Professional Indemnity

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This Proposal Form and all materials submitted shall be held in confidence. Please answer all questions in full and provide all requested information and/or required attachments to enable a quotation or indication to be provided. The completion and submission of this form does not bind the applicant or underwriters to enter into any contract of insurance.

If a question does not apply, please write “N/A”. If the answer is none, state “none” or “0”. If more space is needed, please continue on a separate sheet of the applicant’s letterhead and indicate the question number to which the information responds. This Proposal Form and any separate continuation sheets must be completed, signed and dated by a principal of the business.

11. Individual Experience(s) – Please list the names, date of birth, position, and sector experience of all Directors and/or Partners of the Proposer(s)

14. Please state total number of:

14. Please state gross fees (£) in the columns provided for the last 5 complete financial years:

15. Please provide breakdown of Turnover as follows:

18. Division of Works: Environment – Please specify the percentage of gross fees in the previous year that the following types of work represent:

Home Building

Engineering Construction

Industrial / Hazardous Locations


Commercial / Retail

* Please refer to Question 18.

19. High Rise Buildings

20. Division of Works: Disciplines – Please give an approximate percentage split of the disciplines within your Design and Contract Department (even if such work is sub – contracted):

21. Risk Management – Please confirm:

22. Do you use the services of consultants, sub-contractors or agents?

25. Do you have standard terms of business for use with all clients?

26. Do you limit your liability for consequential loss under your Terms of Business?

27. Please provide the following details:

Retroactive Date
A Retroactive Date is the date from which you have held uninterrupted Professional Indemnity insurance cover, even if you’ve changed insurers during this time, or a date in the past from which your insurer has agreed to cover you. Any claims that arise from events prior to this date is not covered by your insurance.

29. During the past 6 years:

31. Declaration

I/we declare that I/we have made a fair presentation of the risk, by disclosing all material matters which I/we know or ought to know or, failing that, by giving the Insurer sufficient information to put a prudent insurer on notice that it needs to make further inquiries in order to reveal material circumstances.

32. Please upload the following documentation