Legal Expense Insurance Cover Request

Insurance2day Insurance Services Ltd are authorised and regulated by the Financial Services Authority and are members of:

Company Name:

Contact Name - Title & Surname:

Contact Name - First Name:

Business Address:

Postcode:

Contact Number:

E-mail Address:

Cover Required

Legal Expenses Limit of Indemnity	For companies with an estimated annual turnover up to £1 million
With Employers Protection	Without Employers Protection
£50,000	£115	£90
£100,000	£130	£105

Estimated Annual Turnover (£):

Details of Any Other Cover Required:

Method of Payment

If Other, please give details

Inception Date:

Have you ever had an insurance policy cancelled or special terms imposed?

Any additional information/comments:

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