© 2019 by Attorneys Insurance Mutual of the South, Inc.

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Attorneys Insurance Mutual of the South, Inc., Risk Retention Group

200 Inverness Parkway
Birmingham, Alabama 35242

info@attorneysinsurancemutual.com

Tel: 205-980-0009

Toll-Free: 800-526-1246

Fax: 205-980-9009

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Application for Lawyers Professional Liability Policy

(This is an application for a claims-made and reported policy.)

  1. Please answer all questions.

  2. If the answer to any question is none, state NONE.

  3. If applicant is an individual or a corporation, answer all questions required of a partnership.

  4. Application must be signed and dated by owner, partner, or officer.

 Questions? Please call 205-980-0009 or 800-526-1246.

PLEASE READ CAREFULLY THE STATEMENTS AT THE END OF THIS APPLICATION.