Note: Information provided in this form will be provided to solicitors for the defence of the claim, potential claim or in reasonable anticipation of litigation. The information will be used to provide legal advice to Lexon Insurance and to you and your Law Practice. As such the contents are private, privileged and strictly confidential for the exclusive use of Lexon Insurance and its legal advisors.

When completed, please return this form to:

Lexon Insurance

GPO Box 1439

Brisbane Q 4001

Fax: 07 3229 4211

Email:

Privilege

Information provided in this form will be provided to solicitors for the defence of the claim, potential claim or in reasonable anticipation of litigation. The information will be used to provide legal advice to Lexon Insurance and to you and your Law Practice. As such the contents are private, privileged and strictly confidential for the exclusive use of Lexon Insurance and its legal advisors.

Legal information

Lexon Insurance Pte Ltd is a wholly owned subsidiary of the Queensland Law Society (“QLS”) and is a captive insurer providing only professional indemnity insurance to members of the Queensland legal profession in accordance with the QLS Indemnity Rule 2005.

Financial Services Reform Disclosure Notice

Pursuant to ASIC class order relief, the QLS and/or persons responsible for these matters are not licensed under the Corporations Act 2001 (Cth) in relation to the operation of the:

a.  Law Claims Levy Fund

b.  Professional indemnity insurance arrangements made under the Queensland Law Society (Indemnity) Rule 1987 (Qld) and, from the repeal of that Rule, the Queensland Law Society (Indemnity) Rule 2005 (Qld) and

c.  Legal Practitioners Fidelity Guarantee Fund.

The QLS is not regulated under the Insurance Act 1973 (Cth).

Lexon Insurance is exempt from the requirement to hold an Australian financial services licence under the Corporations Act 2001 (Cth) in respect of financial services.

Lexon Insurance is incorporated in Singapore and is regulated by the Monetary Authority of Singapore under Singaporean law, which differs from Australian law. Singapore has a system of financial supervision of insurers and you should consider whether to obtain further information about that.

Lexon is not authorized under the Insurance Act 1973 (Cth) to conduct insurance business in Australia and is not subject to the provisions of that Act which establishes a system of financial supervision of general insurers in Australia.

Lexon has a paid up capital of AUD $19M and any disputes in relation to the terms of the Master Policy will be governed by Queensland law.

Lexon cannot be declared a general insurer for the purpose of Part VC of the Insurance Act 1973 (Cth) and, if Lexon becomes insolvent, you will not be covered by the financial claims scheme provided under Part VC of that Act.

1. Law Practice details

Law Practice details as at the date of the circumstances, acts or omissions allegedly giving rise to the claim or possible claim:

Law Practice name at that date
2. Claimant details
Name of claimant or potential claimant
3. Background to Claim
Please provide a summary of the background to the claim or circumstance together with the details of any allegations made or anticipated. If there are any relevant documents which you think would be useful for Lexon Insurance to see at this stage, please provide copies. Unless it is strictly necessary please do not send your complete file at this point in time.
What are your views on liability?
Do you think anyone else could be liable and, if so, please provide details
What, if anything, have you said to the claimant/potential claimant about the claim or circumstances? Please provide copies of any relevant documentation.
What are your views as to the anticipated heads of loss and current best estimate of loss:
4. Action required
Is any urgent action required eg making an application after a missed limitation period, responding to the claimant or taking steps to reduce/avoid loss arising?
Can the problem be rectified or mitigated? If so, how?
What are the prospects of success?
6. Risk Management
What risk management action, if any, have you taken or do you intend to take in response to the claim/circumstance?
7. Confirmation

I confirm that I am duly authorised by the relevant Principals (sole practitioner / partners / legal practitioner directors / legal practitioner partners) to receive advice and provide instructions to Lexon Insurance and its solicitors.

Signed:
Print name:
Date:

Instructions and Information for Defence v2 Page 5 of 5

Lexon Insurance Pte Ltd © 2012