• First Name*
• Surname*
• Telephone*
• Firms name*
• Email*
  Enter Email Confirm Email
• Renewal Date
  DD slash MM 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

• Thank-you for enquiring about our services. If you have already completed proposal forms and supporting documents please use the field below to upload these in support of your enquiry. Multiple documents may be uploaded to a maximum combined size of 128mb. Alternatively email your documents to us at solicitors@butlerevans.co.uk

• Please upload your Proposal Form & Claims Summaries
  Drop files here or Select files

  Max. file size: 256 MB.
  We accept any proposal form for the purposes of obtaining a quotation. Forms older than 30 days will need re-completing with the most recent information if you wish to proceed with insurance offered.
• Name
  This field is for validation purposes and should be left unchanged.

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