La Playa Media & Technology: Insurance with Intelligence®

Application Form - A la Carte

Please complete this form as far as possible and we'll be in touch shortly.

This form automatically saves the information you type into it. So no need to fill it in all in one go.

 

Info needed for your quote


Your Income

Please split your annual income between the following territories.

Territories
Current full year income
UK/Europe
£
USA
£
Elsewhere
£
Please specify countries
Total
£

Previous Insurance

If you currently have professional indemnity insurance what is the limit and retroactive date?

Limit (£):
£
Retroactive date:

Cover Required

Limit of indemnity required for Professional Indemnity

£500,000
£1,000,000
Other
£

Your privacy practices

If you collect personally identifiable information (PII)

Yes No
Yes No
Yes No

Problems

Yes No

Breach Response Cover required

Number of people to notify in respect of an unauthorised disclosure of PII?

Not Reqd
5,000 people
10,000 people
15,000 people
Other

Staff

What Limit of Indemnity required for Public / Products Liability?

£1m
£2m
£5m
Other
£

Contents at the premises

Please enter the replacement cost as new for each category in the table below.

Location 1 Address

Address & Postcode
Computer and Electronic equipment
£
Other contents
£
Landlord's fixtures + fittings and tenant improvements
£

Location 2 Address

Address & Postcode
Computer and Electronic equipment
£
Other contents
£
Landlord's fixtures + fittings and tenant improvements
£

Location 3 Address

Address & Postcode
Computer and Electronic equipment
£
Other contents
£
Landlord's fixtures + fittings and tenant improvements
£

Contents away from the premises

Please enter the replacement costs as new in the table below. Computers and electronic equipment includes, but is not limited to: laptop, mobile phones, tablets and other electronic equipment.

Within the UK

Computer and Electronic equipment
£
All other business equipment
£

Outside UK within the wider EU

Computer and Electronic equipment
£
All other business equipment
£

Outside EU

Computer and Electronic equipment
£
All other business equipment
£

 


About your business

Could a failure of any of your products or services result in any:

Yes No

Yes No

Yes No

Yes No
Yes No

Yes No
Yes No

Yes No

 

Main Contact