Please complete the form below and upload your completed Professional Indemnity Proposal form. We will get back to you as soon as we can.

In the event of any problems using the form you can email your completed forms to pi@butlerevans.co.uk

Applications for PI Insurance

First Name*
Surname*
Telephone*
Email*
Firms name*
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Your Profession*
Renewal Date
DD slash MM slash YYYY
Fee Income
Have you suffered any claims/circumstances in the last 5 years?*
- YES
- NO
Please indicate if there are any of the following issues:*
- A partner/director has a Bankruptcy/CCJ
- A partner/director has a non-motoring conviction
- The firm has had insurance declined or special terms imposed
- None of the above apply
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