GET A QUOTE FOR AE INSURANCE

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Appointed Solicitors Details

Firm Name:		Fee Earner
House number / House name:		Reference
Street
District
Town / City
County
Postcode:		Email Address:
Telephone number:		Web Site Address
Fax number:
Counsel’s Name		Chambers

Insured’s Details

Company Name:		Contact Name:
House number / House name:		Position
Street
District
Town / City
County
Postcode:
Telephone number:		Fax number:
Your Email Address:
Description of Business:		Number of Employees
Annual Turnover	£	VAT Number
Legal Status

Opponents Details

Company Name:		Contact Name:
House number / House name:		Position
Street
District
Town / City
County
Postcode:
Telephone number:		Fax number:
Email Address:
Description of Business:		Number of Employees (if known)
Annual Turnover (if known)	£	VAT Number (if known)
Latest Accounts Attached
Legal Status
Is the Opponent Insured for these Proceedings
If Yes Please State the Name of the Insurer

Referrers Details

Referrers Name:		Reference:
House number / House name:
Street
District
Town / City
County
Postcode:
Telephone number:		Email Address:
Fax number:

Opponent’s Representatives Details

Solicitors Name:		Reference:
House number / House name:
Street
District
Town / City
County
Postcode:
Telephone number:		Email Address:
Fax number:
Counsel’s Name		Chambers

Claim Details

Please provide a brief but full statement of the nature of the disputes for which a quotation for insurance is required. Please state the value of the claim and counterclaim if one is expected

If Proceedings have commenced please state the following
Court Name		Claim Number
Current Stage of Proceedings
Likely Date of Trial		Time Estimate

If Proceedings have not yet commenced please state the following
Anticipated Court
If Not England & Wales in What Jurisdiction
Likely Date of Issue
Likely Date of Trial		Time Estimate

Evidence


Complexity of the Legal Issues
Highly Complex Fairly Complex Straightforward


Complexity of the Evidential Issues
Highly Complex Fairly Complex Straightforward


Type of Evidence Relied Upon
Oral & Documentary Oral Documentary

Expert Evidence


Please State What Expert Evidence is Required or Has Been Obtained

Existing Legal Expenses Insurance


BTE LEI Cover & Trade Union Membership
Does the Insured Have BTE LEI Cover or TU Membership? Yes No Don't Know
If Yes Please Provide Reason for ATE Cover

Estimated Costs

	Incurred To Date	Estimated Up To and Including Trial

Solicitor’s Costs	£	£
Counsel’s Fees	£	£
Disbursements	£	£

Total	£	£

Opponent’s Solicitors Costs	£	£
Opponent’s Counsels Fees	£	£
Opponent’s Disbursements	£	£

Premium Information


Premium Information
Has the Client Agreed to Pay the Premium Yes No

Declaration

I/We declare that the above information and statements are true to the best of my/our belief and I/we have not missed out any information or facts which are likely to affect a decision to provide cover. I/We have never been convicted of any offence involving fraud or dishonesty or any offence of a similar nature.

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	I/We will make payment of the premium in full (inclusive of IPT) prior to the inception of the policy provided that the Insurance Company accepts this proposal and agrees to issue a policy,
or
	Provided that the insurance company accepts this proposal and issues a policy and agrees to defer the payment of the premium in full (inclusive of IPT) I/We hereby undertake to make payment of the premium in full (inclusive of IPT) within 14 days of the claim having come to an end.

	I/We agree that all information and statements in this proposal and any enclosures are and form part of the contract between me and the insurance company Limited.

	I/We agree to respond promptly to any requests for updates requested by the insurance company and to cooperate fully with my/our appointed solicitors.

Our Terms

GET A QUOTE FOR AE INSURANCE

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Appointed Solicitors Details

Insured’s Details

Opponents Details

Referrers Details

Opponent’s Representatives Details

Claim Details