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Professional Indemnity Insurance for Accountants - Quotation Form  - For an informal chat call 01332 607056

To obtain your quotation please submit the on-line form below * = required field

1. Name and Address of Business

Contact Name: * Business Name: Address 1: * Address 2: Address 3: Town: County: Postcode:* Telephone: * Fax: E-mail: * Date Established:*

2. Please provide details of each partner as follows:

*Name *Age *Qualification *Years experience

3.Total fee income (Excl VAT), please indicate the split as follows:

Last Complete Year Current Year Forthcoming Year Year end Total Fees Average Fees Largest Fee

4. Fee Income - Please give an approximate percentage split according to type of work:

Type of work % Audit, Accountancy, and Company Tax for quoted companies Other Audit and Accountancy Tax Returns Tax Advice Management Consultancy Secretarial and Share Registration Excecutorships and Trusteeships Insolvencies, Liquidations and Receiverships General Insurance Commissions Stock Exchange Commissions Commissions from investment business regulated under Financial Services Act Directorships Computer Consultancy Mergers, Acquisitions, Disposals Other Consultancy only Other Work - please give full details below

5. Current Insurance Information

Name of current Insurer Expiry Date of current policy

6. Have any claims ever been made against you? *

Yes No If so please give details:

7. Are you aware of any circumstances that may give rise to a claim? *

Yes No If so please give details:

8. Limit of Indemnity Required, please select preference/s*

£100,000 £250,000 £500,000 £1 Million £2 Million £5 Million

If you experience problems with the on-line quotation form please contact us

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