MAPFRE Middlesea p.l.c.

Middle Sea House, Floriana FRN 1442 Malta

T: (+356) 2124 6262
[email protected]
Registration Number: C5553

CONDOMINIUM INSURANCE PROPOSAL FORM

ALL RELEVANT QUESTIONS MUST BE FULLY ANSWERED

Name of proposer:

Contact person: ID Card Number:

Contact Number: Email Address:

Postal Address:

Address of Premises to be Insured:

INFORMATION TO BE PROVIDED

About the Block of Flats:

1. (a) Is the block built of bricks, stone, concrete or incombustible material (including YES | NO
basement)?

(b) Is the whole block in a good state of repair and will it be so maintained? YES | NO

(c) How many stories make up the block? (including basement)?

(d) How many flats are there in the block?

(e) How many garages are there in the block?

(f ) How many lifts are there in the block?

(g) Are all the stairs and lift shafts enclosed by walls of brick, stone or conrete? YES | NO

(h) Is there a swimming pool? YES | NO

(i) Are all flats in the block presently occupied? YES | NO

If “NO”, please give details:

2. Have you ever had:

(a) A proposal for similar insurance or renewal of policy declined or policy YES | NO
cancelled?

(b) Any accidents or losses in respect of any sections to be selected? YES | NO

SUM INSURED/ LIMIT OF INDEMNITY

SECTION 1 - BUILDINGS:
Buildings (Sum insured must reflect the current rebuilding value) YES | NO

Does this amount reflect the common parts only? YES | NO

SECTION 2 – CONTENTS YES | NO

SECTION 3 - PROPERTY OWNER’S LIABILITY YES | NO €235,000

If you require a higher limit please state limit required

SECTION 4 - MACHINERY BREAKDOWN YES | NO

Please indicate the limit:

€ 250.000

€ 600.000

€ 1.200.000

Please provide details of lift/s,

Make:

Model:

Year of manufacture:

Are the lift/s inspected yearly by a qualified engineer? YES | NO

IMPORTANT NOTE

You should not sign this Proposal Form and its statements or declarations before you have read and understood them. If this
document is being completed by someone else on your behalf please ensure that the details on it accurately reflect what you
have said.

APPLICABLE LAW

Unless both you and we agree otherwise this contract shall be subject to Maltese Law and to the exclusive jurisdiction of the
Maltese courts.

INSOLVENCY

In the event that we become insolvent and unable to meet our obligations under this contract, limited compensation may be
available to you under the Protection and Compensation Fund Regulations, 2003.

COMPLAINTS

We are committed to providing good quality services. We recognise that a client may not be satisfied with the service provided.
To deal with this we have a complaints procedure. For the sake of clarification a complaint is broadly defined as being a written
expression of dissatisfaction with services that we provide or actions we have taken that require a response. We distinguish
complaints from queries. Queries are challenges to specific decisions in specific circumstances.

The Company will deal with your complaint

The Company does not look at complaints as unwanted. In fact, they may help the Company to see where its services or procedures
may be improved. It is in the parties’ interest for the Insured to let the Company know when the Insured feels that the Company has
made a mistake or done something which the Insured finds unsatisfactory. Even if the Insured does not think that the particular
concern amounts to a complaint the Company would still like to know about it. The Insured will help the Company improve its
service further.

HOW TO COMPLAIN

STEP 1 – CONTACTING THE COMPANY

The first step is to talk to a member of the Company’s personnel or of the intermediary if the Policy was arranged through one. This
can be done informally either directly or by telephone.
Usually the best person to talk to will be the person who dealt with the matter the Insured is concerned about as they will be
in the best position to help the Insured promptly and to put things right. If they are not available or the Insured would prefer to
approach someone else then address the matter to the manager or senior person responsible. The Company will seek to resolve
the problem immediately. If the Company cannot do this then the Company will take a record of the concern and arrange the best
way and time for getting back to the Insured. This will normally be within two working days.

STEP 2 – TAKING THE COMPLAINT FURTHER

If the Insured is still unhappy the next step is to put the complaint in writing, addressing it to the Complaints Officer, setting out
the details, explaining what the Insured thinks went wrong and what the Insured feels would put things right. If the Insured is not
happy about writing a letter, the Insured can always ask a member of the Company to take notes of the complaint which the Insured
will be then asked to sign. The Insured will be provided with a copy for their own reference. This record will be passed promptly
to the Complaints Officer to deal with.
Once the Complaints Officer receives a written complaint, s/he will arrange for it to be fully investigated. The complaint will be
acknowledged in writing within five working days of receiving it and the letter will state when the Insured can expect a full response.
This should normally be within fifteen working days unless the matter is very complicated such as where other organisations need
to be contacted. Where this is the case the Company will still let the Insured know what action is being taken and will inform the
Insured when the Company expects to provide a full response.

