Professional Indemnity proposal form

Cover for claims arising from professional advice, design or services. Whatever your profession, the questions below give us what we need to approach the market.

Fields marked * are required. Anything you're unsure about, leave blank and we'll pick it up with you.

About the business

Your name

Business name

Correspondence address

Contact number

Email address

Business description

Your profession

Profession / discipline

Any professional body membership

Year business established

Number of qualified staff

Number of total staff

Income & activities

Annual fee income

Estimated income next 12 months

Largest single fee in last 12 months

Percentage of income from overseas

Any work in USA or Canada?

Do you sub-contract any work?

Main types of client

Cover required

Limit of indemnity required

Basis of limit

Retroactive date required

Usually the date you first held continuous PI cover

Do you use written contracts or terms of engagement?

Circumstances

Are you aware of any circumstance that could give rise to a claim?

Details of those circumstances

Claims & current policy

Any claims in the last 5 years?

Claims details

Date, type and amount of each claim

Current insurer

Renewal date

Expiring premium

Is there anything else we should know?

Your details go straight to our team. We'll never share them with anyone other than the insurers we approach on your behalf — see our privacy policy.