Professional Indemnity for Rail Industry Professionals

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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. Business Activities

a)Please describe the nature of the work you do

b) Please name the principals for whom you regularly act

c) Are you involved in the manufacture, construction, alteration repair or sale of products other than in a consultancy capacity? If Yes please supply details

Yes

d) Are you a member of any Trade Association? If Yes please advise which

Yes

4. Please state the 3 largest contracts where construction has commenced in the last 3 years:

Start Date	Completion Date	Contract Description	Contract Value

5. Please state the 3 largest contracts where construction is expected to start shortly:

Expected Start Date	Expected Completion Date	Contract Description	Contract Value

6. Please give amount of income for the last 3 financial years plus estimate for the coming financial year.

Year	Income

7. Limit of Indemnity Required, please select preference/s

	£250,000
	£500,000
	£1 Million
	£2 Million
	£5 Million
	£10 Million

8. Quality Assurance

Have you obtained quality assurance accreditation in accordance with BS57501/ISO9002?

Yes

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