Advance Underwriting - Specialists in Mobile Catering Insurance

Regulated and Authorised by FSA

Advance Underwriting Ltd

PO Box 186, Ipswich, Suffolk
England, IP4 4HP

Tel: 01473 711475
Fax: +44 (0)1473 400075

enquiries@
advanceunderwriting.co.uk

Professional Indemnity Quotation Request Form

Welcome to our Quotation Form. Completion of this form does not commit you to taking out the insurance. For assistance please telephone 01473 711475 or click here to send an e-mail. You will also need to send a copy of your c.v and if you have one a brochure for your services or a link to your web site.

+ Click here if you are an insurance broker

This section to be filled in by insurance brokers only

Name
FSA number
Email Address
Email Address (confirm)
Phone Number:
Business Name (broker):
Address 1:
Address 2:
Town / City:
Postcode:

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
Excesss Required
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