IT Contractors Professional Indemnity Insurance Quote Form

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 IT Contractors Professional Indemnity Insurance. Professional Indemnity Insurance is designed for professionals who require cover for their legal liability in the event of any incorrect advice, design or specification which causes financial loss to their clients.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Personal/Company Details
Contact Name:
Limited Company Name: (if operating as a limited company)
Trading Name:
Trading Status:	- - - - - - Please Select - - - - - Sole Trader Partnership Limited Company Limited Liability Partnership Charity Unincorporated Association
Business Address:
Postcode:
Daytime Telephone Number:
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
Proprietors / Partners / Directors Information

Full Names of all Proprietors, Partners & Directors	No. of years in this capacity	Professional Qualifications	Date Qualified
	years
	years
	years
	years

General Questions
Additional Trading name(s) to be insured (if applicable):
Full description of your work undertaken: (Please describe as fully as possible including a percentage split between each activity, where applicable)
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, or any other partner or director ever had any previous professional indemnity insurance declined, cancelled, renewal refused or any special terms imposed?	Yes     No
If yes, please provide details:
Have you, or any other partner or director ever been convicted of any offence other than fixed penalty motoring offences and those spent under the rehabilitation of offenders act?	Yes     No
If yes, please provide details: (e.g. dates, type of offence, any fines, length of custodial sentence, etc.)
Have you, or any partner or director ever been declared bankrupt, or been personally involved with any business which has been placed into receivership, liquidation or been wound up at the request of its creditors?	Yes     No
If yes, please provide details:
Do your business activities covered under this insurance involve any of the countries subject to sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the EU, UK and USA?	Yes     No
If yes,please provide details:
Current Professional Indemnity Insurance / Retroactive Date
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)
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 enquiry which might give rise to a claim?	Yes     No
If yes, please provide details:
Staff
Number of Professionally Qualified Employees:
Number of Technical Employees:
Number of Self Employed / Contract Staff:
Number of Other Employees (e.g. administration, etc.):
Annual Wageroll
Clerical Employee Wages (£'s):
Manual Employee Wages (£'s):
Turnover
Annual Gross Fees / Turnover (UK) (£'s):
Annual Gross Fees / Turnover (EU) (£'s):
Annual Gross Fees / Turnover (Rest of World) (£'s):
Please provide your total fees for the last complete year (£'s):
What is the largest single contract value undertaken in the last 3 years (£'s)?
Has the company previously undertaken any projects in the USA or Canada?	Yes     No
If yes, please provide details:
Sub-Consultants
Do you require sub-contractors to be indemnified under your insurance arrangements?	Yes     No
If yes, please confirm fees paid (last financial year) to sub-contractors (£'s):
Split of Activities
Please specify the split of activities for your gross fees received in the last financial year (or estimate in the first year of trading):
Sale of Own Brand Hardware:	%
Sale of Third Party Hardware:	%
Hardware Installation:	%
Hardware Maintenance:	%
Cabling - Internal:	%
Cabling - External:	%
Sale of Own Shrink Wrap Software:	%
Sale of Third Party Shrink Wrap Software:	%
Sale of Customisable Software:	%
Development of Bespoke Software:	%
Software Installation:	%
Software Customisation:	%
Software Maintenance:	%
Project Management:	%
Supply of IT Contract Staff:	%
Facilities Management:	%
Security Consultancy:	%
Internet Services:	%
Website Design:	%
Website Hosting (using own server):	%
Website Hosting (using third party host):	%
Other Work:	%
Total:	100%
General Questions
Do you anticipate any material changes to your activities or the types of contracts in which you are involved in the forthcoming 12 months?	Yes     No
If yes, please provide details:
Have you changed your name or been part of a merger, de-merger or joint venture, or have there been any material changes to your activities in the past 6 years?	Yes     No
If yes, please provide details:
Are all of your contracts subject to English, Scottish or Northern Irish Law?	Yes     No
If no, please provide details:
Are you responsible for or do you provide any advice or services in connection with the following:
(i) Live trading or mission critical systems?	Yes     No
(ii) Security of systems or networks (other than the installation of third-party anti-virus software or firewalls)?	Yes     No
(iii) Internet Service Provision (ISP) or Application Service Provision (ASP)?	Yes     No
(iv) Medical diagnostics or drug administration?	Yes     No
(v) Games software development?	Yes     No
If yes to any of the above, please provide details:
Are you, or any other partner or director associated or connected (financially or otherwise) with any other organisation?	Yes     No
If yes, please provide details:
Risk Management
Do you have a compliance officer or risk manager?	Yes     No
Name of Compliance Officer / Risk Manager:
Number of years with the firm in this capacity:	years
Complaince Officer's Qualifications (if applicable):
If no, please provide details of the person responsible for internal risk management:
Name of Person Responsible for Internal Risk Management:
Number of years with the firm in this capacity:	years
Qualifications:
Do you ensure that all contracts are subject to your standard terms or are reviewed and approved by your solicitor?	Yes     No
If no, please explain:
Do you seek to limit your liability in contract?	Yes     No
If yes, please state the upper limit at which liability is capped, or explain:
Are all your current contracts progressing to timescale, within budget and with no unresolved issues or problems?	Yes     No
If no, please provide details:
Do you obtain written signoff from your client at each stage of the contract prior to commencing the next stage?	Yes     No
Do you undertake any due diligence to ensure that prospective clients are financially stable with an acceptable credit rating?	Yes     No
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
Excess Required: (A higher excess will reduce the premium)	£250 £500 £1,000 £2,500 £5,000
Public Liability Cover
Do you require public liability cover?	Yes     No
If yes, limit of indemnity required?	£1,000,000 £2,000,000 £5,000,000 £10,000,000
Employers' Liability Cover
Do you require employers' liability cover?	Yes     No
Employers' Liability limit of indemnity: (£10 Million standard limit)
Additional Information
If there is any additional information to disclose or extra cover required, please provide details:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Details Of Current / Previous Policies
Renewal Date / Cover Start Date:	(dd/mm/yyyy)
Current Annual Premium / Best Quotation:	This may help us to get you a better quote
Name of Current / Previous Insurer:	e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

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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.

Estimated Quote Time: 1 to 72 hours