Application

General Information

Name of Applicant Address

City

State

Zip

Phone

Fax

Contact Person

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Law Firm Information

Establishment Date

Number of Support Staff

Number of Counsel Staff

Number of Attorneys, IC's, OC's, & Years with the firm
(Exclude "Of Counsel" working < 20hrs/week)

5+ Years 4 Years 3 Years 2 Years 1 Years < 6 Months Number of attorneys participating in CLE during the past twelve months? Firm's estimated annual gross income Single client annual gross revenues > 50%? Previous Step Next Step

Internal Controls

Do you maintain a Docket Control System with at least two independent date controls? Is a Conflict of Interest System maintained? Are engagement and non-engagement letters used on a regular basis? Previous Step Next Step

Current Insurance

Carrier

Limits & Deductible

Premium

Retroactive / Prior Acts Date

Policy Term

Date of first continuous claims-made coverage

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Claim History

Are you aware of any claims against your firm or any incidents that could result in a claim against your firm within the past five years? If "Yes", How many? Please provide specific details of each, including a description of the allegations, current reserve, and/or indemnity paid, expense paid, etc. Has any member of the applicant firm been refused admission to practice, disbarred, suspended, reprimanded, sanctioned, or held in contempt by the court administrative agency or regulatory body? If "Yes", please provide details Previous Step Next Step

Area of Practice Percentages (percentage must total 100%)

Administration

Admiralty/Maritime

Antitrust/Trade Regulation

Arbitration/Mediation

Banking/Financial Institutions

Bankruptcy

BI/PI Defense

BI/PI Plaintiff

Civil Rights/Discrimination

Collection/Repossession

Communication/FCC

Corporate-Formation

Corporate-General

Crimnal

Divorce

Family Law (all other)

Employee Benefits

Entertainment/Sports

Environmental

Foreign/International

Healthcare

Insurance

Investments/Money Mgmt

Labor Law/Management

Law law/union

Mergers and Acquisitions

Municipal

Oil/Gas/Minerals

Patent

Public Utilities

Real Estate/Commercial

Real Estate/Residential

School Law

Securities

Social Security/Elder Law

Tax/Coroprate

Tax/Individual

Water Right

Wills/Estate Planning/Probate

Work Comp/Defense

Work Comp/Plaintiff

Other

If "Other" Previous Step