Professional Indemnity

Corporate Information

Company Name *

Activity Of The Company *

Title*

First Name*

Last Name*

Occupation *

Mobile *

Email *

Address *

Website

Professional indemnity

Total number of staff other than Typists/Clerical Workers

Typists and Clerical Workers

If sole Director / Partner please answer the following

Is this a part-time occupation?

Yes

Please give brief details of present full time occupation

Description of Firm’s activities for which cover is required: (if there is more than one activity please detail percentage split for each category)

Are any major changes in the Firm’s activities planned or expected within the next two years?

Yes

Please give details

Is the Firm or any of the Directors / Partners connected or associated (fi-manically or otherwise) with any other Firm or Company or Organization

Yes

Please give details

Does the Firm perform work outside the U.K. or work for clients outside the U.K.?

Yes

Please give details including countries and proportion of fees from this work

Does the Firm use a standard form of contract or agreement or letter of appointment?

Yes

Please enclose copies

Does the Firm issue any Brochure or Leaflets or Books etc. describing the Firm’s services or offering any service or facility?

Yes

Please enclose copy

Please give the amount of gross income/fees

Is any work put out to sub-contractors

Yes

Does the Firm require sub-contractors to carry insurance and for what limit?

Yes

What percentage of the Firm’s fees is paid to sub-contractors?

Nature of sub-contracted work

Have any claims been made against the Firm or its present or past Directors / Partners (whether insured or Not?)

Yes

Are any of the Directors / Partners, AFTER INQUIRY, aware of any circumstances which may give rise to a claim against the Firm or its predecessors in business or any of its present or former Directors / Partners?

Yes

What limit of indemnity is required?

250,000

500,000

1,000,000

Do you require insurance for:

Loss of Documents

Yes

If yes, then indicate what limit

Dishonesty of Employees

Yes

Libel or Slander

Yes

Current/Previous Insurance Details Including whether the insured has been declined for insurance in the past

Yes

Insurance Details

We hereby acknowledge and confirm that all the submitted data above are correct and We did not hide any information related to the risk to be insured. And We authorize Brokerage Insurance Brokerage in executing this insurance request with the concerned insurance company and facilitate the policy issuance, renewals and claims follow-up and communicate specific information about us and our account to third parties if needed, in accordance with the privacy policy. We also accept that this insurance application and approval be the basis of the contract and an integral part of the insurance policy.

Professional Indemnity

Professional Indemnity

Find the Quality & the Best Service

Corporate Information

Professional indemnity

If sole Director / Partner please answer the following

Do you require insurance for: