INVESTMENT ADVISERS ERRORS AND OMISSIONS COVERAGE IS WRITTEN ON A CLAIMS-MADE BASIS. EXCEPT AS OTHERWISE PROVIDED, THIS POLICY WILL COVER ONLY CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD. PLEASE READ THE POLICY CAREFULLY.

DEFENSE COST PROVISIONS:

PLEASE NOTE THAT THE DEFENSE COST PROVISION OF THIS POLICY STIPULATES THAT THE LIMITS OF LIABILITY MAY BE COMPLETELY EXHAUSTED BY THE DEFENSE COSTS. ANY DEDUCTIBLE MAY BE SIMILARLY REDUCED OR EXHAUSTED BY DEFENSE COSTS.

A. GENERAL INFORMATION

(Street Address)	(City)	(State)	(Zip Code)

c. Authorized Representative: 

Title:

2. Name of Agent:
    

3. Date firm established:

5. Is the firm registered with the Securities and Exchange Commission under the Investment Act of 1940?
    YesNo

6. Number of offices:      North America         Other  

(please provide a list of locations)

7. Employee census:

Portfolio Managers                Sales/Marketing

Research Staff                    Compliance/Audit

Other      Please explain   

8. a. Name of current independent auditor:
        

9. Does the Applicant use any soft dollar arrangements for the purchase of investment research?
           YesNo

B. CLIENT INFORMATION

1. Please complete the table below for those accounts for which the Applicant acts as an investment adviser:

	No. of Accts	Market Value
Individual Accounts		$
Trusts		$
ERISA Plans		$
Taft-Hartley Plans		$
Non-ERISA Pension Plans		$
Corporate/Institutional		$
General/Limited Partnerships		$
Mutual Funds*		$
REITS*		$
Total		$

* Please provide a list of all funds along with current prospectus, SAI and most recent annual and semiannual reports.

3. Is there an approved list of securities maintained for purchases in customer portfolios?
       YesNo

4. Does the Applicant recommend the use of derivative instruments as part of its portfolio management?
       YesNo

6. Minimum size of accounts accepted for new customers:
        

7. Investment Advisory fees for the past three years: $       $      $

Carrier:     Limit:     Expiration date:

Are copies sent to those other than existing clients? YesNo

Please send an email to Gross Insurance and attach the 2 most recent issues.

C. PAST ACTIVITIES

1. Has the SEC, any state securities regulatory authority or any Self Regulatory Organization (SRO) conducted an inspection, investigation or examination of the Applicant within the past 5 years?
      YesNo

2. Within the past 5 years, has the Applicant been involved in:

3. Has any claim been made under any prior or current Investment Advisers Errors and Omissions Insurance Policy?
       Yes    No

4. Is any Director, Officer, Trustee, Partner or Employee of the Applicant aware of any fact, circumstance or situation which he/she has reason to believe might result in a claim within the scope of the proposed insurance?
        Yes     No

Pertaining to questions 2,3 and 4, it is agreed that any claim judahsing from such suits, claims, or proceedings is excluded from the proposed coverage.

D. OTHER INFORMATION

For each entity proposed for coverage, please attach the following information with this completed Application.

1. With respect to each Applicant Adviser:

f. copy of most recent SEC or other regulatory inspection report, and management’s written response; and

g. copies of any brochures or sales material.

2. With respect to each other Applicant:

E. SCHEDULE OF SUBSIDIjudahES

Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income
Name of Subsidiary	Date Created / Acquired	State of Incorporation -SELECT STATE- Alabama Alaska judahzona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	% of Ownership	Nature of Business
	Domestic or Foreign	Name of Parent Institution		Total Revenues	Total Assets	Net Income

This information is attached to and forms a part of the APPLICATION Form for Investment Advisers E&O Policy.

The undersigned person declares that to the best of his knowledge the statements set forth herein in all sections of this and in any attachments to this APPLICATION are true and correct, and that reasonable effort has been made to obtain sufficient information from all persons proposed for this insurance to facilitate the proper and accurate completion of this APPLICATION. The undersigned further agree that, if between the date of this APPLICATION and the effective date of the Policy, (1) any material change in the condition of the Applicant is discovered or (2) there is any material change in the answers to the questions contained herein, either of which would render this APPLICATION inaccurate or incomplete, notice of such change will be reported in writing to the Company immediately, and, if necessary, any outstanding quotation may be modified or withdrawn.

The signing of this APPLICATION does not bind the undersigned to purchase the insurance but it is agreed by the Applicant, and all persons proposed for this insurance, that the particulars and statements contained in the APPLICATION and the attachments and materials submitted with this APPLICATION (which shall be retained on file by the Company and shall be deemed attached to the Policy, if insurance is provided, as if physically attached thereto) are true and correct and will be the basis of the Policy and will be considered as incorporated in and consisting a part of the Policy. It is further agreed by the Applicant, and all persons proposed for this insurance that such particulars and statements are material to the decision to provide this insurance and that any policy will be issued in reliance upon the truth of such particulars and statements.

PLEASE NOTE: ONLY DULY APPOINTED AGENTS OF THE COMPANY AND LICENSED BROKERS ARE AUTHORIZED TO SOLICIT APPLICATIONS FOR COVERAGE. AGENTS AND BROKERS ARE NOT AUTHORIZEDTO BIND COVERAGE. NO COVERAGE SHALL BE PROVIDED UNLESS THE COMPANY ACCEPTS THE APPLICATION AND BINDS THE COVERAGE.

False Information:

Any person who, knowingly and with intent to defraud any insurance company or other person, files an Application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime.

False Information (Florida Only):

Any person who, knowingly and with intent to injure, defraud, or deceive any insurer, files a statement of claim or an Application with any false, incomplete, or misleading information, is guilty of a felony of the third degree.

False Information (Louisiana Only):

Any person, who, knowingly and with intent to deceive any insurance company or other person, files an Application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime.

False Information (Nebraska Only):

Any person who, knowingly and with intent to defraud any insurance company or other person, files an Application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime, when such person subsequently submits a claim.

False Information (New York Only):

Any person who, knowingly and with intent to defraud any insurance company or other person, files an Application for insurance containing any false information, or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

False Information (Pennsylvania Only):

Any person who, knowingly and with intent to defraud any insurance company or other person, files an Application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any material fact thereto, commits a fraudulent insurance act, which is a crime, and subjects such person to criminal and civil penalties.

Company

Signature of President of Applicant if Corporation, or of General Partner if Partnership

Date

A Policy cannot be issued unless the APPLICATION is properly signed and dated as required.

APPLICATION FOR INVESTMENT ADVISERS ERRORS AND OMISSIONS POLICY

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