Financial Lines Submission Form
Please fill out the following form. Upon completion, a member of the team shall be in contact within one working day.
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Broker Details
Unique Broker Code
If you are a member of the Steadfast Network, or an affiliated HWS Specialty broker, please enter your Unique Broker Code
Broker Name
*
Broker E-Mail
*
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Insured and Business Profile
Name of Insured
*
Trading Name(s)
Sector
*
Financial Services
Professional Services
Construction & Contracting
Manufacturing
Wholesale, Distribution & Retail
Agriculture, Forestry & Fishing
Transport & Logistics
Information Technology
Healthcare & Social Assistance
Education & Training
Hospitality & Food Services
Real Estate & Property Management
Arts, Entertainment & Recreation
Utilities
Mining & Resources
Government & Public Administration
Other
If Other, please specify
Year established
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Submission Details
Enquiry description
*
Territory
*
Last audited financial statements
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Supporting documentation
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e.g. Ownership structure, board composition, number of directors
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Narrative
Countries with legal presence
Countries with employees
Countries with directors/officers on the ground
International revenue split by country
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Coverage and Policy Details
Inception date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Coverage
*
Financial Institutions – FI, PI, Banker Blanket Bond, Investment Managers’ Insurance, Trustee Liability
Professional Indemnity – Accountants, Architects, Engineers, Solicitors, Tech E&O, Emerging Technologies incl. AI and Cryptocurrency
Management Liability – Directors & Officers incl. Side A/B/C, Employment Practices Liability, Crime & Fidelity
Cyber Liability
Transactional Risk
Bonds & Credit Risk
Intellectual Property – Infringement & Enforcement
Life Sciences – Clinical Trials, Devices & Medical Malpractice
Other
If Other, please specify
Limit of liability - Any one incident
*
Limit of liability - In the aggregate
*
Expiring premium
*
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Claims and Risk Information
Loss runs (minimum 5 years)
*
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Loss record narrative
Risk management protocol
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