Please complete the form and click on Submit.

Please input the information for each attorney in the box below:

Attorney’s Name, Bar Admission Date, Date Joined Firm, Relation to Firm, Number of Weekly Hours

If date joined firm is different than prior acts date, please advise.

Please express percentages of the firm’s time devoted (billable hours) in each area during the previous year. Indicate the types of law you practice, not the business of the client you represent, and the percentage (in whole numbers up to 3 digits). The total must equal 100%.

Insurance History
If yes, please fill in the information below.
Firm Management
Claim/Potential Claim/Bar Complaint History
In the last 5 years have any past or present personnel:
If yes to questions a or b, please complete a separate Claim Supplement for each one from the last five years. You will receive a confirmation with a link to the online Claim Supplement after you submit this application.
When the form is complete, click on Submit.