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e.     Are you involved in any process of manufacture, construction,
alteration or repair other than in a consultancy capacity:                                 Please Circle

                                                                                                                              Yes/No

f.      Do you provide your services under standard trading conditions:
If yes, please provide us with a copy.                                                                 Yes/No

g.     Are copies of your Standard Trading Conditions provided to your
customers before you perform the insured service:                                              Yes/No

3. INSURANCE INFORMATION AND CLAIMS HISTORY

a.     Are you currently insured for your professional liability exposure?
If yes, please provide us with the following details:                                               Yes/No

1. Name of insurer
2. Limit of liability	2.1 Third Party & Professional Indemnity combined: Or 2.2 Professional Indemnity Limit:       Third Party Liability Limit:      Overall Combined policy limit of liability:
3. Deductible
4. Premium
5. Number of years consecutively insured (one or more insurers)

b.     Have any claims been made against the company or its present partners or directors in respect of the type of liabilities to which this proposal relates?
(If yes, please attach full details)                                                                           Yes/No

c.     Have you, at any time, been refused similar insurance, or been quoted increased premiums or had special terms imposed?
(If yes, please attach full details)                                                                           Yes/No

 

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