Bankers Blanket Bond

Personal Details

Risk Details

General Policy Details

Personal Details

Proposer Type

Bank Assurance Officer

Select Intermediary branch

Insurance Company

ID Type

ID Number

KRA Pin

First Name

Middle Name

Last Name

Type of Business

Occupation

Date Of Birth

Gender

Male Female

Contact Details

Mobile No.

Telephone No.

Email Address

Postal Address

Postal Office

Town

County

Region

Earth Quake Zone

Physical Address

Which FBBI branch do you want to be served from?

Period of Insurance

StartDate

EndDate

Proposer Details

Name of Proposer

Principal / Employer address

Street

Area/Estate

City/Town

County

Date Established

Principal Activities

Has the proposer been involved in, or been subject to, any mergers or acquisitions in the past five years?

Are any plans for merger or acquisition, consolidation or divestment being considered?

State all shareholdings greater than 15% of the Proposer’s ordinary share capital

Shareholders Details 1

Shareholder Name

Percentage Held

Employee Details

Description	Current Year Figures	Previous Year Figures
Total number of employees
Out of which Number of employees abroad
Number of temporary staff
Compliance department and internal audit staff numbers
Sales staff, front office and any employees directly involved with third parties
Administrative and business support staff

Number of Branches

Branch Details 1

Type of Branch

Please provide a complete list of subsidiaries of the proposer to be covered

Subsidiary Details 1

Subsidiary Name

Country

Percentage Held

Acquisition Date/ Creation Date

Principal Activities

Number of Staff

Please state the consolidated figures for the following

Description	Current Year	Previous Year
Total Assets
Paid up Capital
Earnings before Income Tax (EBIT)
Total Deposits
Total Loans
Total Funds under Management

Please state consolidated figures for the following

Number of Client

Inactive accounts (being those with no movements in or out during the past 12 months

Savings and Deposit Accounts

Please split in percentage the Proposer’s operating income

By activities performed

Activities Details 1

Activity

Percentage

By type of client

Activities Details 1

Activity

Percentage

Does your company work with a network of independent agents?

Human Resources

How many employees are there in the Human Resources department performing the HR functions for the Proposer and all its subsidiaries?

Does the Proposer have an employee Handbook/Manual?

Are employees trained and re-trained, if necessary, on all aspects of

Physical and electronic data security?

Operational Procedures?

Are the duties of each employee arranged so that no one employee is permitted to control any transaction from commencement to completion?

Are all employees required to take an uninterrupted, two weeks holiday / vacations each calendar year?

Do you have an established group recruitment policy which assesses the suitability for all positions?

Are references for new employees requested and verified?

Does the Proposer verify the criminal records of each employee?

Are initial verification repeated at regular intervals (at least every 2 or 3 years)?

Do you have established employee leaving procedures?

Are departures communicated to the EDP Department for immediate code access to systems cancellation?

Does the Proposer have a written Code of Ethics?

Are all management and employees

Provided with a copy of such Code?

Required to agree in writing that they have read the ethics code and are abiding by said code?

Are all employees trained on

The proper implementation of the Proposer's personnel policies and procedures

Fraud awareness?

Do you require all independent contractors to have separate insurance policy?

Internal Controls and Procedures

Are there any written Group policies (norms, standards, golden rules, not procedures) that cover all business processes?

Are any branches or subsidiaries allowed to maintain different operational procedures than the Proposer?

Does each operational business unit have its own internal control function responsible for daily controls and verification?

Do you maintain dual control over the handling of

Securities and other values?

Company checks, drafts and other 'safety stationary'?

Dormant accounts (if dormant for longer than 12 months)?

Access Codes, Cyphers, Test Keys)?

Access to Property whilst in safes and / or vaults?

Are 'nostro accounts' reconciled on a daily basis by employees’ independent from payment preparation and authorization?

Audit and Compliance

Do you have an internal audit department which has separate duties from the auditing services provided by an external accountant?

