PROFESSIONAL INDEMNITY QUOTATION

PROPOSER

Name
T/as
Trading Since Territory

LOCATION

Address
Postcode

CONTACT DETAILS

Tel
Fax
Mob
Email
Web

TRADE

Trade
Staff : Qualified Staff
Staff : Non Qualified Staff
Turnover :
Describe your Services/Advice/Design
Individual CV's can be emailed to quotations@wallace-group.co.uk

WORK SPECIFICS

Give A Split Of Activties (As Applicable)
% Mixed Trade Split Activities Annual Fees for Advice/Design
Total
Largest fee in last 12 Months
Largest contract in last 12 Months

COVER REQUIRED

Cover Limit Required :

CATEGORY SPECIFICS

Tick if your work involves any of the following...
Environmental Work :
Structural Design :
Commercial Property Management :
Commercial Property Rent Reviews :
Work For Public Limit Companys :
Company Secreterial & Share Registration :
Directorships :
Executorships & Trusteeships :
Fund Management :
Insolvencies, Liquidations, Receiverships :
Investment Advise :
Mergers, Acquistions, Disposals :
Mortage Advice :
Pensions Advice :
Non-Accountancy Advice :
If ticked give details...  

LIABILITY EXTENSION

You can include Liability insurance
Employers Liability?
Employee Number?
Employee Wageroll?
   
Public Liability?
Any work away?
If ticked give work away details...

INSURANCE HISTORY

Required Date
Current Insurer
Policy Num
Premium Claims Excess
Current Broker

CLAIMS RECORD

Tick if any claim in last 5 years
Give claim details, types, dates :

OTHER INFORMATION

Telephone 02870325999 for assistance