Lloyd Manley Associates - Professional Indemnity Enquiries

Please complete the following Professional Indemnity Enquiry form

General:
Company Name:
Address 1:
Address 2:
Post Code:
Telephone:
E-mail:
Business description:
Type of Firm:
	Limited Company
	Partnership
	Sole Trader
	Other
If 'Other' please specify:
When established:
Gross fees in last financial year:	£
Gross fees in current financial year:	£
Number of years experience of Principal/Director:
Limit of indemnity required:
Are all your operations in the UK?	Yes No
Are you currently insured?	Yes No
If Yes: Renewal date
If Yes: Name of current insurer
Have you had any claims in the last 5 years:	Yes No
If Yes, please give details:
Your name:	Position:

Authorised and Regulated by the Financial Services Authority for General Insurance Business No. 302600