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Solicitors’ Professional Indemnity
Insurance Proposal Form 2017
1. Name and Address of Firm
Practice name (include all names under which you practice and to be insured).
2. Prior Practices
Please list the names of all prior practices of which this practice is a successor practice in the last 10 years.
Please use Section 18 if required.
Contact Name
Telephone Number
Main Oce Address
Contact E-mail Address
Website
Solicitors Regulation Authority Registration Number Date Established
Name of Practice Date Established Date of Succession
Do you have any other oces, other than the main oce listed above for which you are seeking cover?
If yes, please provide details on a separate sheet. If there is no resident Partner/Member/Director at any of these
oces, please identify the oce concerned and explain how the oce is supervised.
What is the status of the firm? (LLP, Limited etc.)
Have any of the listed practices reported any circumstances or claims?
If YES, please refer to Question 11.
YES
YES
NO
NO
Title Name(s)
Date of
Birth
Solicitor status
(Principal, Member,
Director/consultant/assistant)
*E/NE
Full Time /
Part Time
Date
Qualified
Roll No
Title Name(s)
Date of
Birth
Role (e.g. HR, IT,
Finance, Barrister,
Legal Executive,
Licensed
Conveyancer etc.)
Fee
Earner
Yes/No
Full Time /
Part Time
Qualification
Regulatory
Body
3. Alternative Business Structures
Is the practice in the process of or considering becoming an Alternative Business Structure
regulated by the SRA within the next 12 months?
If YES, please provide full details including any application form or documentation.
YES NO
4. Company Ownership / Directorships
Is the practice or any Principal/Member/Director of the practice, connected financially, or otherwise,
with any other practice, company or business for which it renders professional services?
If YES, please provide details in Section 18.
5. Solicitor Details
Please provide all information requested for every Principal, Member, Director, assistant and consultant who will be
employed by your practice as at the policy inception. If any person listed is a Registered Foreign Lawyer or a Registered
European Lawyer, please note RFL or REL alongside solicitor status. Please enclose Curriculum Vitae for every Principal/
Member/Director in your practice who has not held this position in the Firm for at least three years.
YES NO
Please list additional solicitors in Section 18 or on a separate sheet.
*Please state Equity or Non-Equity (E/NE)
Legal disciplinary practices/alternative business structures: Non-Solicitor Principals
Please provide all information requested for every non-solicitor principal, member or director as at the policy inception.
Year Ending UK USA/Canada Elsewhere Total for the Year
Last Complete Year
Previous Year
3rd Year
4th Year
5th Year
6. Other Staff (State if None)
Number of non-solicitor fee earning staff:
Number of all other staff (inc secretarial):
7. Practice Fees
(a) The practice’s accounting year end is:
(b) Please provide gross fee income for the last three accounting periods and an estimate of gross fee income for the
next accounting period.
Part TimeFull Time
Part TimeFull Time
(c) Has any one client or group of clients generated 20% or more of your annual gross fee
income in any of the last three years?
If YES, please provide full details in Section 18 of the client and the work undertaken.
(d) If your practice is represented in the USA/Canada do you have; a local oce or
representative; anyone holding power of attorney on your behalf; a reciprocal referral
agreement; bank accounts in the USA/Canada; or do you act as trustee for any trust
which has any USA/Canadian operation?
If YES, please provide full details in Section 18.
(e) Please provide full details (in Section 18) of all clients domiciled in the USA/Canada included above and the work
undertaken for them and whether the work is under UK or US law.
(f) Please provide full details (in Section 18) of any legal advice given in respect of foreign law, jurisdictions or
contracts not subject to English Law and what experience your firm has in the different jurisdictions.
(g) In respect of advice given to US clients is this in accordance with UK law only?
If YES, please provide full details in Section 18.
YES
YES
YES
NO
NO
NO
8. Client Details
Please state percentage totalling 100% of gross fees arising from the categories of clients listed below:
Merchant Banks, Finance Houses, Hire Purchases and Credit Sales and other concerns providing
Finance (other than Building Societies).
Public Quoted Companies (Takeover & Merger & Share Issue work only).
Property Developers or Property Investment Companies (including their commercial conveyancing).
Sub-Prime Lenders.
