Professional Indemnity Insurance for Miscellaneous Professions including Management Consultants - Quotation Form

Note: Consulting Engineers, Building Services Designers, Draughtsmen and Interior Designers should use the Architects form.

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 give a brief description of the type of work carried out:

3. Please provide details of each principal/partner/director as follows:

Name Age Qualification Years experience

4. Please give an approximate percentage split by type of work

Type of work %

5. Please give gross fees for the last financial year and estimate for the coming year:

Last Financial Year Estimate for the Current Year

6. Please give details of the 3 largest contracts in the last 5 financial years (give details of current projects if new business):

Client Start Date Description Total Contract Value Fee Approximate completion date

7. Do you work other than from a UK office?

Yes No If so please give details:

8. Have any claims ever been made against you?

Yes No If so please give details:

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

Yes No If so please give details:

10. Current Insurance Information

Name of current Insurer Expiry Date of current policy

11. 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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