Media professions on line quotation facility

Business name*

Name*

Prefix First Last Suffix

E-mail*

Nature of business*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Telephone*

Fax

Do you hold a current professional indemnity policy?*

Yes
No

If you've answered 'yes', please provide the retroactive date of your existing policy

Do you require cover for any contracts subject to any other law than UK law?

Yes
No

Is cover required for work undertaken in countries outside of the UK?

Yes
No

Level of PI cover required*

Your fee income*

Level of public liability required*

Level of employers liability required*

Level of cover required for electronic portable equipment*

Office contents

Computer equipment at premises

Please provide your total annual wage roll

Is any manual work undertaken?

Yes
No

Do you design or provide services in relation to any of the following:

Application service provision, internet service provision or other managed services?
Web hosting, domain name registration, transactional website design?
Print-only work, authoring or journalism, event management?
Do you undertake any contracts for your customers without a written specification, which includes campaign details, quantity, timings and sign-off procedures?
Direct marketing, sales promotion or telemarketing?
Publishing or broadcasting?

Claims or circumstances

Are you after reasonable enquiry aware of any shortcomings in your work which could lead to a claim against you for any of the risks you wish to insure or any losses from the suspected dishonesty or malice of an employee or self-employed freelancer?
Has any claim or loss, whether successful or not, ever occurred or been made against you or your predecessors in business, or any past or present partner, principal, director or employee in respect of any of the risks to be insured (whether previously insured or not)?

This could include: A shortcoming which you cannot reasonably put right, a complaint about your client’s work or anything your client has supplied which cannot be immediately resolved, an escalating level of complaint on a particular project.

Media professions on line quotation facility

Please complete your details below.