Follow the steps to effectively complete the application form.

1. Click ‘Get Form’ button to access the application form and open it in the editor.
2. Begin by entering the full name of the applicant firm in the designated field, followed by the firm's address, including address 1, address 2, city, county, state, zip code, and the contact phone number.
3. Complete the contact information section by providing the email address of the applicant firm and the date the firm was established.
4. Fill in the Federal Identification (Fed ID) number and indicate the total number of lawyers in the firm. If applicable, specify whether the firm has other office locations.
5. Provide a detailed list of any additional office locations and the number of attorneys at each location.
6. Specify the requested effective date and enter current policy limits, deductibles, and any desired Optional coverages.
7. Answer all yes/no questions regarding current insurance status, including questions about endorsements and predecessor firms.
8. Complete the Practice Profile section by indicating the percentages of each area of practice based on gross revenue or billable hours, ensuring the total equals 100%.
9. If applicable, document any claims or incidents that might result in professional liability claims and provide detailed explanations in the designated sections.
10. Review the applicant's authorization and certification statement carefully before signing. Provide the signature, title, date, and printed name of an authorized officer or partner of the firm.
11. Once all sections of the form are filled out, use the options available to save changes, download, print, or share the completed form as needed.

Complete your application online to secure your professional liability insurance coverage.