SUPPLEMENT 1       APPLICATION FOR LAWYERS PROFESSIONAL LIABILITY INSURANCE INDIVIDUALS FOR WHOM COVERAGE IS BEING SOUGHT   FULL NAME OF APPLICANT                 IN ACCORDANCE WITH QUESTION 2.G. PLEASE NAME ALL PERSONS FOR WHOM COVERAGE IS SOUGHT, WHETHER OWNER(S), PRINCIPALS, PARTNERS, OFFICERS, EMPLOYED LAWYERS, AND OF COUNSEL .       Name Title Month/Year Admitted To CA Bar State Bar Member Number Date of hire by Applicant Previous Firm 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21               Applicant hereby warrants that the statements set forth herein are true, complete and accurate and that there has been no attempt at suppression or misstatement of any material facts which are known, or should be known. Applicant agrees that this Supplemental Application shall become the basis for any coverage and part of any policy that is issued by the Company.                   Date:  Signature: Title: