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PROFESSIONAL INDEMNITY INSURANCE
FOR THE DESIGN AND CONSTRUCT INDUSTRY
Name of insurance broker (if any) making this declaration of facts
Name of person completing this form
Postcode of Insurance Broker (if any)
Contact email address
Contact Telephone Number
Page 1 of 9
Please answer all of the questions below. The answers given and any other information provided to Camberford Law PLC form the basis of the contract(s) of insurance effected.
If any material facts are not disclosed by virtue of the answers You have provided herein, You must disclos ethese separately to Camberford Law PLC.
The information provided in this form will be sent to You for a principal of the practice to sign, date and return following any instruction given to Camberford Law Plc to arrange cover.
Unless You advise us otherwise Policy Documents will be issued by email.
Please provide a full answer to every question. Please ensure that all answers are typewritten or printed in block letters with the spaces provided.
A principal of the practice will be asked to sign the form and any separate sheets.