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.

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