COVER-PRO APPLICATION
CORPORATE TRAINER SUPPLEMENT
1. Full name of the Applicant Firm:
2. Please indicate the percentage of your annual reve
nue from the last fiscal period involving:
Human resource training
(sexual harassment, discrimination, diversity training, etc
…) %
Team building and / or Leadership development: %
Computer software or other systems training: %
Financial planning / Retirement planning: %
Other (specify): %
Other (specify): %
Other (specify): %
Other (specify): %
TOTAL (Must equal 100%) %
3. Does the Applicant use a standard contrac
t? Yes No If yes, please attach a sample contract.
4. Please prov
ide the following detail on the firm’s five (5) large
st projects/clients in the last two (2) years in terms of
revenue gen
erated:
Client / Project Name:
Client’s Industry:
Approximate revenue generated from this project: $
Description of services provided:
Client / Project Name:
Client’s Industry:
Approximate revenue generated from this project: $
Description of services provided:
Client / Project Name:
Client’s Industry:
Approximate revenue generated from this project: $
Description of services provided:
Client / Project Name:
Client’s Industry:
Approximate revenue generated from this project: $
Description of services provided:
Client / Project Name:
Client’s Industry:
Approximate revenue generated from this project: $
Description of services provided:
PI-PLSP-CTSUPP 03/10 Page 1 of 2
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PI-PLSP-CTSUPP 03/10 Page 2 of 2
A
DDITIONAL INFORMATION
This section may be used to provide additional information to
an
y
question on this ap
plication. Please
identif
y
the ques
t
ion number to which you are referring.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Cover-Pro application and is subject to the same conditions as state on the application.
Name (Please Print)
Title (Mus
t be Principal, Partner or Officer
)
___________
_______________________________
Signature Date
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