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Pubs & Bars Hotels Guest House / B&B Shops & Salons Hair & Beauty

Lifestyle & Specialist

Sports Clubs & Gyms Golf Clubs Third Sector 3D Printing SaaS Businesses Alternative Therapies

Professional Indemnity

Design and Construct Accountants Architects Engineers Miscellaneous Technology

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FCA Authorised - Firm Ref 1029698

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13+ years specialist broking

Technology Professionals Professional Indemnity Insurance – Quote Request

Please provide a full answer to every question. Where a question does not apply, enter "N/A". We'll use this to obtain tailored professional indemnity terms for your technology business. If you need more room for any answer, use the "Additional information" box at the end. This form should be completed by a principal, partner, director or member.

Your contact details

Contact name *

Contact position

Contact email *

Contact telephone *

Preferred contact method

1. Your details

a) Full business name *

Date established

b) Business description *

c) Registered address *

Email address

Website

Other locations

Is cover required for any overseas representation outside of the UK?

If yes, please provide full details

During the past five years, other than declared above, has your name changed, or has any amalgamation or takeover occurred, or has there been a change of legal status — or are any such changes planned?

If yes, please provide details

Do you require cover for any subsidiary companies?

If yes, please provide details

Are you BS EN ISO 9000 accredited?

Professional body or trade associations to which you belong

2. Principal / director details

a) Details of all principals / partners / directors / members

Name

Age

Qualifications

Years in this capacity with you

Years industry experience

b) Has any principal, partner, director or member been involved in any other business in the past five years which has been declared bankrupt, insolvent or gone into liquidation?

If yes, give details of the business including name, address, trade and dates

3. Staff details

a) Principals / partners / directors / members

b) Quality assurance staff

c) Employees

4. Business income

Month of financial year end

Gross turnover for the past year, plus an estimate for the current and forthcoming year, for work undertaken in:

Past year ending (£)

Current year (£)

Coming year (£)

UK and rest of world excluding countries subject to USA / Canada law

Rest of the world (excluding USA / Canada)

Countries subject to USA / Canada law

Splits in gross turnover between UK / rest of world and USA / Canada for territories in which you have local representation

For countries subject to USA / Canada law: details of work and countries involved

5. Business activities

Approximate percentage of turnover relating to each activity

Enter a percentage against each activity that applies (leave others blank). The total should equal 100%.

Hardware – distribution of other brands

Hardware – sales of own brand

Hardware – maintenance or configuration

Electronic components – passive

Electronic components – active

Robotics / process control / control panels – manufacturing

Robotics / process control / control panels – configuration / maintenance

Robotics / process control / control panels – software

Software – distribution of third-party software

Software – package writers

Software – customised or tailored

Software – bespoke

SCADA (supervisory control and data acquisition) systems

CAD / CAM (computer-aided design / manufacturing) systems

Consultancy – advice on system requirements (no sale)

Consultancy – project management (including sales)

Telecom – hardware

Telecom – airtime provider

Telecom – network management

Telecom – VNO (virtual network operator)

Telecom – network operation

Telecom – fixed or mobile infrastructure manufacture

Telecom – BSS / OSS provision or integration

Web design

Service provider – web hosting

Service provider – internet service provider

Service provider – business process outsourcer

Service provider – data warehouse / storage / hosting

Service provider – application / SaaS

PKI (public key infrastructure)

Training

Contract staff supply

Other

Other – please provide details

Current total: 0% (should equal 100%)

Estimated breakdown of clients by percentage turnover

Financial

Medical

Aviation

Pollution control equipment

Power generation / water utilities

Process control equipment

Mass transit / transportation systems

On-line fund transfer

Gas / petrochemical / nuclear

Fire / security / emergency

Current total: 0% (should equal 100%)

What do you consider to be the most significant potential risks associated with the activities declared, and how have these been minimised?

6. Contracts

Your three largest contracts in the past three years

Contract details

Your three largest contracts anticipated in the next 12 months

Contract details

How many customers do you currently undertake work for?

Value of your average contract

Length of your average contract

7. Intellectual property

Does your legal advisor review your website content before publication?

Do you enforce an acceptable email and internet use policy?

What procedures are in place to ensure you do not breach IP rights or copyrights?

8. Your business

Do you utilise sub-contractors or consultants?

What work is undertaken by sub-contractors or consultants?

