Professional Indemnity – Governors Liability Claim Form

Professional Indemnity - Governors Liability Claim

(This Claim Form is to be completed in respect of Professional/Governors for Actual or alleged breach of professional duties)

N.B. Please complete a separate form for each individual claim notification.

Fields marked with an * are required

Your Details

Your Details (Person completing form)

Your Name

Your Position

Phone

Does your claim involve one of the following? *

School Details

To confirm the correct school details, please click the following link:

Get Information about Schools - GOV.UK (get-information-schools.service.gov.uk)

Name of School

Address Line 1

Address Line 2

City

Postcode

URN

Claimant Details

Name

Address Line 1

Address Line 2

City

Postcode

Phone

National Insurance Number (if applicable)

Date of Birth

Incident Details

Please confirm when the breach is alleged to have occurred

Please confirm the nature of the alleged breach

Please provide a general description of the circumstances involved

Please confirm who is alleged to have undertaken the act leading to the breach, and the capacity in which they were acting

Please provide any other information relevant to this loss/incident

Legal and Insurance Information

Please confirm whether criminal or civil action has been taken

Please confirm whether there is an insurance policy in place which may cover this loss

Supporting Information

In addition to any correspondence that may have been received, please upload any internal documentation generated as a result of this incident e.g. incident/investigation report, witness statements, etc

Please note no more than 10 documents can be attached with your application but that each document cannot be larger than 50MB. Please also note that the maximum combined size of files submitted with your application cannot exceed 50MB. If you exceed this capacity your claim will not be received.

File Upload

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Risk Protection Arrangement