Fillable Professional Indemnity Insurance Arrangements For Western Australian Law Practices

2. LAW PRACTICE DETAILS

Does your law practice generate 90% or more of its gross fee income from undertaking criminal law work?

Yes

If yes, please note the undertaking in the declaration below.

A Legal Practice (other than a LFE) that derives at least 90% of its legal fees from the practice of criminal law during the 12 month period ending 31 December 2016 is entitled to a 30% Criminal Law

discount on the Annual Contribution. A Legal Practice entitled to a Criminal Law discount is not entitled to any other discount.

Does your law practice have a Law Society of Western Australia’s Quality Practice Certificate?

Yes

Does your law practice qualify for the Risk Management Discount?

Yes

A Legal Practice will qualify for a 5% discount (the Risk Management Discount) on its Annual Contribution if it has met the training requirements set out below:

•

All of the Partners or Practitioner Directors and at least 80% of the employed Practitioners of the Law Practice have attended at least two (2) hours of Law Mutual (WA) approved risk management

training in the period 1 March 2016 to 28 February 2017 (for the 2017/18 insurance year).

The approved training for the purpose of the Risk Management Discount is set out below:

•

Risk management seminars held by Law Mutual (WA)

•

Select CPD seminars held by the Law Society of Western Australia

•

External training courses or in-house training approved by Law Mutual (WA)

Does your law practice intend to conduct a multi-disciplinary partnership during the period 30 June 2017 to 30 June 2018?

Yes

If yes, please attach a separate page with the following information:

(a) When will / did the multi-disciplinary partnership commence?

(b) What disciplines other than a law practice will your practice conduct?

(c) Please provide details of your practice’s professional indemnity insurance for those activities (other than as a legal practitioner) including the name of the insurer and the limit of indemnity.

What is your actual gross fee income for the period 1 January 2016 to 31 December 2016?

If you are unable to provide your actual gross income for this period, you will need to provide your best estimate of your gross fee income for the period.

If you were not operating for all of this period, please provide your best estimate of your gross fee income for 12 months from the commencement of your practice.

3. FOR NEW PRACTICES

Commencement date of the law practice if after 30 June 2017:

What is your best estimate of gross fee income for the 12 months beginning from your commencement date?

4. UNDERTAKING, DECLARATION AND ACKNOWLEDGEMENT

I declare that the information that has been provided on this form is true and correct.

I undertake that the Law Practice will produce, within 7 days of a written request by Law Mutual (WA), documentary proof that it has met any requirements entitling it to

the Criminal Law or Risk Management Discount.

The Law Practice agrees that if such documentary proof is not produced to the satisfaction of Law Mutual (WA), the Law Practice will immediately repay to Law Mutual

(WA) the equivalent of the Discount it received together with the GST payable thereon. Further, the Law Practice will not again be entitled to the Discount until it has

completed two consecutive years of the relevant requirements.

I acknowledge that the information provided in this Form will be used by Law Mutual (WA) in processing the Law Practice’s application for professional indemnity

insurance and that I will provide verification of any of the information in the Form if it is required by Law Mutual (WA).

I acknowledge that if the Law Society determines that the information cannot be verified and an incorrect declaration was made either deliberately or without any proper

basis, it may refer the this Application Form to the Legal Practice Complaints Committee as a complaint in accordance with Section 409 of the Legal Profession Act 2008.

Signed:

Date:

Must be signed by the sole practitioner or partner

Sole Practitioner / Partner Name:

Name of authorised contact of business if different from the above:

TELL US NOW ABOUT ANY CLAIMS OR CIRCUMSTANCES

If the law practice or any practitioners named in this form are aware of any claims, or circumstances which may give rise to a claim, that have

not previously been notified to Law Mutual (WA) they should provide full details to Law Mutual (WA) in writing immediately.

DID YOU KNOW?

•

Your law practice is entitled to a 5% discount on its Annual Contribution if it is has a Law Society of WA Quality Practice Certificate?

Contact the Law Society of Western Australia for further details.

•

The Law Society of WA provides its members with the opportunity to participate in the Limitation of Liability Scheme. This may limit the

quantum of your Law Practice’s liability in the event of a successful claim against it. Contact the Law Society of Western Australia for

further details.

•

Law Mutual (WA)’s website contains tools and information that can assist you to better manage your professional liability risks.

Visit our website at .au

LAW MUTUAL (WA) COLLECTION NOTICE: Law Mutual (WA) collects the personal information contained in this form pursuant to the provisions of the Privacy Act, 1988 and the Australian Privacy Principles.

The information is collected by Law Mutual (WA) to enable it to administer and conduct its professional indemnity scheme and to provide its services and benefits to its members and the public. Those services

and benefits are set out in detail on the Law Mutual (WA) website (.au). If the information collected in this form is not provided, Law Mutual (WA) may not be able to provide its services as

effectively. Individuals who wish to access information held about them, who wish to make any complaints or who wish to obtain details about information which is disclosed by Law Mutual (WA) to overseas

recipients may do so by accessing the Privacy Collection Notice located on the Law Mutual (WA) website or may contact the Law Mutual (WA) Privacy Officer.

Professional Indemnity Insurance Arrangements For Western Australian Law Practices - 2017-2018 Page 2

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