Directors and Officers Quote Request

Please note:

  • This is a proposal form for a policy relating to claims made against the Insured during the period of the policy only – CLAIMS MADE.
  • Please answer all the questions giving full and complete answers. Please use a separate sheet of paper if insufficient space. If necessary please write additional relevant facts on a separate sheet of paper.
  • The proposal form must be completed and signed & dated by a person who is of legal capacity and have the authorisation to request Directors & Officers Liability insurance for the Proposer.
  • This form does not bind the Proposer but will form part of the Insurance contract if taken up.

Please supply the following information:
The last Annual Report & Accounts for the company
The last Interim Report (if applicable)

Step 1 of X

Step 2 of X

During the past 5 years has:

The name of the Company changed?

Any acquisition or merger taken place?

Any subsidiary been sold/ceased trading?

Any Rights Issue taken Place?

The capital structure of the Company changed?

The Company changed its external auditors or legal advisors?

Step 3 of X

Step 4 of X

Is the company:



Listed on the London Stock Exchange?

Listed on any other Stock Exchange?

Step 5 of X

Please list below the full names of all persons who, at the date of this proposal form, are Directors or Officers of the Company and the capacity in which they respectively serve.

Step 6 of X

Please list details of Subsidiary Companies that you wish to be included under this Insurance:

Learn more about our data protection policy.