Directors & Officers Issue Cover Request

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

Thank you for your interest in our Directors & Officers insurance scheme, to enable cover to be issued please complete your details below:

Company Name:

Contact Name - Title & Surname:

Contact Name - First Name:

Business Address:

Postcode:

Contact Number:

E-mail Address:

Acceptance Criteria:

(If you do not comply with all or any of the criteria below please call Insurance2day on 01384 423 888 for details of other products which may be more suited to your requirements)

You can confirm that the company, and any subsidiaries thereof:

- Is a UK registered private company with a turnover less than or equal to 10,000,000 (GBP)

- Has no assets in North America

- Has no previous claims or circumstances that may lead to a claim under this policy

- Is not involved in telecoms, IT, pharmaceuticals or bio-tech and is not a financial organisation

- Latest audited report and accounts show a positive net worth

If you have opted to add Company EPL cover, please confirm that the company, and any subsidiaries thereof:

- Has a written grievance procedure in place and has not been the subject of any Employment Practice claims

- Is not currently undergoing, or does not contemplate within the next 12 months any employee layoffs or early retirements

If you have opted to add Crime cover, please confirm that the company, and any subsidiaries thereof:

- Has no business activities outside the UK and is also not a legal partnership, a gambling establishment, a jeweller or precious metal dealer, an outsourcing company, a transit company or a cash carrying company

Can you confirm that you comply with all of the acceptance criteria detailed below:

Please provide full details if you do not comply with the Acceptance Criteria

Directors & Officers Limit of Indemnity:

Confirmation of Annual Premium (£)

Method of Payment

If Other, please give details

N.B. No cover is in place until payment is received and you receive written confirmation of cover.

Please press the submit button to request cover