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ICO
, all your personal information is protected under the
Data Protection Act 2018
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Use test data
About your business
What is your specific trade/profession?
Do you have a secondary trade/profession?
Yes
No
What is your business postcode?
Which of these categories best describes your business?
SOLE TRADER
PARTNERSHIP
LTD COMPANY
Your policy details
Policy start date
Your details
Title
Mr
Mrs
Miss
Ms.
Dr (Male)
Dr (Female)
First name
Last name
Contact details
Is your correspondence address the same as your business address?
Yes
No
Email address
Telephone number
Alternative phone number
Do you have any employees? (including labour only subcontractors)
Yes
No
Total employees (excluding partners and directors)
Your Payment Preference
How do you usually pay for your insurance?
Do you use a van for your business?
Yes
No
Has your business done (or do you plan to do) any work for customers based outside the UK?
Yes
No
What's the largest fee income you've earned from any one client?
Please select which of the following activities you carry out
Audit Work
Book Keeping
Company flotations
Company/corporate Tax Consultancy
Computer consultancy
Corporate Finance, Listed or Quoted companies
Directorships, Executorships & Trusteeships
General Accountancy
Initial Public Offering of shares
Insolvency, Liquidation & Receivership
Introducer Commissions From Third Party Intermediaries
Management Consultancy
Mergers, Acquisitions & Disposals
Offshore work
Payroll
Personal tax consultancy
Secretarial and share registrations
Other
Are you a member of ICAEW, ACCA, CAI or ICAS?
Yes
No
Other than as an introducer, have or do you intend to carry out any investment or financial services work?
Yes
No
Do you work for listed companies?
Yes
No
Do you do work for clients in the financial services sector?
Yes
No
Please either agree or disagree with the following statements
Have you made any claims (whether insured or not) or has anyone asked you for compensation in the last 5 years?
Yes
No
Are you aware of any circumstances over the last 5 years that could give rise to a claim being made against you or the company?
Yes
No
Does the company have any current or ongoing legal or contractual disputes?
Yes
No
Are there any ongoing legal disputes with current or former employees?
Yes
No
Have you been subject to any disciplinary hearing or investigation undertaken by your professional body?
Yes
No
Has anyone with control over or a financial interest in the business, including you, your family, or any partner/principal/director, had any insurance proposal declined, renewal refused or cover terminated for any reason?
Yes
No
Has anyone with a financial interest in the business, including you, your family, or any partner/principal/director, received a County Court Judgement (CCJ) regarding debt (either as an individual or in connection with a business)?
Yes
No
Has anyone with control over or a financial interest in the business, including you, your family, or any partner/principal/director, been declared bankrupt or been granted an Individual Voluntary Arrangement (IVA)?
Yes
No
Has anyone with control over or a financial interest in the business, including you, your family, or any partner/principal/director, been a director of a company which went into liquidation?
Yes
No
Has anyone with control over or a financial interest in the business, including you, your family, or any partner/principal/director, been convicted of any criminal offence other than a motoring offence or an offence that is now considered "spent" under the Rehabilitation of Offenders Act 1974?
Yes
No
Additional comments
Additional comments
Terms agreement
I Agree
I Disagree
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