Engineering Insurance

Personal Details

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First Name

Last Name

Phone

Address

Occupation

Corporate Details

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Company Name

Phone

Address

Location

Insurance Details

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During the past five years, has the name of the firm been changed or has any other firm been purchased or any merger or consolidation taken place?

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Yes

If so, give full details.

Total number of principals, partners and staff

Does your firm, any partner, principal or staff manage, own or have financial control of any bank, trust company, mortgage or loan association, title guarantee or real estate company or undertake work as executor, trustee, director or company secretary?

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Yes

If so, please give full details.

Have you recently discharged any of the staff or severed relationships with any Partner or is such discharge or severance being contemplated?

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Yes

If so, give details.

Do you give work to independent firms, subcontractors and/or specialists?

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Yes

If so, give details.

Are you financially connected with a client?