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The Professional Indemnity for Information Technology Consultants - Quotation Form

Premiums from £199.00

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 Business Established:

2. Please provide details of each partner as follows:

Name Age Qualification Years experience

3. Please state the total numbers of:

Principals Managers Technical Personnel Support Personnel Sales and Marketing Other

4. Turnover including fee income in £:

UK USA/Canada Other Total £ Total gross fees in last financial year Estimated Gross Fees for the next financial year Largest fee from any one client

5. Percentage split of turnover including fees in the past year or if a new firm your anticipated figures:

Type of work % Hardware Sales of own brand Distribution of other brands Installation Maintenance Software product sales Shrink wrapped / Off the shelf software Customisable software Software services Installation including configuration (no code changes) Customisation (including code changes) Developing bespoke applications Maintenance Services Consultancy Contract Staff Training Application Services Provider Internet Services Provider Internet services (excluding web hosting) Web hosting (please provide terms and conditions) Other Work - please give full details below

6. Please give details of your three largest contracts commenced in the past three years or if a new business expected contracts.

Start date / End date Name of client / Business of client Nature of contract Total Value Income to you

7. Current Insurance Information

Name of current Insurer Expiry Date of current policy

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. 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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