PROFESSIONAL INDEMNITY & LIABILITY INSURANCE ISSUE COVER REQUEST
Thank you for your interest in our combined professional indemnity and liabilities insurance scheme, to enable cover to be issued please complete your details below:
Company Name (if applicable):
Contact Name - Title & Surname:
Contact Name – First Name:
Contact Number:
E-mail Address:
Please give a detailed description of your business activities outlining your roles and responsibilities:
What Date Do You Require Cover From:
Have You Been Previously Insured?
If YES, What is The Retroactive Date?
Professional Indemnity Limit of Indemnity (£):
Public/Products Liability Limit of Indemnity:
Are You a Member of Any of The Following Organisations:
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