Professional Indemnity Insurance Arrangements For Western Australian Law Practices - 2017-2018

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Professional Indemnity Insurance Arrangements
for Western Australian Law Practices
30 June 2017 – 30 June 2018
FORM A - APPLICATION BY SOLE PRACTITIONER OR PARTNERSHIP
POST:
Law Mutual (WA)
EMAIL:
.au
PO BOX Z5345, PERTH WA 6831
IN PERSON:
The Law Society of Western Australia
(DX 173 PERTH)
Level 4, 160 St Georges Terrace
Perth WA 6000
ENQUIRIES:
(08) 9481 3111
Original copy not required. If sending by email, please scan and attach a signed copy of the completed form.
1. CONTACT DETAILS
Name of Legal Entity:
(If different) Law Practice Trading Name:
Practice Street Address:
Suburb:
State:
Postcode:
Postal Address:
Suburb:
State:
Postcode:
Phone:
Mobile:
Email:
2. LAW PRACTICE DETAILS
Names of Sole Practitioner / Partners who will hold practising certificates (attach list if insufficient space):
Surname
Given Names
Names of employed solicitors who will hold practising certificates (excluding partners) (attach list if insufficient space):
Surname
Given Names
e: H
Full-time: Part-tim
rs/Wk (P/T):
General Employees (e.g. Secretaries, Law Graduates)
No. of employees who are employed more than 20 hours/week:
No. of employees who are employed less than 20 hours/week:

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