BusinessInsuranceQuotations.com
Directors and Officers Liability Proposal Form
1. Your Name:
Company Trading Title:
Type of Company:
Sole TraderPartnershipLimited Company-
2. Address of your premises:
Post Code:
Telephone Number:
E-mail address:
Website address:
3. Description of Business:
4. Date Established:
5. Turnover:
£
Please confirm that the company and any subsidiaries - - is A UK registered private company with a turnover below £10,000,000 - 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-technology and is not a financial institution - latest audited report and accounts show a positive net worth.
Yes No
If previous answer was no, please give details
Directors and Officers limit of liability:
£1,000,000£2,000,000£5,000,000Other-
Do you require Employment Practice Liability Cover?
If you require Employment Practice Liability Cover, please confirm that -
You have a written greivance procedure in place and have not been the subject of any Employment Practice claims, and
You are not currently undergoing, or do not contemplate within the next 12 months and employee layoffs or early retirements.
6. Current Insurance
Name of current insurers (so that we don't approach them!)
Expiry date of current insurance
Current premium (if known)
Please supply me with an estimate within 105 working days. (We will attempt to meet the target, but please be aware that it does require our insurers to respond quickly as well!)
Done
Please check your details, and when you are happy that all is correct, tick the 'Done' box and then click the Submit button above...