TAKING YOUR COMPLAINT ELSEWHERE

If you are still not satisfied with the Complaints Officer’s response, you can always seek advice elsewhere. You may contact:

Office of the Arbiter for Financial Services

First Floor
St Calcedonius Square
Floriana FRN1530
Malta
Telephone: 8007 2366 or 21249245
E-mail: [email protected]
Website: www.financialarbiter.org.mt

The Office of the Arbiter will expect that you have a final reply to your complaint from us before approaching them.
DATA PROTECTION PERSONAL PROCESSING CLAUSE

The Proposer is hereby informed and expressly consents, by signing this document, to the processing of the data voluntarily provided
in this document, as well as of any data which might be provided to MAPFRE Middlesea Plc or “The Company” directly or through
an Insurance Intermediary, and those obtained by recording telephone conversations or as a result of browsing through Internet
webpages or by other means, for the enforcement of the agreement or regarding a quotation, application, or the contracting of any
service or product, even after the end of the pre-contractual or contractual relation, including, if applicable, any communication
or international data transfer which might be made for the purposes specified in the Additional Data Protection Information which
is available from any MAPFRE Middlesea Plc Office or through www.middlesea.com/insurance-mt/data-protection/

The Proposer consents in turn to the recording of any telephone conversations with the Company regarding the insurance
agreement.

MAPFRE Middlesea Plc may view the Proposer’s data in files regarding the fulfilment and non-fulfilment of monetary obligations.
Should the data provided pertain to physical persons other than the Proposer, the latter guarantees that he/she has obtained and
has their prior consent for the communication of their data and has informed them, prior to their inclusion in this document, of
the purposes of the data processing, communications, and other terms established herein and in the Additional Data Protection
Information.

The Proposer declares that he/she is older than eighteen (18) years of age. Likewise, should the data provided belong to minors,
as the minor’s parent(s) or guardian(s), he/she expressly authorises the processing of the said data, including; if applicable, data
pertaining to health, for the management of the purposes specified in the Additional Data Protection Information which is available
from any MAPFRE Middlesea Plc Office or through www.middlesea.com/insurance-mt/data-protection/

The Proposer guarantees the accuracy and truthfulness of the personal data, including sensitive personal data provided,
undertaking to keep them duly updated and to notify MAPFRE Middlesea Plc of any changes in them.

Basic data protection information

Controller: MAPFRE Middlesea Plc

Purposes: Management of the insurance agreement, creation of profiles for suitable enforcement of the
insurance agreement, integral and centralised management of the relation with the MAPFRE
Group, and delivery of information and advertising on MAPFRE Group products and services.
Standing: Execution of the project.
Recipients: Data may be communicated to third parties and/or data transfers may be made to third-party
countries in the terms stipulated in the Additional Information.
Rights: You can exercise your rights of access, rectification, removal, limitation, objection, and
transferability, specified in the Additional Data Protection Information.
Additional Information: You can view the Additional Data Protection Information which is available from any MAPFRE
Middlesea Plc Office or through www.middlesea.com/insurance-mt/data-protection/

Check this box if you object to the processing and communication of your personal data by MAPFRE
Middlesea Plc for the delivery of information and advertising of the Company products and services, of the various MAPFRE
Group companies, and of Third party companies with which any MAPFRE Group company has entered partnership agreements. If
you do so, we will be unable to inform you of any discounts, gifts, promotions, and other benefits associated with the MAPFRE Group
customer loyalty plans.

In any case, your consent to the treatment of your data for these purposes is revocable, and you may withdraw your consent or
exercise any of the rights mentioned at any time as specified in the Additional Data Protection Information which is available from
any MAPFRE Middlesea Plc Office or through www.middlesea.com/insurance-mt/data-protection/

PROFESSIONAL SECRECY

I consent on my behalf and on behalf of any other person specified in this form (others), that the Company or any other member
of the Group may exchange some or all of the information with my insurance intermediary, appointed experts, other insurance
companies or the Malta Insurance Association for the purpose of administering my insurance proposal and policy, handling and
settling of claims, detecting, preventing and suppressing fraud and the keeping of statistics. I also authorise (on my own behalf
and on behalf of others) insurance companies and intermediaries to disclose information about or relevant to my insurance history
for these purposes.

I understand (and have explained to Others) that when I tell the Company about an incident which may or may not give rise to a
claim, the Company may pass information relating to it to the Malta Insurance Association and / or other insurance companies
and intermediaries. In doing so we will ensure that this communication is carried out confidentially and within the terms of the
Professional Secrecy Act, 1994

Material Facts are those facts which are likely to influence us in the acceptance or assessment of this proposal and it is
essential that you disclose all of them. If you are in doubt about whether a fact is material then for your own protection you
should disclose it since failure to do so could invalidate your policy.
DECLARATION
I have read or have had read to me the contents of this completed proposal form and agree that the above statements are to the
best of my knowledge and belief correct and complete and will form the basis of the contract between me and MAPFRE Middlesea
p.l.c. (us). I confirm that I have disclosed all Material Facts and accept our standard form of policy for this type of insurance. I am
satisfied with the way the proposal has been completed. I confirm that if this form has been completed by one of our employees
and/or authorised intermediary on my behalf such person shall, for that purpose be regarded as my agent and our agent. I agree
to read the policy and be bound by the terms, conditions, limitations and exclusions of the said policy.

Before signing this document, please read the basic data protection information given in the PERSONAL DATA PROCESSING
clause. By signing this document, you consent to the processing of your personal data, including sensitive personal data in the
terms and conditions stipulated in said clause.

Period of insurance required

Signature of
Date
applicant

Intermediary

COND PRF 01.05.18.

MAPFRE Middlesea p.l.c. (C-5553) is authorised by the Malta Financial Services Authority to carry on both Long Term and General
Business under the Insurance Business Act, 1998.