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% REVENUE

AREA OF LAW

Administrative Law

Admirality Personal

Anti-trust

Appellate Practice

Banking

Bankruptcy

Civil Liberties/Civil Rights/Discrimination/Class Action

Collection/Repossession

Commercial Law

Communications

Condemnation Residential

Corporate Law

Criminal Syndication

Domestic Relations

Entertainment, including Sports

Environmental Law- Regulatory

Estate Planning

General Business Litigation

Immigration

Insurance (other than torts)

International Law

Investment Counseling/Money Management

% REVENUE

AREA OF LAW

Other (provide details below)

Patents/ Trademarks/ Copyright

Personal Injury - Defendant

Personal Injury - Plaintiff

Public Utilities

Tax Litigation

Tax Planning

Wills, Trusts and Probate

Workers' Compensation - Applicant

Workers' Compensation - Employer

Real Property

Commercial

Homeowners Association

Landlord/ Tentant

Residential

Syndication Development

Title Work

Securities (Registered Or Exempt)

Bonds

Federal and/ or State

Private Placement

Public Offerings (including intrastate offerings)

TOTAL (MUST EQUAL 100%)


Any reported incidents/claims in the past 10years?
YES NO If YES, how many
Any Bar disciplinary proceedings in the past 10 years?
YES NO If YES, how many


Do you have a dual
calendaring system?
YES NO
Do you have a system for cross-referencing your client list to protect potential
conflicts of interest?
YES NO


If you are a solo practitioner, do you have a lawyer who will be responsible for
your affairs if you are absent for an extended period of time (vacation, illness,
disability)?
YES NO
Have you sued for fees
in the past 5 years?
YES NO




LIMITS DESIRED
(check only one)


DEDUCTIBLE DESIRED
(check only one)


Currently Insured:
YES NO
If YES, expiration date?

NAME OF CARRIER
ANNUAL PREMIUM


Name(s) of Lawyer(s) to be Insured


Prior Acts Date


Employment Date





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