PROFESSIONAL INDEMNITY INSURANCE POLICY PROPOSAL FORM









Please provide the following details of all Partners/Directors/Principals:

Is coverage required in respect of past work for any Partner/Principal who has left, retired or died?
YesNo

If ‘YES’ please give the following:

Please state the following:








Please state the 5 largest contracts where construction has commenced during the past 6 years



Please give details of Contracts where construction is expected to commence in the next 12 months

State whether you undertake Supervision of Contract works being executed?
YesNo


Do you engage persons outside your organization?
YesNo





Loss Record for 5 years






YesNo





YesNo


YesNo


YesNo


YesNo