ProSuranceGroup Inc.

Quick Quote

For a premium estimate, complete the following online Financial Services Questionnaire form below. Click the Submit Button at the bottom of the page to send to ProSurance Group Inc. directly.

You can also download the Questionnaire and fax it to us at: (650) 428-0860.
Our team will respond to you within 48 hours. *

FINANCIAL SERVICES QUESTIONNAIRE
Financial Planners, Investment Advisers, Life Insurance Agents and Registered Representatives

* required field


1. General Information
Individual/Firm Name: *
Address: *
Address Cont.:
City: *
County: *
State: *
Zip: *
Total Number of Professionals: *
Contact Name: *
Contact Email: *
Telephone Number: *
Fax Number:
Limits of Liability Desired: *
Retention: *
Type of Entity of Services Provided: * Financial Planner
Registered Investment Adviser
Life Insurance Agent
Registered Representative
Other


2. Revenue
Total Projected Revenue For Current Fiscal Year * $
3. Claims
Has any claim, suit or arbitration been made against the firm or its professionals? *

yes no

Number of closed claims * Amount Paid *
Number of open claims * Amount Reserved *

Has the firm or any of its professionals been disciplined by any regulatory agency? *

yes no

4. E & O
Current Professional Liability Coverage? *
yes no

If yes, types of coverage *:
    Life
    Registered Investment Adviser
    Financial Planner
    Broker-Dealer
Insurer and Inception Date *
Limits of Liability *
Deductible/Retention *
Premium *
Retroactive Date *
5. Other
List any special requirements:



Spam Protector *
Enter the text you see to prove you are a human, and then press submit.
Note: the words shown are NOT case-sensistive


* Nothing in this indication obligates ProSurance Group Inc. to you in these or any other terms. This contigent indication, should it be converted to a a bindable quotation, is contigent upon receipt, review, and acceptance of a signed application and attachments not already submitted, within 15 days of binding. If this indication is coverted into a bindable quotation, ProSurance Group Inc. reserves the right to modify or withdraw such contingent quotation based upon any information contained in the application and attachments not already fully disclosed in your submission.


Recent Posts

Why ProSurance Group Inc.

Prosurance Group, Inc. is an organization experienced in protecting Financial Service Professionals.


We'll help you through:
  • Innovative policy terms
  • Flexible underwriting
  • Competitive financing
  • Sound financial backing
  • Responsive claims service
No One Expects To Be Sued
But as a financial professional, you and your firm could be. Clients rely on your knowledge and expertise to help them and you may be liable for any mistakes you might make. No matter how carefully you perform your job, your daily activities can put your career and financial existence at risk. At any moment, in any situation, an unhappy client can bring a complaint against you.