Regulated and Authorised by FSA
Catering
Prof. Indemnity
Property
Legal Expenses
Other
Advance Underwriting Ltd
PO Box 186, Ipswich, Suffolk
England, IP4 4HP
Tel: 0845 650 1379
Fax: +44 (0)1473 400075
enquiries@
advanceunderwriting.co.uk
Professional Indemnity Information Request Form
Page 1 of 2
Name
Title
Company
Address
E-mail
Phone
Nature of Business
Date Business Established
Effective Date of Cover(dd/mm/yy)
Limit of Indemnity Required
£100000
£150000
£250000
£500000
£1000000
£2000000
£5000000
Excesss Required
£500
£1000
£2500
£5000
Previous Claims
Is cover required for any partner or director for liability arising from any previous business ?
Yes
No
Please provide details of directors/partners
No of Years
Name
Qualifications
Age
Experience
Please give details of fee income
Fee Income
Date Ending dd/mm/yy
Previous Year
Current Year
Is any fee income derived from overseas?
Yes
No
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