Please complete the form below and upload your Solicitors PI Proposal form. We will get back to urgently.

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

First Name*
Surname*
Telephone*
Firms name*
Email*
Enter Email Confirm Email
Renewal Date
Date Format: MM slash DD slash YYYY
Fee Income
Please indicate if any of the following apply:*
- 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
- The firm has been subject to Regulatory intervention
- None of the above apply
Have you suffered any claims/circumstances in the last 6 years?*
- YES
- NO
Please upload your Proposal Form & Claims Summaries
Drop files here or
Proposal forms should be signed & dated within the last 30 days. Claims summaries should be dated by the Insurers within the last 30 days.
Name
This field is for validation purposes and should be left unchanged.