Join Now
Browse Template

Professional Indemnity Insurance Application Form

Miscellaneous Professions

Ensure full compliance with Professional Indemnity Insurance requirements. Our template simplifies duty of disclosure for seamless insurance applications.

How to Tailor the Document for Your Need?


Create Document

Click "Create Document" button and the document will be prepared with your account details automatically filled in.


Fill Information

Please fill in any additional information by following the step-by-step guide on the left hand side of the preview document and click the "Next" button.


Get Document

When you are done, click the "Get Document" button and you can download the document in Word or PDF format.


Review Document

Please review the document carefully and make any final modifications to ensure that the details are correct before sending to the addressee.

Document Preview

Document Description

Are you in need of a Professional Indemnity Insurance Application Form that allows you to fulfil your duty of disclosure before entering into a contract of general insurance with an insurer?

Our template simplifies the entire process, ensuring compliance and comprehensive coverage. From specifying the period of insurance and desired limit of liability to addressing important aspects like cover for fraud, dishonesty, cyber liability, and automatic reinstatement, our template covers it all. It even includes additional information requirements, such as corporate profile, financial statements, contracts, and resumes, to complete your application. We have included comprehensive sections covering applicant details, business information, financial details, risk management, insurance history, and claims experience, all designed to facilitate a smooth and efficient application process. 

Simplify your Professional Indemnity Insurance application, fulfil your duty of disclosure, and secure the coverage you need with our user-friendly template. Streamline the process, save time, and ensure compliance with our SEO-friendly Professional Indemnity Insurance Application Form template.

How to use the document? 

How to Use the Professional Indemnity Insurance Application Form: A Step-by-Step Guide

1. Start by filling out the basic details: a. Provide the period of insurance, including the start and end dates. b. Choose the desired limit of liability required from the given options. c. Specify the excess/deductible requested from the available options. d. Indicate if you need cover for Fraud & Dishonesty, Principals' Previous Business, Automatic Reinstatement, and Cyber and Privacy Infringement Liability.

2. Prepare additional information: a. Gather relevant documents, such as a corporate profile, brochures, financial statements, standard contracts, and resumes of principals. b. If applicable, include your business plan with projections for new businesses.

3. Provide applicant details: a. List the names and company registration numbers of all firms seeking coverage. b. Disclose any name changes, mergers, or purchases and attach relevant details. c. Enter your address and website address. d. State the establishment date of your firm. e. Specify the number of principals, partners, directors, and different staff categories.

4. Outline the qualifications and experience of your principals: a. Provide names, qualifications, year qualified, and years as principal, partner, or director for each individual in key positions.

5. Describe arrangements for business continuity: a. If you have only one principal, explain how business continuity is ensured when the principal is unavailable.

6. Describe your business: a. List professional licenses held by you and your principals. b. Mention professional societies and associations you and your principals are members of. c. Provide the percentage breakdown of services you offer to clients.

7. Disclose other professional or business activities: a. Specify if you engage in any additional professional or business activities beyond what's described. b. Attach details and provide fee income from these activities, if applicable.

8. Share financial details: a. State your financial year end date. b. Provide total turnover and gross profit for the current year, past year, and projected coming year. c. Indicate the percentage of fee income derived from work in different locations. d. List foreign countries where you provide services and the number of staff in each location.

9. Outline your five largest projects or contracts from the past five years: a. Include client names, services performed, start and end dates, locations, and fees.

10. Demonstrate risk management practices: a. Explain your use of written contracts, agreements, or engagement letters with clients. b. Specify if client contracts are reviewed by a law firm. c. Answer questions about contract contents, changes, written confirmations, disclaimers, subcontracting, and subcontractor insurance.

11. Provide insurance history: a. If you have similar insurance, provide details of the current or previous coverage, including the insurer, policy limit, excess, and retroactive date. b. If similar insurance applications were refused or canceled, share the relevant information.

12. Report claims experience: a. Disclose any previous claims, lawsuits, or disciplinary actions against you or your principals. b. Include details such as dates, claimants, allegations, status, and amounts paid.

13. Review and declaration: a. Carefully read the Important Notices section. b. Understand that the proposal and accompanying documents will form the basis of the insurance contract. c. Confirm the accuracy of the provided information. d. Sign and date the declaration section.

By following these step-by-step instructions, you can efficiently complete the Professional Indemnity Insurance Application Form and ensure all necessary information is included

Related Documents