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Contact details

* Name of Insured 
* Nature of Business 
 * Address 
 * Telephone No. 
Fax Number 
 * Email 


Employee Details
Details of Directors
Name Qualifications
Date Qualified
Experience

Number of Employees


Contract details
Turnover for:
 
This Year £
Last Year £
Two Years Ago £
               Details of 3 Largest Contracts
Name Size of Contract (£s) Duration of Contract

Will your activitivties change significantly over the next 12 months?
Do you undertake any work outside the UK or do any work for clients based outside the UK?


Limit of Indemnity
Limit of Indemnity Required



Claims

Have you held Professional Indemnity Insurance Before

Have previous Insurers been notified of all cases likely to give rise to a claim
Have any claims been made against you in the last 10 yrs
Have you suffered any loss in the last 10 yrs

Are you aware of any circumstances which might:
Give rise to a claim
Cause a loss to you
Might affect consideration of your proposal

General Questions

Is cover required for previous business

Are you a member of any regulatory bodies, associations etc
Have you sustained any loss through fraud or Dishonesty of an Employee
Do you have any knowledge of an employee committing fraud
Do you obtain references for employees going back 3 yrs or more
Have you ever had insurance refused
Have you ever had an application to a regulatory body/association refused
Have you ever had any disciplinary proceedures made against you







Professional Indemnity insurers

 

Professional Indemnity Proposal

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