YES NO Is cover required for the previous business activities of any Principal? If YES, please state: Name of Principal Name of Previous Firm From / / From / / From / / Period To / / To / / To / / Y/E / / £ Y/E / / £ Y/E / / £ Fees for Last 3 Yrs Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Reason for Leaving Position in Firm Is there separate insurance covering the activities of this Firm for the Period stated above? ___________________________________________________________________________________ Is cover required for predecessor practices to the Proposer/s? If YES, YES NO please provide full details: Name of Predecessor Date Commenced Date Ceased Reason for Cessation DO NOT ANSWER IF PROPOSAL IS FOR RENEWAL OF INSURANCE WITH CHURCHILL INSURANCE CONSULTANTS Name of current insurers Name of your broker Renewal date Limit of indemnity Premium Excess (a) Please state total numbers of: Principals Qualified staff
YES NO Is cover required for the previous business activities of any Principal? If YES, please state: Name of Principal Name of Previous Firm Period From / / To / / From / / To / / From / / To / / Fees for Last 3 Yrs Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Y/E / / £ Reason for Leaving Position in Firm Is there separate insurance covering the activities of this Firm for the Period stated above? ___________________________________________________________________________________ YES NO Is cover required for predecessor practices to the Proposer/s? If YES, please provide full details: Name of Predecessor Date Commenced Date Ceased Reason for Cessation DO NOT ANSWER IF PROPOSAL IS FOR RENEWAL OF INSURANCE WITH CHURCHILL INSURANCE CONSULTANTS Name of current insurers Name of your broker Renewal date Limit of indemnity Premium Excess (a) Please state total numbers of: Principals Qualified staff
Property-Professionals-proposal-form.docx