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:
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.
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.