Paralegals E and O Insurance

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information

First Name *

Last Name *

Street *

City *

State *

ZIP / Postal Code *

Primary Phone Number *

E-Mail Address *

Fax # *

Total Number of:

Directors, Partners or Owners

Messengers

Office Staff

Any Other Employees (servers)

Give Date Firm was First Established

During the Past 5 Years:

Has the name of the firm been changed?

If yes, give previous name(s)

Has any firm been merged in or amalgamated with applicant?

If yes, please give name(s) and dates of such mergers.

Give details of all services rendered and approximate percentage of fees obtained from each:

Filing or recording documents in the county or similar offices

Certifying of court records

Notifying lawyers of court case dates

Title abstracting

Process servicing

Lawyers messenger

Any other services (describe in full)

Please provide the gross fees earned during the last 12 months

Has any claim been made in the last TEN years against yourself, any of your past or present owners, officers, partners, directors, or employees, either individually or otherwise on account of errors and omissions for Paralegal Services?

If yes, please give particulars

Have you or any of your past or present owners, officers, partners, directors or employees any knowledge or information of any circumstance whatsoever which might give rise to a claim against you in connection with your Paralegal Services?

If yes, give particulars

Has any application for insurance made by you or your firm ever been declined, cancelled or non renewed?

If yes, state reason

Do you now carry or have you ever carried this type of insurance?

If yes, give full particulars including company, limit and period

Amount of insurance required and deductible required.

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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Grand Rapids, MI 49546
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