Swafford Insurance - Online Quote

Firm Name*

Contact Person*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone*

Fax

Email Address*

Year Established*

Please provide attorney information below by Adding Attorneys Manually OR by Uploading a Roster Document.*

Add Attorneys ManuallyUpload a Roster Document

Add Attorneys Manually*

Upload a Roster Document*

If you choose to upload your Attorney Roster, please ensure the following information is included for each attorney.

Full Name
Year bar exam was passed or the number of years in practice
States where attorney is admitted
Date the attorney joined the firm
Hours worked per week
Retroactive Date (if different than date of hire)

Check here if you are not currently insured

I am not currently insured

Expiration Date*

Current Carrier*

Limits*

Deductible*

Expiring Premium

Renewal Premium (if known)

Optional Coverages

Title AgencyClaim Expenses Outside Limit (CEOL)First Dollar Defense

Is your firm currently insured for cyber liability?

YesNo

In the past 5 years, have there been any claims/incidents/grievances against Applicant or member/past member of the firm or predecessor Firm?*

YesNo

If yes, please upload any available claim documentation to our secure server.

Please provide a brief summary (including any payments).

Please enter the % of gross billings from each area of practice. Percentages must total 100%.

	%
Administrative Law – General
Admiralty/Maritime
Adoption
Antitrust/Trade Regulation
Arbitration/Mediation
Bankruptcy
Banks/Savings and Loans
Business Contracts and Transactions
Civil Rights and Discrimination
Civil Litigation – Plaintiff
Civil Litigation - Defense
Class Action/Mass Torts – Defense
Class Action/mass Torts - Plaintiff
Collection/Repossession
Commercial Law
Communications
Construction Law
Corporate Organization/Formation
Criminal Law
Divorce with client asset values Less than $1 million
Divorce with client asset values $1 million to $5 million
Divorce with client asset with values Greater than $5 million
Elder Law
Entertainment
General Corporate/Business
Healthcare
Immigration and Naturalization
Insurance Defense litigation
International Law
IP – Copyright/Trademark
IP – Patent
Juvenile
Labor Relations
Local Government Law/Municipal
Medical Malpractice - Defense
Medical Malpractice - Plaintiff
Mergers and Acquisitions
Oil and Gas
Pension and Employee Benefits
Personal Injury other than MedMal – Defense
Personal Injury other than MedMal – Plaintiff
Public Utilities
Real Estate Commercial
Real Estate Residental
Real Estate Forclosure
Real Estate Land Use and Zoning
Real Estate Title
Securities Law
Social Security
Taxation – Opinions
Taxation - Planning
Taxation – Preparation
Wills, Trusts, Estates with client asset values Less than $1 million
Wills, Trusts, Estates with client asset values $1 million - $5 million
Wills, Trusts, Estates with client asset values Greater than $5 million
Workers’ Compensation Litigation – Plaintiff
Workers’ Compensation Litigation – Defense
Other

Total Percentage of Gross Billings Calculated from Fields Above (Must Equal 100%). Note: Please make adjustments to individual fields above if the total below does not equal 100%.

Does the firm have a conflict avoidance system?*

YesNo

Does the firm regularly use engagement/declination letters (When applicable)?*

YesNo

Are there 2 calendars to track important dates?*

YesNo

How many suits for fees have you filed against your clients in the last 2 years?*

Number of non-Attorney Employees?*

Number of Attorneys planning to retire within the next 3 years?*

No coverage is bound or implied by submitting information via this form. Premium estimates provided from information on this form are only anticipated pricing and non-binding indications. Actual quotes are subject to completion and acceptance of a new business application with supplements (if applicable) and underwriting approval. Estimates may fluctuate based on information provided to us in your application. If you agree to the terms, click "I Agree" below.*

I Agree

FIRM INFORMATION

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INSURANCE HISTORY

CLAIM HISTORY

AREAS OF PRACTICE

INTERNAL CONTROLS