adjudication.co.uk

Legal Expense Solutions Limited

Constructors Protection Service (CPS)
Company and Client Information Request Sheet

Name of Company:
(including all subsidiary or associated businesses requiring cover)
Address:
Postcode:
Telephone:
Fax:
Contact Name:
Job Title:
Business:
Date Business Commenced:
Turnover:
Last 12 months
(actual) £
Next 12 months (estimated) £
Please indicate the Limit of Indemnity for each and every Adjudication: £10,000   £25,000
Please indicate the Limit of Indemnity for each and every Arbitration: £100,000   £250,000

You will be required to bear the first £1,000 of Legal Expenses incurred in each and every claim.

Please note that disputes arising out of contracts entered into before acceptance of this proposal will not be covered by this insurance.

Please remember that you must provide Insurers with all material information which is likely to influence acceptance of this proposal or the premium and other terms imposed. Failure to give this information may give Insurers the right to reject any claims made or void the insurance altogether. If you are in any doubt about a particular fact, you should disclose it.

Declaration

I/We declare that to the best of my/our knowledge and belief the above statements are true and I/we agree that this proposal shall be the basis of the contract between me/us and Insurers and to accept the Insurer's Policy applicable to this insurance. If anyone else has completed this proposal, they acted as my/our agent.

NB. Submitting this proposal form does not bind you or the Insurers to complete the insurance. A signed proposal document may be required before such completion.

:: Legal Expense Solutions Limited ::
:: 52-54 Gracechurch Street ::
:: London EC3V 0EH ::
:: lrmproposal@adjudication.co.uk ::

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