Do you ensure sub-contractors or consultants have PI insurance in place?

Do you ensure their PI limit matches your PI limit?

How are sub-contractors or consultants managed?

Has the business discharged any employee, or severed relationships with any partner or director, due to unsatisfactory performance?

If yes, please provide details

Who are your top three competitors?

9. Risk management

Is a client confidentiality policy in place?

Do you always prepare and agree a written specification of the intended work with your clients before contracts are accepted, and make amendments to it with your client during the contract?

If no, please provide details why not

Are amendments to the original specification always countersigned by the customer?

Do you use conditions of contract in every case? (If yes, please supply a copy)

Are all contracts subject to your standard terms and conditions?

If no, are all contracts vetted by a legally qualified person before being agreed?

Do you always obtain a letter of acceptance from customers at the conclusion of a project?

Have you experienced delays in past contracts?

Have you sued a customer for non-payment of a contract in the past three years?

Is there a formal procedure for customer complaints?

Are complaints reviewed by senior management at regular intervals?

Do you operate anti-virus software?

Are copy records stored off-site and updated at least weekly?

Is any individual authorised to sign cheques as sole signatory for business / client accounts?

If yes, please provide details

10. Previous insurance

Has any insurer ever:

Declined to pay a claim in full or part?

Cancelled or declined to renew?

Invited renewal at special terms?

Cancelled / avoided a policy?

If yes to any of the above, please give full details

11. Current insurance

a) Date of expiry of current PI policy

b) Name of insurer

c) Limit of indemnity

d) Excess

e) Premium

f) Retroactive date

12. Requested cover

Limit of indemnity required

Excess required

Policy inception date

Is cover required for errors, acts or omissions occurring prior to the first date of the period of insurance given?

If yes, please specify the retroactive date required

13. Claims and circumstances

In respect of any of the liabilities to be covered by this insurance, has any claim (whether successful or not) been made against, and/or loss suffered by, you, any predecessor, or any present or former principal, partner, director or member — individually or otherwise?

If yes, provide full details incl. year of incident, amounts involved, circumstances, and steps taken to prevent recurrence

After full enquiry, is any principal, partner, director, member or employee aware of any claim pending, or any circumstance existing, which might give rise to any claim by or against you, any predecessor, or any present or former principal, partner, director or member?

If yes, please provide full details

Have you suffered any loss from the fraud, dishonesty or malice of any partner, director, member, employee or self-employed sub-contractor or consultant?

If yes, please provide full details

14. Declaration

It is essential that every firm or proposer, when seeking a quotation to take out or renew any insurance, discloses to insurers all material facts and information (including all material circumstances) which might influence the judgement of an insurer in assessing whether or not to accept the risk and on what terms. The obligation to provide this information continues up until the time that there is a completed contract of insurance. Failure to do so entitles the insurers, if they so wish, to avoid the contract of insurance from inception and so enables them to repudiate liability thereunder. If you have any doubt as to what constitutes a material fact or circumstance, please ask for advice.

Any personal data you supply will be processed for the purposes of providing insurance, handling claims and related purposes, offering renewal, research/statistics, providing information or services you request or that may interest you (where you have consented), notifying you of changes to our service, and safeguarding against fraud and money laundering. Data may be shared with group companies, reinsurers, other intermediaries, insurance reference bureaus, credit and fraud-detection agencies, loss adjusters, professional advisers and regulatory authorities, and may be transferred outside the EEA with appropriate safeguards. You may ask that your data is not used for marketing, and you have the right to access the personal information held about you. Full privacy details are available from the underwriter on request.

Print name *

Position *

Date *

Anything else we should know?

Additional information Use this box for any answer that needed more room, or anything else that may help us obtain the most competitive terms for you.

Fields marked with * are required.

By submitting this form you are providing consent for Miller & Partner Ltd to contact you in relation to this quotation and any related insurance products.

Office: Vivian House, Roman Bridge Close, Mumbles, Swansea, SA3 5BG

Call 01792 001350

Email: [email protected]

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Miller & Partner is an Authorised Representative of Gauntlet Risk Management Ltd and are authorised and regulated by the Financial Conduct Authority (FCA) under firm reference number 1029698. You may check this on the Financial Services Register by visiting the FCA website, https://www.fca.org.uk/firms/financial-services-register or by contacting the FCA on 0800 111 6768 Privacy Policy