Professional Indemnity Proposal Form

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PROFESSIONAL INDEMNITY PROPOSAL FORM
Completion of this proposal form in no way binds the Proposer to purchase professional indemnity
insurance, nor does it bind Insurers to provide the required insurance.
1)
NAME:
ESTABLISHMENT DATE:
ADDRESS:
2)
Details of all Principals, Partners or Directors:
NAME
AGE
QUALIFICATIONS
1.
2.
3.
4.
3)
Breakdown of Company Turnover:
UK
USA/CANADA
OTHER
TOTAL
TOTAL TURNOVER IN LAST FINANCIAL YEAR
£
£
£
£
ESTIMATED GROSS FEES FOR NEXT FINANCIAL YEAR
£
£
£
£
LARGEST FEE FROM ANY ONE CLIENT
£
£
£
£
4)
Full Description of Activities, with percentage breakdown (estimated if no historical data):
%
%
%
%

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