Contact Details

Staff Details:

Technical Staff:

Note: The professional liability of such independent firms is not covered under the proposed policy.

Nature of Activities

List some of the largest and typical jobs performed by your firm during the last five years (brief description including values and fees)

General questions regarding project

NATURE OF YOUR WORK/RESPONSIBILITY/PERIOD

TECHNICAL DETAILS

SURROUNDING PROPERTY

SCOPE OF COVERAGE

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provide the total gross income / fees for the past three years derived from Professional Services.In addition, please list projected income / fees for the current year. (Financial Year end – 30th June)

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For the income/fees described above, please give the approximate percentage derived from each of these activities

Please provide the following:

To what professional association(s) does the Applicant Firm belong?

Please include a list of Applicant Firms five (5) largest jobs or projects during the past three(3) years

Note: Please upload a copy of your standard contract.

It is agreed with respect to above Question, that if such knowledge or information exists any claim or action arising therefrom is excluded from this proposed coverage.

Publishing section

Indicate percentage of each type of book published / distributed:

Gross Annual Sales for:

Note: Attach current list of books published and description of standard procedures for checking originality, works, accuracy or content, title clearance, etc.

For those business periodicals / trade journals for which the applicant has published, please list below a sample of five published works:

Editorial Procedures:

Broadcasters Liability Application:

Programming Procedures:

Printing Services

Indicate the percentage of gross receipts derived from each of the following:

Is any partner or Director aware, after enquiry, of any circumstances which may result in any claim being made against the :

Please state names and addresses for :

Partner/Director Details