning of the policy period.
C. The policy will not cover any loss for which a claim is first made after:
The expiration of the policy period or its earlier termination date, if any; or
The Extended Reporting Period if any and then only in accordance with the terms described in the policy.
D. The policy will only cover claims which are first made:
During the policy period; or
During an Extended Reporting Period if any and then only in accordance with the terms and conditions described in the Extended Reporting Period Section of the policy.
E. Please request a copy of the Policy and review the terms and conditions to obtain more information.
F. The limits for Defense Costs are included in the policy limit except where the laws of the province of Quebec apply.
G. This policy will not cover you or any of your associates for mortgage brokering services provided in a province where they are not licensed to practice as a mortgage broker or associate.
Disclosure and Consent
As part of my application for insurance I consent to the collection and use of personal information required for purposes of considering my application for errors and omissions insurance by the insurer Echelon General Insurance Company and the authorized insurance broker, LMS PROLINK Ltd . The insurer and the broker are authorized to collect, use, and disclose personal information and provide such personal information to third parties, as required for the purpose of underwriting this application for insurance, as permitted by the relevant provincial and federal privacy laws or other applicable laws. The privacy policy of Echelon General Insurance can be viewed at the website www.echelon-insurance.ca.
I understand that at any time I may ask to review the personal information pertaining to my application for insurance and the insurer and broker will be obligated to provide me with any information I am entitled to receive under the relevant provincial and federal privacy laws or other applicable laws.
I have reviewed the information in this Application, gathered information from all partners/directors/ officers/ employees/ssociates under this entity whether present or prior regarding their knowledge or awareness any error, omission or negligent act in the performance of professional services for others.
The Claim Information Forms, if any, that are attached to this Application include the details of:
All fact situations and incidents which have occurred in the past and which may reasonably be expected to result in a claim, suit or arbitration against the us (the Applicant);
All fact situations and incidents which have occurred in the past and which may reasonably be expected to result in a claim, suit or arbitration against us (the applicant) in the future. All such claims, suits and incidents have been reported to our (Applicants) current or prior insurer(s). It is understood and agreed that all such claims, suits, arbitrations, fact situations and incidents will be excluded from coverage under any policy issued by the Company.
It is understood and agreed that failure to provide true and complete response to any of the questions, statements or request for information in this Application or to provide any other information material to this Application may, at the sole option of the Company, result in the voiding of the insurance policy issued in reliance on this Application and /or denial of coverage for specific claims asserted against us (the Applicant) or any other insured under the policy. The undersigned on behalf of Applicant and all other insured under any this policy issued by the Company, hereby waives any defence to an action by the Company for recession of such policy based upon misrepresentation of fact or failure to disclose material information in connection with this Application. Applicant agrees to hold the Company harmless from all loss as a result of any such misrepresentation or failure to disclose, including, without limitation, all costs and attorney fees incurred by the Company in connection with said action for rescission.
I HEREBY DECLARE that the above statements and particulars are true to the best of my knowledge, that I have not suppressed or misstated any facts and I agree that this application shall form part of the insurance policy. I also acknowledge that I am obligated to report any changes that could affect the disclosures in this application that occur after the date of signature, but prior to the effective date of coverage.
Name:
Date:
Please check this box to confirm that you are authorized to complete the renewal application on behalf of the mortgage brokerage.
PLEASE CONTACT KRISTIN MAVROUDI AT LMS PROLINK IF YOU ARE HAVING ANY DIFFICULTY WITH THE ONLINE RENEWAL APPLICATION.
Kristin Mavroudi:
Phone: 800-663-6828 x 7703
Fax: 416-595-1649
Email: KristinM@lms.ca
If your application has been successfully delivered to LMS PROLINK if you will receive an email delivery
confirmation to the email address listed on the top of this application.
(NOTE: all fields must be filled in