Does the audit team periodically review the segregation of duties, accuracy of records, management and supervisory procedures and the physical and non-physical internal controls?

Does the internal audit department have remote audit capabilities in order to monitor branch activities between 2 audits?

Does the latest management letter of your external auditors contain major comments on internal controls?

Do the external auditors review the EDP department?

Is there an Audit Committee implemented?

Do you have a compliance officer who monitors and implements all regulatory directives, rules, principles and guidelines?

Value at Risk

Please state the maximum value of securities (including negotiable collateral, unissued stock certificates, etc.)

At Head office:

At Main Branches:

At Other Branches:

At Custodians:

Please state the maximum amount of cash:

At Head office:

At Main Branches:

At Other Branches:

At individual Tellers

At Custodians:

Please state maximum amounts / values carried by

Armored motor vehicle:

Cash

Securities

Messengers:

Cash

Securities

Are all doors fitted with substantial locks?

Are all windows fitted with substantial barred?

Are all branches equipped with metal detector systems?

Are all branches' entrance equipped with mantrap systems?

Are there alarm systems against burglary connected in all locations?

Are the Teller Safes on premises?

Safe Deposit Boxes

Do you provide Safe deposit boxes facility?

How many locations provide safe deposit boxes facility?

How many safe deposit boxes are there?

At Head office

At Main branches

At Other branches

How many of these are rented?

At Head office

At Main branches

At Other branches

Are all safe deposit boxes in a separate safe deposit vault?

Are all boxes under dual control?

Funds Transfer and Remittance

Do you operate or subscribe to any automated teller machine network or electronic point of sale system?

Do you make or receive funds transfer instruction via any of the following methods?

Interbank electronic communications systems(SWIFT, ... )

Internet?

Electronic mail?

On-line cash management?

Other

Do you permit the transfer of funds via telephonic or facsimile instruction?

Lending Procedures

Do you operate and maintain a formal loan policy manual or similar internal document?

Are all loans independently reviewed to ensure compliance with the loan policy manual or similar internal document?

Treasury and Capital Markets

Are trader / dealers conversations tape-recorded?

Is there a formal list of authorized counter parties and brokers?

Are there permanent limits monitoring (financial limits, range of products, counter parties, etc.) by employees independent of the front-office employees?

Is there separation of duties for each day's trading transactions?

Do front-office and back-office units report to different Management line?

Are front-office employees authorized to operate after normal working hours?

Are front-office employees authorized to operate outside of the Company's premises?

Fund/Investment/Asset Management Companies

Do you offer fund / investment / asset management services to third parties?

Treasury and Capital Markets

Do you offer Treasury and Capital Market Fund / Investment / Asset Management services to Third parties?

Computer Systems

Have you designated a Data Security Officer, who is charged with responsibility for the implementation and administration of data security?

Do you use temporary staff in your EDP department?

Are there Technology policies and standards covering the following subjects:

Security and access control?

Data protection?

Back-up contingency plan?

Network and telecommunication?

Development?

Micro-computers (PCs)?

Are the Technology policies and standards available for review?

Are the Technology policies and standards enforced in all locations / subsidiaries?

Is there an internal EDP audit department?

Are passwords used to afford varying levels of entry to the computer system depending on the need and authorization of the user?

Do systems force passwords to be changed at least every 30 days?

Are Human Resources and EDP databases synchronized so that only existing and authorized employees can access the Systems?

Do you utilize any recognized software security packages to control access to your computer systems?

Are passwords encrypted to recognized standards?

Are data centers located in purposely built premises?

Are the data processing centers specifically protected?

Are there positive entry control procedures used to restrict the entry of non-authorize personnel into your data processing center?

Is at least one file generation (data, programs and systems) stored and secured off-site from the main data center in a restricted area?

Does the Company have a disaster recovery and business continuity plan that covers all technology operations (including telecommunication and Internet services)?

Internet Facility

Do you provide an Internet facility?

Do you have formal terms and conditions for the use of your Internet facility, which outline the obligations and responsibilities of the users?

Is the identity of users verified and authenticated?

