Fillable COVER-PRO APPLICATION HANDWRITING / DOCUMENT ANALYST SUPPLEMENT n (Philadelphia Insurance Companies)

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COVER-PRO APPLICATION HANDWRITING / DOCUMENT ANALYST SUPPLEMENT n (Philadelphia Insurance Companies)

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COVER-PRO
SM
APPLICATION
HANDWRITING / DOCUMENT ANALYST SUPPLEMENT
1. Full name of the Applicant Firm:
2. What percentage of the Applica
n
t’s g
ross annual revenue comes from the following activities?
% Law enforcement / Criminal prosecution
% Criminal defense
% Civil litigation
% Other:(specify)
% Other:(specify)
% Other:(specify)
1
00 %
TOTAL MUST EQUAL 100%
3. What certifications does the Applicant hold?
4. Is the Applicant a member of any profess
ional ass
ociations? Yes No If yes, list the associations.
ADDITIONAL INFORMATION
This section may be used to provide additional information to
any
question on this application. Please
identify the question number to which you are referring.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cove
r-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or
Officer)
__________________________________________
Signature Date
PI-PLSP-HASUPP 08/
10 Page 1 of 1
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COVER-PRO APPLICATION HANDWRITING DOCUMENT ANALYST SUPPLEMENT n (Philadelphia Insurance Companies)

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Completed 7 November 2020

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