Lawyers Professional Liability Insurance

Premium Estimate Questionnaire
- Complete this form to receive a premium estmate. Quotations and coverage may be issued only upon acceptance of a fully completed application.
* REQUIRED FIELDS

To which attorney in your firm should insurance matters be addressed?

Contact Name *
 
Please indicate, in the spaces below, the number of attorneys in your firm according to their years in practice:
 
 
What percentages of time (not income) do you spend in the following practice specialties?
(Indicate % in whole numbers, total must equal 100%)
 
 

Your Claim History

 
 

Your Insurance History