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» Professional Liability Insurance Application
Small Business Professional Liability Insurance Application
Here's the additional information we need to quote your Professional Liability Insurance!
Please confirm the full legal name of your company to be shown on the Certificate of Insurance
*
If you are operating as a sole proprietorship (i.e. without Inc., Ltd., LLC etc...), please include "operated by" or o/b followed by your first and last name after the company name.
Kindly Just Confirm The Best Email To Reach You at
*
We just need it to match up for your completed application with the file we've already started for you!
Is this a New Business?
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Yes, just starting up
No, I already have insurance, but I'm looking for better options
What is the RETROACTIVE DATE on your current policy or what M/D/Y did you first start your professional liability policy?
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What was your last completed year's revenue
$1 - $50,000
$50,000 - $100,000
$100,001 - $200,000
$200,001 - $300,000
$300,001 - $400,000
$400,001 - $500,000
$500,001 - $600,000
$600,001 - $700,000
$700,001 - $800,000
$800,001 - $900,000
$900,001 - $1,000,000
More than $1,000,000
Do you have any revenue that comes from outside of Canada?
*
No, all my revenue is from within the country
Yes, we have operations in the US
Yes, we have operations in the US AND/OR other countries
Please specify the % of revenue from the US
Please specify the % of revenue from other countries
What other countries you operate in?
Please select any/all that apply
*
I am one of the following: Mortgage/Insurance Broker, Investment Advisor, Home Inspector, Freight Forwarder, Legal Consultant, Tour Operator, Crane Inspector, Actuary/Auditor
I am aware of a prior claims or know of circumstances that may give rise to a claim for the insurance I'm applying for.
I was cancelled/lapsed/non-renewed by my last insurance company
I subcontract services of others
What is the date of loss of the claim/incident?
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Please provide a brief description of the claim/incident, the amount paid, reserved and/or if it is open or closed.
The more details the better!
Have you had more than one claim?
No, only the one
Yes
Please provide details for the other claims
Please include dates, cause of loss, payout, and if the claim is still open or if it was closed.
What was the reason given for the cancellation?
What % of your work is Subcontracted to others?
Please provide a detailed description of your operations and services provided.
*
Please be thorough and include everything you do.
How Much Professional Liability Insurance Would You Like?
*
$ 1,000,000
$ 2,000,000
$ 5,000,000
I need a different limit from these
Note: This coverage is also called Errors & Omissions or E&O insurance.
Please enter the Professional Liability limit needed.
Is there any other insurance that you require?
Commercial General Liability (CGL)
Property/Building/Contents coverage
Cyber Insurance
Automobile Insurance
Other types of insurance not listed here
Please check any that you're interested in.
What other types of insurance are you looking for?
Is there anything else you'd like to share with us or think we should know about you, your operations, the risk etc.?
Claims Experience
*
I confirm that there are no incidents that may result in a claim under any of the insurance for which I am applying to purchase on this site, there is no legal actions taken against any of the companies to be insured within the last five years, there are no cease and desist orders issued against my company, and no instances of a partner or director being found guilty of any criminal, dishonest, or fraudulent activity, nor any investigations by a regulatory body.
Consent
*
I accept and confirm that I have verified the information supplied and that it accurately reflects the details of the company applying for insurance. Additionally, I authorize the use of this information to attempt to secure insurance quotes on my behalf and agree that I can contact by ALIGNED Insurance Ltd. regarding insurance matters.
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About Us
Our Team
Why Work With Us?
Business Insurance Products
Commercial General Liability
Professional Liability Insurance
Commercial Property Insurance
Commercial Auto Insurance
Small Business Insurance
Cyber Insurance
Directors & Officers Liability Insurance
Ocean Marine Insurance
Equipment Breakdown Insurance
Pollution Liability Insurance
Surety & Bonding Insurance
Cannabis Insurance
Other Insurance Products
Online Insurance Products
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