The Professional Indemnity for Solicitors - Quotation Form

Premiums from £1,575.00

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

1. Name and Address details

Practice Name: *
Main Office Address :
Postcode:
Main Office Telephone: *
Main Office Fax:
Practice Web Site:
Contact E-mail: *
Date Established
Is your practice an incorporated practice? Yes No
Do you have any other offices, other than the main office listed above, for which you are seeking cover ? Yes No
If yes please list the addresses

2. Prior Practices - please list the names of all prior practices to which this practice is a successor practice

Name of practice	Date Established	Date of succession




Have any of your practices above reported any circumstances, incidents or claims in the last 5 years ? Yes No If yes please refer to question 7

3. Solicitors details - provide all information requested for every Principal, Assistant and Consultant who will be employed by your firm as at the inception date of the policy. If anyone is listed as a Registered Foreign Lawyer or Registered European Lawyer, please note RFL or REL alongside solicitor status. If you are a newly established practice, please e-mail us a Curriculum Vitae for every Principal in your firm.

Title (Mr, Mrs, other)	Solicitors Full Name	Date of Birth	Solicitor status (Principal/ Assistant/ Consultant)	Full/Part Time	Roll Number (as shown on practising certificate)

4. Other Staff

Number of non-solicitor fee earning staff :
Number of all other staff:

5. Practice Fees

Total gross fees for the last annual accounting period or, if you are a new practice, estimated fees for the coming year
Does any one client or group of clients generate 20% or greater of your annual fees ? Yes No

6. Practising certificate - in the last 10 years has any fee-earner in the practice:

Ever been refused a practising certificate?	Yes No
Ever been granted a conditional practising certificate?	Yes No
Been the subject of a costs penalty order?	Yes No
Been reprimanded by the Disciplinary Tribunal	Yes No
Practised in a firm subject to investigation or an intervention by the Law Society (including OSS)?	Yes No
Had a civil or criminal judgement against him or her?	Yes No
Been investigated by another regulatory body other than the law society (eg. FSA)	Yes No
If YES to any of the above please provide details below

7. Claims and circumstances

Has your practice, or any prior practice, reported any circumstances, incidents or claims to the Solicitors Indemnity Fund (SIF), the Assigned Risks Pool or to Qualifying Insurers in the:
Insurance Year 1999-2000 (SIF)	Yes No
Insurance Year 2000-2001	Yes No
Insurance Year 2001-2002	Yes No
Insurance Year 2002-2003	Yes No
Insurance Year 2003-2004	Yes No
If YES to the 1999-2000 insurance year, please provide an updated claims history supplied by SIF for your practice and any practice to which you are a successor practice by e-mail to solicitors@heritage-insurance.co.uk or fax 0845 280 2443. If YES to any other insurance year, please provide claims information from other Qualifying Insurers or the Assigned Risks Pool for all circumstances, incidents or claims reported since 01/09/2000 by your practice and any practice to which you are a successor practice by e-mail to solicitors@heritage-insurance.co.uk or fax 0845 280 2443
Have any circumstances, incidents or claims reported by you or any prior practice in the last 5 years arisen as a result of the dishonesty of any principal or employee of the practice?
Yes No
If YES please give details below including how the matter was resolved and the procedures/processes in place to avoid re-occurence

After making full enquiry of all principals and employees of your practice are you aware of any circumstances, incidents or claims that you have not reported to your current or any prior insurers?
Yes No
If YES please explain below

Please note that you have an obligation under your current professional indemnity insurance policy to notify these matters to your insurer and we shall ask you to confirm that you have done so before cover can be put in place.

8. Current coverage

Are you currently in the Assigned Risks Pool ?

Yes No

If YES please explain below

Has any qualifying insurer refused to offer your firms terms for professional indemnity insurance?

Yes No

If YES please explain below

Please provide details of your current insurance below

Current Insurer	Limit £	Excess £	Premium £

9. Area of Practice

Area of practice (rounded to nearest whole %)	%
Administering oaths, taking affidavits and notary public
Agency Advocacy
Arbitration, Adjunction and Mediation
Children, Mental Health Tribunal and Welfare
Commercial Work including all Company Work - Non Securities related
Conveyencing - Commercial
Conveyencing - Residential
Criminal Law
Debt Collection
Defendant litigious work for insurers, Defendant Personal Injury Work
Employment - litigious
Employment - non-litigious
Financial Advice and Services regulated by the Law Society
Immigration
Landlord and Tenant - litigious
Landlord and Tenant - non-litigious
Lecturing and Related Activities and Expert Witness Work
Litigious work other than given in any other category
Matrimonial
Non-litigious work other than given in any other category
Offices and Appointments
Parliamentary Agency
Personal Injury (Claimant)
Property Selling, Valuations and Property Management
Town and Country Planning
Trust, Probate and Wills and Tax Planning
Commercial work including all Company Work - Securities related Please give details below

Financial Advice and Services where your practice has opted into regulation by the FSA. Please give details below

Intellectual Property including patent, trademark and copyright. Please give details below

Note total must =100%
Do you provide management services or investment advice to any entertainment clients or sporting professionals?
Yes No If YES please explain below

In the last six years, has your practice or any prior practice accepted instructions for any class actions?
Yes No If YES please explain below

With which Legal Services Commission Quality Marks or other quality standards, eg. LEXCEL or Investors in People is your firm currently accredited? Please specify below

10. Requested Cover

Limit of indemnity - please limit to a maximum of 4 choices
	£1 Million
	£2 Million
	£3 Million
	£4 Million
	£5 Million
	£6 Million
	£7 Million
	£8 Million
	£9 Million
Other
Excess - please limit to a maximum of 4 choices
	£ Nil
	£ 1,000
	£ 3,000
	£5,000
	£10,000
	£25,000
	£50,000
	£75,000
	£100,000
Other

11. Significant change

Do you expect there to be any significant change to or in your practice in the coming year?
Yes No
If YES please e-mail details to solicitors@heritage-insurance.co.uk or fax 0871 750 2186

12. Other Material Information

Is there any other material information that may be relevant to this application?
Yes No
If YES please e-mail details to solicitors@heritage-insurance.co.uk or fax 0871 750 2186

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

Financial Services Agency number - 447154