Lloyd’s Insurance Company Coverholder Onboarding –Service Provider Attestation
Coverholder Legal
Name (“The firm”)
PINSponsoring
Service Provider(Managing Agent)and Lloyd’s &Lloyd’s Europe
Syndicate Number
Sponsoring Broker

As the sponsoring Service Provider please confirm the following declaration for this
proposed coverholder:
We have reviewed the submission on ATLAS and to the best of our knowledge theinformation uploaded is correct, including the correct classes, regions and level of authority.
We also confirm Business aligns with Lloyd’s Performance StrategyThe business proposed to be bound by the firm is likely to support sustained long-term
profitability based upon a realistic underwriting driven business proposal

We have made suitable enquiries regarding any prior performance of this business

The firm will not sub delegate any of its underwriting authorities or systems to a thirdpartyCommissions are fair and reasonable, and the link between remuneration andprofitability is strong and interests are aligned

Fees are transparent and are proportionate with services delivered

Third party firms uphold Lloyd’s values, protects the brand and provides good valuefor policyholders
The firm will provide a valuable product/service for the intended policyholders



The firm and its key personnel have the experience, level of skill and understanding towrite this proposed business

The firm (and its staff where relevant) hold the correct licenses or authorisations
required to trade and conduct the proposed activities that will be granted to it, and havesufficient knowledge of local laws and regulations



The firm has suitable and effective underwriting systems and is able to provide us withdata that enables adequate assessment of ongoing suitability and allows the us to meet
Lloyd's Insurance Company’s reporting standards data requirements

If the firm will be handling claims, we are satisfied that it has the requisite claims skills,
conflict of interest policies and resources to handle claims efficiently, effectively andfairlyInsurance documents, bordereaux and any marketing/website materials have beenvetted/approved by us and are in line with any applicable Lloyd’s and Lloyd’s Insurancecompany requirements

We have fully completed our due diligence with no outstanding actions on the proposedcoverholder, its policies; procedures; systems; controls; and governance, the product,
and the target market. We have no concerns about the firm’s suitability to beonboarded as a Lloyd’s Insurance Company coverholder.

Attestation
I confirm the firm has been assessed and reviewed against the points in this document
and the firm meets the Service Provider’s and Lloyd’s Insurance Company’srequirements.
Name and position:

Signature:

Date:

In addition to the above attestation please confirm that:
You have liaised with the relevant Lloyd’s country manager(s) prior to submitting thisapplication and have confirmation from them of their support for the firm to be approvedYou have liaised with Lloyd’s Europe and have met any additional requirements
needed for its oversight and received its confirmation supporting the firm to beapprovedYou have reviewed the referral criteria on, identified any required referrals andachieved approval from said individuals.

Attestation
I confirm the above interactions and referrals have been made by the Service Providerand we can evidence these referrals should this ever be required.
Name and position:

Signature:

Date:

For Lloyd’s Internal Use
Regulatory referral
required?
Y/N and reason

Underwriting referral
required?
Y/N and reason

Customer oversight referral
required?
Y/N and reason

Risk Screen Checks
completed
MED checks completedSigned Undertaking
received
Date submission processed:

Regulatoryreferralconfirmation
received?
Underwritingreferralconfirmation
received?
Customeroversight
approval
received?

Name ofreviewer andposition: