Professional Indemnity Insurance Quote Form

For UK Customers Only

Please insert your details below and one of our commercial advisers will contact you shortly with a professional indemnity insurance quote.

This form is designed for quotes for Professional Indemnity Insurance only. Professional Indemnity Insurance is designed for professionals who require cover for their legal liability in the event of any incorrect advice, error or ommission which causes financial loss to their clients.

Personal/Company Details
Proposers Name(s):
Limited Company Name (if applicable):
Trading Name:
Trading Status:	- - - - - - Please Select - - - - - Sole Trader Partnership Limited Company Limited Liability Partnership Charity Unincorporated Association
Postal Address:
Postcode:
Daytime Telephone Number:
Mobile Telephone Number:
E-Mail Address:
General Information
Occupation/Profession:
Description of your work undertaken: (Please describe as fully as possible)
Trading Experience
How many years has your business been trading?	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 30+ Years
Number of years experience (if different)	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 30+ Years
Proposer Details
Have you had any previous professional indemnity insurance declined, cancelled, renewal refused or any special terms imposed?	Yes     No
If yes, please provide details:
Are you aware of any fraud, dishonesty, bankruptcy or administration order applicable to any past or present principal, partner, director or employee?	Yes     No
If yes, please provide details:
During the past 6 years has the business name been changed, have any other businesses been purchased, or has any merger or consolidation taken place?	Yes     No
If yes, please provide details:
Claims Experience
Have you, or any other partner or director (past or present) suffered any claim (whether successful or not) in the last 10 years?	Yes     No
If yes, please provide details:	Date of claim: Cost of claim:£ Details of claim: ---------------------------- Date of claim: Cost of claim:£ Details of claim: ---------------------------- Regrettably, if you have more than 2 claims, we will be unable to provide you with a quotation.
Are you, or any other partner or director aware of any circumstances after investigation which might give rise to a claim?	Yes     No
If yes, please provide details:
Staff
Number of Proprietors/Partners/Co. Directors:
Number of Employees: (Do not include proprietors, partners or directors)
Turnover
Annual Gross Fees / Turnover (UK) £s:
Annual Gross Fees / Turnover (EU) £s:
Annual Gross Fees / Turnover (Rest of World) £s:
Sub-Consultants
What percentage of turnover do you pay to outside or sub-consultants or third parties?	%
If fees are paid to outside or sub-consultants,are they engaged in a binding contract accepting responsibility for their own neglect, error or omission for the work they undertake?	No     Yes
Professional Indemnity Cover Required
Limit of Indemnity required:	Please Select £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £3,000,000 £5,000,000
Does your company currently have professional indemnity insurance?	Yes     No
Do you currently have a retroactive date for your current policy?	Yes     No
If yes, please provide the retroactive date of your current policy:	(dd/mm/yyyy)
Additional Information
Any additional information / cover required:
Details Of Current / Previous Policies
Current Annual Premium:	This may help us to get you a better quote
Current/Previous Insurer:
Renewal Date / Cover Start Date:	(dd/mm/yyyy)

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct, then press the Request Professional Indemnity Quote button and we will contact you shortly with a quotation.

Superquote.com is an introducer appointed representative of Midlands Insurance Services who are authorised and regulated by the Financial Services Authority. FSA Number: 306382.