Camberford Law PLC

Guidance Notes

1. Company Details

1.1. Please state the name and address of the principal Company for whom this insurance is required. Cover is also provided for the subsidiaries of the principal Company, but only if you include the data from all of these subsidiaries in your answers to all of the questions in this form.

	Insured Company

	Contact Name

	Address

	Telephone

	Fax

	Email Address

	Website

1.2. Please state when your company was established

1.3. i) How many directors and / or partners are there in the Company?

ii) Please state below the details of all Partners / Directors.

iii) Please state the number of employees

					Marketing / Sales / Business Development
					I.T. / Technical
					Other

1.4 If you require Employers’ Liability cover, please supply your Employer PAYE Reference(s). (This information is required for us to provide Employers’ Liability cover. Where you have more than one PAYE Reference, please advise each one making it clear which company they apply to)

1.5 If you do not have a PAYE Reference, please confirm that you are exempt and give the reason.

1.6. Please state your fees received in respect of the following years:

Currency

Date of Financial Year End (dd/mm)

	Last Complete Financial Year	Estimate for Current Financial Year	Estimate for Next Financial Year
(a) Domestic Turnover
(b) USA Turnover
(c) Other Territory Turnover
Total Turnover
Operating Profit / Loss

Date of Birth

Years in Position

Years Experience

Qualifications

Please answer all questions fully and carefully. There is a duty to disclose all material facts. Material facts are those that affect the judgment of a prudent Underwriter.

The proposal form and the information you provide forms the basis of the insurance policy you are purchasing and therefore is extremely important. Full disclosure should eradicate many issues at the time of a claim being made on the policy.

Full Name of Proposer
If a Limited Company please insert this name in the full name of the Proposer.
If a sole trader – please list your name in the full name of the Proposer and any Trading Name below this.
If a partnership, list all partners’ names in Full Name of Proposer and any Trading Name in the next box.

Full description of activities
Please make sure that you list every activity you undertake to ensure we cover your activities correctly and prevent any issues at the time of making a claim.

T: 020 8315 5000

F: 020 8460 2118

E: mail@camberfordlaw.com