Firm details
The name of your firm in full, including trading title if any:
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Principal address (including postcode):
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Telephone number:
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Mobile phone number
Fax number:
Email address:
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DX number:
FCA exemption number:
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Compliance manager:
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(In order to recommend ATE Insurance products, law firms are required to obtain an exemption number from the FCA in addition to their SRA requirements).
Main contact:
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Email
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Year firm established
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Full Name:*
Position:*
Professional Qualifications*
If engaged in the business for less than 5 years, provide preceding employment history:
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Full Name:
Position:
Professional Qualifications
If engaged in the business for less than 5 years, provide preceding employment history:
Full Name:
Position:
Professional Qualifications
If engaged in the business for less than 5 years, provide preceding employment history:
Full Name:
Position:
Professional Qualifications
If engaged in the business for less than 5 years, provide preceding employment history:
Full Name:
Position:
Professional Qualifications
If engaged in the business for less than 5 years, provide preceding employment history:
Full Name:
Position:
Professional Qualifications
If engaged in the business for less than 5 years, provide preceding employment history:
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Further details
Please give details:
Please give details:
Please give details:
Please give full details below of your fraud and/or money laundering checks and provide copies of relevant paperwork:
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Confidentiality agreement
I/We agree to treat as secret and confidential any information and/or material relating to the business, affairs, finances,
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Data protection
By completing this form you consent to DAS Legal Expenses Insurance Company Limited, and/or any member of the
You can ask to see a copy of the information DAS Group holds about you by writing to the
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Application checklist
If any of the above forms are not available please specify
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Declaration
Director/Partner’s signature:
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Date
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Director/Partner’s name (BLOCK CAPITALS):
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You must tell us when the information in this form changes
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I/We:
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Authorise (Bank Plc):
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Branch:
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Address (including postcode):
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Client account number:
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Client account sort code:
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To provide DAS Legal Expenses Insurance Company Limited | DAS House | Quay Side | Temple Back | Bristol | BS1 6NH
Signed:
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Position:
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Date
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If you are human, leave this field blank.