Do you encrypt data whilst it is stored or held within your Internet facility?

Are firewalls and / or comparable software used to authorize access to your Internet facility?

Do you use any anti-virus software?

Do you monitor and produce reports on intrusion / unauthorized access activity?

Do you restrict access between your Internet facility and your main computer system?

Are intrusion test (scanning, etc.) organized on a regular basis?

Do you have a fully tested disaster recovery and business continuity plan for your Internet facility?

Particulars of Coverage

State the Limit of Indemnity and Excess required:

Limit of Indemnity required

Deductible

Have you in existence any blanket Fidelity insurances?

Professional Liability:

Do you require Professional Liability?

Have you in existence any Professional Liability insurances?

During the last five years has the Proposer received any admonishment or critical directive from any regulatory authority?

Is the proposer currently involved in any litigation as a defendant?

Does the Proposer undertake trust activities or discretionary account management?

Directors and Officers Liability

Do you require Directors and Officers Liability?

Have you in existence any Directors & Officers Liability insurances?

Limits of Coverage

Bankers Blanket Bond

Description	Limit Amount	Deductible for Each and Every Loss
Infidelity of Employees
On premises – Money or property
In transit – Money or property
Forgery or Alteration
Securities
Counterfeit Currency
Damage to Offices and Contents
Legal Fees

Electronic and Computer crime

Description	Limit Amount	Deductible for Each and Every Loss
Computer Systems
Electronic Computer Programs
Electronic Computer Instructions
Electronic Data and Media
Computer Virus
Electronic Communications
Electronic Transmissions
Electronic Securities
Forged Tele-Facsimile
Customer Voice Initiated Transactions
Mobile Money Transfers

Annual Aggregate Limit

General Policy Details

Are you now or have you ever been insured for this type of policy ?

Has any insurance company ever

Declined your proposal ?

Cancelled or refused to renew your policy?

Required an increased premium or imposed special conditions?

Declined your claim?

Insurance and Loss History

Please provide below information on any insurance claims you have reported in the last 5 years

Type of loss

Year of Incident

Claim Amount/ Value

Add Loss

Bankers Blanket Bond Proposal

Personal Details

Contact Details

Period of Insurance

Proposer Details

State all shareholdings greater than 15% of the Proposer’s ordinary share capital

Shareholders Details 1

Employee Details

Number of Branches

Branch Details 1

Please provide a complete list of subsidiaries of the proposer to be covered

Subsidiary Details 1

Please state the consolidated figures for the following

Please state consolidated figures for the following

Please split in percentage the Proposer’s operating income

By activities performed

Activities Details 1

By type of client

Activities Details 1

Work with agent details

Agent Details 1

Human Resources

Are employees trained and re-trained, if necessary, on all aspects of

Are all management and employees

Are all employees trained on

Internal Controls and Procedures

Do you maintain dual control over the handling of

Audit and Compliance

Value at Risk

Please state the maximum value of securities (including negotiable collateral, unissued stock certificates, etc.)

Please state the maximum amount of cash:

Please state maximum amounts / values carried by

Armored motor vehicle:

Messengers:

Are they connected to?

Safe Deposit Boxes

How many safe deposit boxes are there?

How many of these are rented?

Funds Transfer and Remittance

Do you make or receive funds transfer instruction via any of the following methods?

In respect of corporate or business accounts only:

Lending Procedures

Treasury and Capital Markets

does this include:

Fund/Investment/Asset Management Companies

please state:

Treasury and Capital Markets

please state

does this include:

Computer Systems

Are there Technology policies and standards covering the following subjects:

Does this include:

does this include:

Does this include:

Internet Facility

Do you offer any of the following?

Please identify the method used:

Particulars of Coverage

Bankers Blanket Bond

State the Limit of Indemnity and Excess required:

Professional Liability:

Directors and Officers Liability

Limits of Coverage

Bankers Blanket Bond

Electronic and Computer crime

General Policy Details

Has any insurance company ever

Insurance and Loss History

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