Miscellaneous Professional Indemnity Insurance proposal form

PLEASE NOTE: If any Partner, Principal, Director or Employee is aware of any claim relating to activities carried out by them in previous practice or employment, details should

2. Please submit, with the Proposal Form, all relevant information including Financial Report & Accounts, Brochures, etc. Should there be insufficient room in the Proposal Form

Signing of this proposal does not bind Underwriters to offer nor the applicant to accept insurance, but it is acknowledged and agreed that this proposal (together with all

5.3 Has any application for Professional Indemnity insurance made by the Firm or any partner, principal or director ever been cancelled, declined or had special terms imposed. Yes No

5.4 Has any claim, whether successful or not, ever been made against the Firm or its predecessors orany past or present partner, principal, director or employee. YES NO If YES

Has any proposal for similar insurance made on behalf of the business, any predecessor of the business, or any principal, partner or director ever been declined or has any

Has any proposal for similar insurance made on behalf of the business, any predecessor of the business, or any principal, partner or director ever been declined or has any

PLEASE NOTE: If any Partner, Principal, Director or Employee is aware of any claim relating to activities carried out by them in previous practice or employment, details should