Miscellaneous Professional Indemnity Insurance Quote

Professional indemnity insurance indemnifies you from the legal liability and legal defence costs you may incur as a result of breaching a duty of care to your clients.

THE PROPOSAL FORM AND MATERIAL FACTS

Please bear in mind that we need to get to know you; your insurer needs to get to know you. The more information you give us, the better we know you.
Please provide any supplementary information that you feel will be useful to us.

YOUR CLAIMS HISTORY

Best to start tracking this from the moment you have a notification because the more information you are able to give to a prospective insurer, the better. Once prepared you don’t have to prepare it again – only update the information as the matter progresses! Brief summaries of incidents from memory leave open the possibility for omission; for example it would be helpful for you to explain to us significant details such as…… insurers felt you had a valid defence, however settled for commercial reasons - you might even have something to this effect on your file. If you move away from an insurer, ask them to prepare a confirmed claims experience for you. These are helpful and often difficult to obtain later.

RISK MANAGEMENT

Not to be underestimated. Professional Liability Risk Management has met its day and it applies to all of us. It’s quite simple but will not happen overnight. It concerns everybody in the firm and the administrative procedures as well as technical know- how. In a nut shell it basically relates to a careful review of how you all do what you do; a consideration of what could go wrong with your work in each area; a careful examination of any near-miss and the implementation of realistic measures over a period of time that will actually help to minimise the possibility of circumstances and claims from occurring.

Professional Indemnity Insurance for Miscellaneous Professions

Proposed policyholder’s full name:

Proposed policyholder’s business activity:

Proposed policyholder’s web site: www.

If any other entities are to be covered, please list the names of such entities

Proposed policyholder’s main office address:

Postcode

Telephone

How long has the proposed policyholder been established.

Do at least 50% of the partners/directors have at least five years relevant experience?

Does the firm currently have professional indemnity insurance?

Does any one client represent more than 50% of the total income of the entities to be covered?

Is 20% or more of the total income of the entities to be covered paid to sub contractors?

Do the entities to be covered ensure that sub contractors are fully qualified and carry professional indemnity insurance? If No please give full details in the Additional Information Box below.

Has any insurer declined, cancelled or non-renewed any prior policy or application for professional indemnity or similar insurance of any of the entities to be covered? If Yes please give full details in the Additional Information Box below.

Has any entity to be covered sustained any loss due to fraud or dishonesty by an employee or third party or has any entity to be covered reason to suspect such activity? If Yes please give full details in the Additional Information Box below.

Has any entity to be covered been subject to any disciplinary or regulatory enquiry or proceedings or fines, penalties or other sanctions by a governmental, regulatory or professional body? If Yes please give full details in the Additional Information Box below.

Is any entity to be covered aware of any claim (whether insured or not) ever having been made against any entity to be covered or its predecessor? If Yes please give full details in the Additional Information Box below.

Is any entity to be covered aware of any facts or circumstances that may give rise to a claim against any entity to be covered or its predecessor? If Yes please give full details in the Additional Information Box below.

Names of partners and directors (CV if less than five years experience)

Full Name	Qualifications	Date Qualified	Number of years at the firm

Gross fee income for the last completed year:

Total fee Income

UK fee Income

Overseas fee income

(excl US & Canada)

US & Canada fee Income

Estimated Gross fee income for the forthcoming year:

Total fee Income

UK fee Income

Overseas fee income

(excl US & Canada)

US & Canada fee Income

Largest contracts/projects carried out by the firm in the last five years

Name of Client	Nature of project/contract	Total contract value	Income

Limit of Indemnity Required for Quotation- you may select more than one box

£100K£250K£500K£1M £2M £5M

Other

Additional Information Box

I declare and agree, on behalf of the proposed policyholder and all proposed insured's, that to the best of their knowledge and belief the statements set forth herein are true and that, if the Company agrees to insure, the material statements in this proposal or in any other information supplied, shall be the basis of the contract and shall be incorporated into and constitute part of the policy.

It is hereby agreed that the Company is authorised to make any investigation and inquiry in connection with this proposal that it deems necessary.

I Agree

If you have already completed a proposal form, or a renewal form, you may submit that to pii@blackfriarsrgoup.com or by fax to 0845 838 7966 or by mail to Blackfriars Group, 6 Congleton Road, Sandbach, Cheshire. CW11 1HN

Professional Indemnity Insurance : Miscellaneous Professions

Miscellaneous Professions Professional Indemnity Insurance