Insurance Brokers, Insurance Companies, Underwriting Agencies and similar organisations (other than
handling of claims under insurance policies).
All other clients.
Total
%
%
%
%
%
%
%
9. Practising Certificate And Regulatory Matters
In the last 10 years has any fee earner in the practice or any fee earner previously employed in the practice:
(a) ever been refused a practising certificate?
(b) been granted a conditional practising certificate?
(c) been reprimanded, fined or otherwise sanctioned by the Disciplinary Tribunal?
(d) practised in a firm subject to an investigation or an intervention by the Law Society or SRA?
(e) had an award made for inadequate professional service by the Legal Ombudsman,
LCS, CCS or OSS?
(f) Entered into any regulatory settlement agreement with the SRA?
(g) had a civil or criminal judgment against him/her?
(h) been investigated by any other regulatory body other than the Law Society or SRA?
(i) acted as an intervening agent or taken over an intervened firm?
Has the Practice:
(j) at any time in the last three years been the subject of a monitoring visit from the Solicitors
Regulation Authority?
(k) ever been the subject of any visit from or enquiry by the Forensic Investigation Unit of the
Law Society or SRA or received notice of a proposed visit?
If YES to any of these, please provide full details in Section 18 and include a copy of all reports issued by the SRA, LCS,
CSS, OSS, Solicitors Disciplinary Tribunal and/or any other regulatory body.
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
10. Claims And Circumstances
(a) Has your practice, or any prior practice, reported any circumstances, incidents or claims to,
Qualifying Insurers or the Assigned Risk Pool?
If YES, please provide claims information from Qualifying Insurers or the Assigned Risks Pool
for the last 6 years (or date of commencement of the practice if later) for your firm and any
firm to which you are a successor practice.
(b) Have any circumstances, or claims reported by you or any prior practice in the past arisen as a
result of the fraud or dishonesty of any Principal/Member/Director or employee of the practice?
If YES, please provide details in Section 18 including how the matter was resolved and the
procedures / processes in place to avoid re-occurrence.
(c) After making full enquiry of all Principals/Members/Directors and employees in your practice,
are you aware of any circumstances, incidents or claims that have not been reported to your
current or prior insurers (including any letters of complaint about your service or dispute as
to outstanding fees)?
If YES, please provide details in Section 18.
(d) After making full enquiry of all Principals/Members/Directors and employees in your practice,
are you aware of any circumstances, incidents or claims that have been notified to your current
or prior insurers but have not been accepted by insurers as a valid or effective notification?
If YES, please provide details in Section 18.
Please note that you have an obligation under your current professional indemnity policy to notify all circumstances
and claims as soon as practicably possible. All such notifications of which you are aware that have not been
reported to your previous insurers must be declared.
11. Previous Insurance
(a) Are you or has any solicitor referred to above been in the Assigned Risks Pool?
(b) Have you ever failed to pay either your premium (including run-off premium) and/or any excess?
(c) Have you ever failed to pay or defaulted on a repayment where the premium was financed?
(d) Have you or any prior practice ever been refused professional indemnity insurance?
(e) Are you or has any solicitor referred to above been or is currently the subject of an IVA or
other arrangement?
(f) Are you or has any solicitor referred to above been convicted of (or charged but not yet tried for)
any criminal offence Involving fraud or dishonesty?
If YES to any of the above, please provide details in Section 18.
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
12. Current Insurance (not required if we already arrange your insurance)
13. Your Insurance Requirements
Limit of Indemnity
Excess
Premium(excluding insurance tax)
Limit of Indemnity
Excess
Current Broker
£
£
£
£
£
Last
Year
Prior
Year
Prior
Year 2
Administering oaths, taking
adavits and Notary Public
% % %
Agency Advocacy
% % %
Acting as an Arbitrator,
Adjudicator and Mediator
% % %
Children, Mental Health
Tribunal and Welfare
% % %
Corporate/Commercial,
(excluding work related to
public companies)
% % %
Conveyancing - Commercial % % %
Conveyancing - Residential % % %
Lecturing and related activities
and expert witness work
% % %
Litigation (Commercial) % % %
Litigious work other than
included in any other category.
Please specify in Section 18.
% % %
Matrimonial / Family % % %
Non-litigious work other than
included in any other category.
