PROPOSAL FORM FOR PROFESSIONAL INDEMNITY
(For chartered Accountants/ Solicitors/ Advocates/
Architects/ Consulting Engineers)

Name of Proposer
Address
Telephone
Fax
       
Profession
     
Qualification and Experience
Name Age Qualification Years of experience
   

Annual Earnings

         

Geographical Area  

            

Proposed Period of Insurance

         

Named of Previous Insurer

        
Reason for changing the insurer
       
Previous Claims History (Last five years)

I/We certify that the above information is true to the best of my/our knowledge and belief
            
Date
Place

 


 


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