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Professional Indemnity Quote
Details
Name of Practice:
*
Address & Postcode:
*
Contact Telephone:
*
Website:
Email:
*
Establishment Date:
Number of directors/partners:
1
2
3
4
5
5+
Number of all other staff:
Under 5
Between 5-10
Between 11-20
Between 21-30
30+
Please select your profession from the following list:
*
Please Select....
Accountancy
Design and Construct
Engineer
Estate Agents
Financial Advisor
Insurance Broker
IT Consultants
Management Consultants
Marketing and Media
Recruitment Consultant
Solicitors
Other Profession
Please select a fee band applicable
for your last 12 months trading:
(or anticipated income if new business)
*
Please Select....
£0-10,000
£10,000 - £25,000
£25,000 - £50,000
£50,000 - £75,000
£75,000 - £100,000
£100,000 - £125,000
£125,000 - £150,000
£150,000 - £175,000
£175,000 - £200,000
£200,000 - £250,000
£250,000 - £300,000
£300,000 - £350,000
£350,000 - £400,000
£400,000 - £450,000
£450,000 - £500,000
£500,000 +
If fee income exceeds £500,000, please state exact
amount:
Limit of Indemnity required:
Accountancy
Please provide an approximate percentage split of your fee income in the following:
Accounting and compliance taxation & quoted/public companies:
Accounting and compliance taxation & other:
Auditing & quoted/public companies:
Auditing & other:
Book keeping:
Directorship:
Executorships and Trustees:
Insolvencies, Liquidation and Receiverships:
Insurance, Building Society, Stock Exchange/Investment Commission:
IT Consultancy:
Management Consultancy:
Mergers, Acquisitions, Disposals:
Taxation (consultancy only):
Payroll Services:
Secretarial and Share Registration:
If others please describe:
Design & Construct
Working Environment
Please provide an approximate percentage split of your fee income in the following:
Bridges:
Dams:
Mines:
Harbours or Jetties:
Sewage Schemes:
Foundations and Underpinning:
Water Schemes:
Nuclear or Atomic Projects:
Chemical, Petro-Chemical and Refineries:
Housing Schemes (2-3 floors):
High Rise Buildings:
Schools, Hospitals, Municipal Buildings:
Commercial / Industrial Systems Buildings:
Merchant Plant and Bulk Handling Equipment:
Leisure Centres:
Swimming Pools:
Churches / Ecclesiastical:
Roads / Highways / Motorways:
Cladding / Glazing / Curtain Walling:
Roofing:
Airports:
Railways:
Amusement Parks:
Aviation / Automotive / Military / Marine:
Demolition:
Flooring:
If others please describe:
Type of Work
Design and Build Only
Design Only
Adjudicator/Arbitrator:
Architectural Services as Defined in Work Stages
C-L of RIBA Architects Appointment:
Building Surveying:
Consultancy Engineering & Civil:
Consultancy Engineering & Structural:
Consultancy Engineering - Environmental:
Consultancy Engineering - Geotechnical:
Consultancy Engineering & Mechanical:
Consultancy Engineering & Electrical:
Consultancy Engineering & Heating & Ventilation:
Expert Witness:
Feasibility Studies:
Interior Design:
Landscape:
Non Structural Refurbishment:
Town Planning / Consultancy:
Planning Supervisor:
Project Co-ordinator:
Project Management:
Quantity Surveying and Surveying (not listed above):
Structural Surveys/Reports/Valuations:
If others please describe:
Financial Year Status
Previous
Last Complete
Current (Estimate)
Financial Year End (dd/mm/yy):
Turnover where the firm(s) design & constructs
from their own design and provides full technical supervision:
Turnover of those departments where the firm(s)
provides design & technical services where no
construction is involved by firm(s):
Turnover where the firm(s) constructs from other
designs preformed on behalf of firm(s):
Turnover where firm(s) constructs from other's
design & technical supervision preformed on
behalf of the firm(s):
Other turnover not mentioned):
Engineer
Please provide an approximate percentage split of your work carried out:
Bridges:
Dams:
Mines:
Harbours or Jetties:
Sewage Schemes:
Foundations and Underpinning:
Water Schemes:
Nuclear or Atomic Projects:
Chemical, Petro-Chemical and Refineries:
Housing Schemes (2-3 floors):
High Rise Buildings:
Schools, Hospitals, Municipal Buildings):
Commercial / Industrial Systems Buildings:
Merchant Plant and Bulk Handling Equipment:
Leisure Centres:
Swimming Pools:
Churches / Ecclesiastical:
Roads / Highways / Motorways:
Cladding / Glazing / Curtain Walling:
Roofing:
Airports:
Railways:
Amusement Parks:
Aviation / Automotive / Military / Marine:
Demolition:
Flooring:
If others please describe:
Please give the split of gross fees recieved in the last complete financial year:
United Kingdom
Overseas Contracts
Consulting Engineering:
Civil:
Structural:
Soil & Foundation:
Mechanical:
Electrical:
Heating & Ventilation:
Architectural:
Town Planning / Quantity Surveying:
Structural Surveying Inspection Reports:
Valutations on Existing Property:
Planning Supervision:
Adjudication / Arbitrator:
Expert Witness:
Any work other than listed above, please give full details:
Estate Agents
Please provide an approximate percentage split of your fee income in the following:
Estate Agency including Probate, Matrimonial & Market Appraisal:
Management Letting's & Residential Properties:
Management Letting's & Commercial Properties:
If others please describe:
Financial Advisor
Please provide an approximate percentage split of your fee income in the following:
