Notification procedures

Solicitors Notification Form

E-mail address (Required)

Name of firm:

Address:

Telephone number

Contact:

Policy Reference:

Broker details: (if applicable)
Claimant details:

Date instructed:

Date terminated:
Brief details of retainer

Has a Formal Claim been made against you?	Yes No

Details of how the claim arose and the allegations made:
Date of alleged act

Date of first awareness of potential claim:

Have proceedings been threatened or commenced?	Yes No

Do you feel in any way responsible or liable?	Yes No

What is the possible quantum?

Any other comments:

DCS
5th Floor Minster House
42 Mincing Lane
London EC3R 7AE

tel: 0870 839 0839
fax: 0870 839 0939