Please specify in Section 18.
% % %
Oces and Appointments % % %
Parliamentary Agency % % %
Pension Trustee % % %
Personal Injury (Claimant) -
Fast Track
% % %
Personal Injury (Claimant) -
Other
% % %
Personal Injury (Defendant) % % %
Probate and Estate
Administration
% % %
Property Selling / Valuations
and Property Management
% % %
Tax Planning / Mitigation % % %
Last
Year
Prior
Year
Prior
Year 2
Defendant litigious work
for Insurers
% % %
Employment - Contentious
% % %
Employment - Non
Contentious
% % %
Financial Advice and
Services regulated by the
Solicitors Regulation
Authority
% % %
Immigration % % %
Landlord and Tenant –
Litigious
% % %
Landlord and Tenant – Non
Litigious
% % %
Town & Country Planning % % %
Trusts % % %
Corporate/Commercial
work, including public
companies
% % %
EC Competition Law and
Human Rights Law
% % %
Financial Advice and
Services where your
practice has opted into
regulation by the FCA
% % %
Intellectual Property
including Patent,
Trademark
and Copyright
% % %
Marine Litigation % % %
Mergers & Acquisitions
including Management
% % %
Total must equal 100%: % % %
14. Area Of Practice
Please provide the percentage of Gross Fees allocated to each Area of Practice during the last financial year and the two
prior years. Please round up to the nearest whole percentage.
If you indicate a percentage in any of the areas below,
please provide full details in Section 18, including the
highest deal values for these areas over the last 3 years.
For FCA work please request our ‘FS Questionnaire’.
(a) Has your practice or any prior practice ever provided management services or investment
advice to any entertainment clients or sporting professionals?
If YES, please provide details in Section 18.
(b) Has your practice or any prior practice ever accepted instructions for any class actions or
other group litigation?
If YES, please provide details in Section 18.
YES
YES
NO
NO
(c) Has the practice or prior practice within the last 20 years ever sold or provided advice in
connection with financial services products.
(d) Has your practice or any prior practice undertaken work in relation to selling or advising on
any mortgage endowment policies in 1990 or any subsequent years?
If YES, please request a Financial Services Questionnaire from us.
(e) Has your practice or any prior practice ever advised on any Home Income Plans or Equity
Release Plans?
If YES, please request a Financial Services Questionnaire from us.
(f) Does your practice carry out any work for which no fees are charged?
If YES, please provide details in Section 18.
Personal Injury
(a) Has your practice or any prior practice ever accepted referrals from personal injury claims
companies and/or their agents?
If YES, how many personal injury cases (from claims companies) have you undertaken in
the last six years?
(b) If your practice or any prior practice has undertaken personal injury work please provide the following details in
respect of the 12 months.
Conveyancing
(a) During any of the last six years has the practice or any prior practice undertaken any
residential or commercial conveyancing work?
If YES, please request a Conveyancing Questionnaire from us.
Please provide the following.
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
Last Year
Small Claims
%
Fast Track
%
Multi Track
%
. Residential Commercial
Approximate number of transactions in the last full accounting year
Highest value in the last full accounting year
£ £
Average value in the last full accounting year
£ £
(a) In the last six years has the practice or any prior practice undertaken any transactions that
have been received from a mortgage broker, developer or other intermediary?
(b) In the last six years has the practice or any prior practice undertaken any
re-mortgage transactions?
(c) In the last six years has the practice or any prior practice undertaken any Right To
Buy transactions?
(d) In the last six years has the practice or any prior practice undertaken any back to
back transactions?
(e) In the last six years has the practice or any prior practice acted for multiple (more than 5)
purchasers in the same development or building?
If YES to any of the above, please provide details in Section 18.
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
Wills and Probate
(a) Does your firm undertake Will Writing?
If so, do you use Certainty - the National Will Register – to register the wills you have created?
(b) Do you hold any Wills where the testator may have died and the Will you executed has
not been discovered by the beneficiaries/executors?
(c) Do you hold Wills which may have been superseded by a newer Will held by another firm
which could lead to the possibility of you administering a revoked Will?
(d) Has the firm undertaken any Wills and Probate work in the last 3 years?
If YES Please provide details in Section 18.