Pensions:
Endowments:
Other Life:
Mortgages:
Building Society Agencies:
PHI Medical:
Private Client Portfolio Management (Discretionary):
Private Client Portfolio Management (Non-Discretionary):
Investment In Unit Trusts / Insurance Bonds:
Dealing in Listed, Unlisted UK or Foreign Securities:
Dealing in Bonds (e.g. Euro Dollar) or Commodities:
Structured Capital at Risk Products:
Split Capital Investment Trusts / Zero Dividend
Preference Shares:
If others please describe:
Insurance Broker
Please provide an approximate percentage split of your fee income in the following:
Personal Lines:
Commercial Lines:
Professional Indemnity:
Construction:
Aviation:
Marine:
Risk Management / Consultancy:
If others please describe:
IT Consultants
Please provide an approximate percentage split of your fee income in the following:
Hardware Sales:
Hardware Installation / Maintenance:
Software Product Sales:
Software Services:
Internet Services:
If others please describe:
Management Consultants
Please provide an approximate percentage split of your fee income in the following:
Strategic Consultants:
Organisation, Design & Development Consultancy:
Quality Management:
Manufacturing Systems Consultancy:
Financial Management & Consultant only:
Project Management:
Human Resources Consultancy:
Recruitment Consultancy (Permanent Staff):
Recruitment Consultancy (Temporary Staff):
Marketing Consultancy:
Telecommunications Consultancy:
Computer & IT Consultancy:
Outsourcing & Facilities Management Consultancy:
Design & Creativity Consultancy:
Quality Assurance Consultancy:
Health & Safety Consultancy:
Interim / Locum Management:
Training Services:
If others please describe:
Marketing & Media
Please provide an approximate percentage split of your fee income in the following:
Commercial TV & Production of Advertisements:
Commercial TV & Media Space Purchased:
Other Media & Production of Advertisements:
Other Media & Media Space Purchased:
Production of Printed Literature/Documents:
Direct Marketing:
Telemarketing:
List Broking:
Sales Promotion:
Marketing:
Market Research:
Public Relations:
Specialist Design:
Corporate Identity Work:
Event/Conference Organisation:
Multimedia Consultancy:
If others please describe:
Recruitment Consultant
Please provide an approximate percentage split of your fee income in the following:
Clerical IT:
Other Professionals:
Medical/Nursing/Care:
Drivers/Warehouseman:
Blue Collar / Manufacturing:
Construction Manual:
If others please describe:
Solicitors
Please provide an approximate percentage split of your fee income in the following:
Adjudication / Arbitration:
Agency Advocacy:
Children Work, Mental Health Tribunal & Welfare:
Commercial/Corporate Excluding Public Companies:
Commercial/Corporate Including Public Companies:
Commercial Litigation:
Conveyancing Commercial:
Conveyancing Residential:
Criminal:
Debt Collection:
Defendant Litigation (Insurers):
Employment:
Estate Agency, Property Management & Valuation:
Expert Witness / Lecturing Work:
Financial Advice & Regulated by the SRA:
Immigration:
Intellectual Property Including Patent, Trademark & Copyright:
Landlord / Tenant:
Marine Litigation:
Matrimonial Family:
Oaths, Affidavits & Notary Public:
Offices and Appointments:
Parliamentary Agency:
Personal Injury (Defendant):
Probate and Estate Administration:
Town & Country Planning:
Wills Trusts & Tax Planning:
Litigation Work (other):
Non Litigation (Other):
If others please describe:
In the last 10 years has any fee earner in the firm ever:
Been refused a practising certificate?:
Please Select....
Yes
No
Been granted a conditional practising certificate:
Please Select....
Yes
No
Been the subject of a costs or penalty order
or been reprimanded by the Solicitors Disciplinary
Tribunal:
Please Select....
Yes
No
Practised in a firm that has been subject to an investigation
or intervention by any regulatory department of the Law Society
or Solicitors Regulation Authority including the Office for the
Supervision of Solicitors (OSS), Consumer Complaints Service (CCS)
or the Legal Complaints Service (LCS)
Please Select....
Yes
No
Been investigated by any other regulatory body other
than the Law Society (e.g. FCA):
Please Select....
Yes
No
Had a civil or criminal judgement
(other than minor traffic offences) against him or her?:
Please Select....
Yes
No
Had an award for inadequate professional service
made against him or her by the OSS/CCS/LCS in the
past 10 years?:
Please Select....
Yes
No
Has your practise been in correspondence with
and/or recieved a formal visit from the Investigating
Account of the OSS/CCS/LCS or any other proper
officer of the OSS/CCS/LCS in the past 10 years?:
Please Select....
Yes
No
If 'yes' to any of the above, please provide full
details and include all reports issued by the
SDT, OSS, CCS, LCS and/or any other regulatory
body:
Any Other Miscellaneous Professions
Please give details of your full business activities with
approximate work splits in percentages: (e.g. Private Invgestigator, Event Organiser, Interior Designer, etc)
Claims History
Have you had any claims in the past 5 years?:
Please Select....
Yes
No
If Yes, please provide full details of all claims:
Additional Information
Please state any other additional information that
you would like to make us aware of:
