Full names of all entities requiring cover, including trading names, and commencement date of business.
Particulars of each person giving advice (including name, age, qualifications, and years of experience). Please email CVs through to email@example.com
Period, Limits and Excess of Insurance
Include description of professional services provided / Fees received last financial year / Fees received current financial year to date.
Claims / Insurance History
If 'Yes' please provide the following information. If 'No', please proceed to insurance history section below
Declaration for and on behalf of Named Insured *
I/We declare and warrant that after enquiry all statements and particulars contained in this proposal and addenda are true and that no information whatever has been withheld which might increase the risk of the Underwriters or influence the acceptance of this proposal and should the above particulars alter in any way I/We will advise the Underwriters as soon as practicable.
I/We understand that failure to disclose any material facts which would be likely to influence the acceptance and assessment of the proposal may result in the Underwriters refusing to provide indemnity or voiding the policy in every respect.