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
15. Significant Change
Do you expect there to be any significant change to or in your practice in the coming year?
If YES, please provide details in Section 18.
16. Material Information
Is there any other material information that may be relevant to this form?
If YES, please provide details in Section 18.
17. Risk Management Section
(a) Please provide the name and status of the person responsible for risk management in your practice.
(b) i. Please provide the name and status of the person nominated as the Compliance Ocer for Legal Practice.
(c) What Compliance Software does the practice utilise to carry out
the duties of the COLP.
Please state if none.
(d) Does the practice always obtain satisfactory written references when engaging new
Principals, Members or Directors and employees, including procedures for verifying
qualifications, previous experience, previous claims and/or circumstances?
(e) Is any Principal, Member, Director or Employee allowed to sign cheques on his/her
signature alone?
If YES, is there any upper limit for a sole signatory and if so what?
(f) Are employees who receive cash/cheques in the course of their duties required to pay in daily?
If NO, please provide details on a separate sheet.
(g) How often are checks carried out on all entries in the Cash Book with
all paying in books, receipts, counterfoils and vouchers?
(h) How often is a bank reconciliation carried out?
ii. Please provide the name and status of the person nominated as the Compliance Ocer for Finance and Administration.
Status:
Status:
Status:
Full Name:
Full Name:
Full Name:
(i) Which Legal Services Commission Quality Marks or other quality standards, e.g. LEXCEL, Investors In People, Law Society
Conveyancing Quality Scheme is your practice currently accredited with? Please specify and give the date of accreditation.
(j) Do you have written work instructions or checklists for the services provided?
(k) Do you have a time recording system?
(l) If you have an e-mail capability do you have an e-mail/internet user policy in place and enforced?
(m) Please outline the steps taken to review work undertaken by staff and describe how they are supervised.
(n) Are all relevant telephone conversations the subject of a note on the file?
(o) Please describe the diary system in operation (including back-up procedures).
(p) Do you have the required procedures in place throughout your firm for:
(q) Please confirm that all fee earners and employees are kept up to date with relevant
changes in legislation and other legal developments which could affect the work and
services they carry out.
If necessary, list further details in Section 18.
If necessary, list further details in Section 18.
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
NO
NO
NO
NO
i. Vetting clients including checking for conflicts of interest?
ii. Vetting clients including checking for conflicts of interest?
iii. Carrying out Money Laundering checks?
iv. Registering claims and complaints?
18. Additional Information
Confirmation – Please Read Carefully
Your duty to make a fair presentation of the risk
It is your duty to make a fair presentation of the risk to the Insurer. In accordance with the Insurance Act 2015 you
must disclose all material information which you know or ought to know. Material information is information that
would influence an Insurer in deciding whether a risk is acceptable and, if so, the premium, terms and conditions
to be applied. As an organisation you will be deemed to know all material information that is known to your senior
management and those responsible for arranging your insurance and which should have been revealed by a
reasonable search. Please contact us if you are in any doubt about what information needs to be disclosed.
Declaration
I/We declare the following;
I/We understand that I/We have a duty to make a fair presentation of the risk to be insured and that failure in this duty
could result in the policy being invalidated and/or any claims not being paid or not being paid in full.
I/We understand that the information provided will be used by the broker and/or insurers to arrange and administer
the insurance. This may necessitate sharing information with third parties and that information may be shared with
business partners to deliver any additional services provided with this insurance.
I/We understand that completion of this proposal form does not bind the Insurer to a contract of insurance.
If any information provided as part of this application for insurance materially changes before a contract of insurance
is concluded, I/We will immediately advise Professional Indemnity Insurance Brokers or the Insurer.
All facts provided within this proposal form or provided separately as part of this application for insurance are true or
substantially true and any representations as to matters of expectation or belief are made in good faith.
Professional Indemnity Insurance Brokers Ltd | Providence House The Borough Wedmore Somerset BS28 4EG
tel 0345 251 4000 | email info@professionalindemnity.co.uk | Company Registration Number 07165987
An Appointed Representative of Ten Insurance Services Ltd which is authorised and regulated by the Financial Conduct Authority (FCA)
This form must be signed by a principal of the firm
Signature:
Print name:
Date:
Position:
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Completed 1 October 2019

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