Professional Liability Insurance for Recognized Organizations with DOJ Accredited Representatives

This is an application for a Claims Made Policy.
Is your organization a 501(c)(3): *

Client Case Management Information

Do you have a client case management system or similar tracking software? *

Insurance History (must be completed in full)

Lawyers Professional Liability Insurance:
 Policy Period (M/D/Y) (From/To)Insurance CompanyLimitPremium
Policy Information
Policy Information
Policy Information
Policy Information

Claims History

Has any person in your organization been the subject to any past disciplinary or criminal proceedings? *
Does any person to be insured have knowledge or information of any act, error, or omission which might reasonably be expected to give rise to a claim against them? *
Has any claims or suits been made against an Accredited Representative? *
Do you conduct any business activities outside of the USA where any OFAC Economic and Trade Sanctions or any other Regulations are currently in place? *

By clicking Submit it is understood that the insurance applied for will be issued on the acceptance of the application by Company.  I/We hereby declare based upon my/our knowledge and upon reasonable investigation, the above statements are true and that I/We have not suppressed or misstated any material facts and this application shall be the basis of the contract with Lloyds of London.

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