Momenta Associates On-Line Quotation Form

Business Name:	Contact Name:
Address 1:	Address 2:
County:	Postcode:
Telephone:	Fax:
Email:	Associate Code:
What were your total fees received for the last completed financial year? £
Do you currently hold Professional Indemnity Insurance?   Yes No
If Yes, please confirm when you first incepted this cover.

If a customer is unhappy with the work you have done and brings an action against you for professional negligence or simply decides not to pay your bill for this reason, then Hiscox Professional Indemnity policy will protect you. Please select your Professional Indemnity from the options below:

• The limit of indemnity selected provides cover for any one claim made during the policy period and the number of claims is unlimited.
• The limit of indemnity will cover damages awarded, with unlimited legal defence costs payable in addition.