Panel Solicitor Application - Acasta Europe Limited

1) Practice General Details

Name of Firm*

Trading Name (if different)

Law Society Registration Number

Registered Office Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Branches

Company Reg No.

Date Incorporated

Is the Practice:

Partnership
LLP
Limited Company

Does the Practice have an in-house IT Department?

Yes
No

Practice Website Address

Practice DX Address

2) Contact Address for this Application

Contact Name

First Last

Position

Phone

Email

3) Professional Indemnity Insurance Details (Please provide a copy of the Insurance certiﬁcate)

Insurer

Policy Number

Limit of Liability

Renewal Date

To the best of your knowledge and belief has any partner, director, shareholder or employee of the firm ever been: (If Yes provide full details in Additional Comments or on separate sheet.)

a) convicted of any criminal offence (save minor motoring offences) or is any offence pending?

b) subject to any disciplinary proceedings by the Law Society or is any offence pending?

c) subject to a professional negligence claim or notification that such a claim is pending?

d) refused Professional Indemnity Insurance?

4) Financial Crime Policies

Can you confirm that your company has and runs a compliant and up to date anti-money laundering, anti-bribery & corruption and financial sanction policy.

Yes
No

5) Information Distribution Directive (IDD) & General Data Protection Regulation (GDPR)

All disclosure docs issued are in accordance with the regulations imposed in the IDD.

Yes
No

The company has in place a compliant and up to date data protection policies and procedures in place including all changes brought in new GDPR regulations.

Yes
No

Do all staff receive the relevant training and CPD as required under the provisions of the Insurance Distribution Directive?

Yes
No

6) Practice Volume of Cases per Annum per Type

Please list below the ATE volumes per annum for Acasta European Insurance for each case type.

RTA

P/L

E/L

IND

DBA Protector

COMMERCIAL

OTHER

7) Verification of Identity Reference Checks and Data Protection Waiver

Please note that to comply with current regulatory requirements Acasta European Insurance are required to know their client. You may be required, to provide additional information from time to time, which will verify your practice and its partners etc.

8) Declaration and Authority to Acasta European Insurance Company Limited

We declare that the statements and particulars contained within this application form including any attachments and the appendices are true and correct and we have not suppressed or misstated any facts. We agree that all details within this application form and any subsequent agreements shall form the basis of any contract affected thereon. We undertake to inform Acasta European Insurance of any material alteration to these facts occurring before the completion of any agreement or at any time thereafter. This application must be signed by a Partner or Director of the applicant firm in accordance with practice agreed mandates:

Name

First Last

Position

Date

Please upload any supporting files here

Solicitor Panel Application Form