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SUPPLEMENT 8      
P.I. PLAINTIFF ADDITIONAL INFORMATION
     
  Full Firm Name:    
    Total number of personal injury/plaintiff cases open at present time:    
  Average number of cases being handled by each attorney at any one time    
         
  Average Dollar Value of Personal Injury / Plaintiff Cases:  
  less than $25,000      
  $25,000-$100,000      
  $100,000-$250,000      
  $250,000-$500,000      
  $500,001 and above      
         
  What percentage of your plaintiff practice is in the following areas?  
 
Current Year: Last Calendar Year:
Medical Malpractice Medical Malpractice
Lawyer's Professional Liability Lawyer's Professional Liability
Product Liability Product Liability
Employment Liability/ADA Employment Liability/ADA
Other: Describe: Other: Describe:
 
         
  Please list the top five dollar values of your firm's open personal injury / plaintiff cases:  
 
  Expected Settlement Attorney fee Net to client
1) 
2) 
3) 
4) 
5) 
 
         
  This information is for underwriting purposes only and will not be released to any other party.  
         
  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: