Professional
indemnity insurance quote for a charity |
| Please provide a full description of
all your activities i.e services and products that
you provide to your customers |
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| How many people do you currently employ
in your company - full and part time. |
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| Is your business run from your home? |
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| Preferred start date of insurance policy |
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Who is your currrent professional indmnity
insurer (if applicable)
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| Please indicate your target premium
(if applicable) |
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| If you have a company website please
input the address in the following box |
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| In what year was your business extablished? |
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| Please indicate how much your turnover
was for the last 12 months |
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| What do you estimate your turnover to
be for this current trading year? |
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| How is this turnover made up in geographical
terms, |
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UK
USA
WORLDWIDE EXC UK AND USA)
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| If you employ the services of sub-contractors
what percentage of your turnover is paid to them? |
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| Do you work in any of the following
areas? If you answered YES to any of the following
then please input details in the bottom box. |
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Nuclear
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Medical
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Aviation
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Railways
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Oil and Petrochemical production
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Live trading systems for financial
markets
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| If you answered yes for any of the above
then please input details here |
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| Please input details of any professional
associations that you are a member of: |
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| Have you ever been involved in any
circumstances which have or might result in any claim
being made under a policy of this nature? |
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| If you answered yes to the above then
please input details here |
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| Has any insurer ever declined a proposal
or renewal? |
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| If yes please provide details |
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| Has any insurer ever imposed special
terms? |
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| If yes please provide details |
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| Has any insurer ever cancelled or avoided
an insurance policy? |
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| If yes please provide details |
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| Have you been or are you currently insured
under a Professional Indemnity policy? |
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| If 'Yes', please provide name of insurer,
excess and renewal date: |
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| Specify limit of indemnity: |
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| YOUR CONTACT DETAILS |
| Name |
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| Company name |
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| Correspondance address |
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| Postal code |
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| Email address
(required to submit form) |
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| Daytime telephone number |
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| Alt number e.g Mobile phone |
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| When would you like to be contacted |
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Their
may be a need for us to obtain further information
from you to complete the quotation, if so,
one of our advisors will contact you by telephone
on the landline business number you have supplied
to us on this form.
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