info@safeguardip.com
0203 633 0766

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Application Form

Please complete the short application form below answering the questions as fully as possible. We will respond within 24 hours to confirm receipt and aim to have an indication of terms within 5 working days. If you have any queries on the form please call on 07970119163

- Step 1 of 3

About the Applicant

Company Name *

Postcode *

Company address *

Company Website *

Phone Number *

Contact Name *

Contact Email Address *

Brief description of product/service offered *

Financial information

Last years turnover (£) *

Jurisdictions where it was generated (%)

United Kingdom%

Asia%

Australia%

Europe - Non EU%

USA%

ROW%

Europe%

Canada%

12 month revenue forecast (£)

Jurisdictions where it was generated (%)

United Kingdom%

Asia%

Australia%

Europe - Non EU%

USA%

ROW%

Europe%

Canada%

From Inception have you raised GBP 10,000,000 or more in funding for the business?

Is any of your turnover noted above from contracting parties (eg.licensees/distributors/manufacturers) with whom you have a contract?

Risk Management

During the past 5 years have you

i. Needed to seek advice or have proceedings ever been commenced, or have a warning letters been isues against you?

If yes

ii. Been involved in any legal proceedings or investigations relating to your alleged infingment of a third party intellectual property

If yes

iii. Needed to seek advice or have you ever commenced proceedings or have warning letters issued against you?

If yes

iv. Been involved in any legal proceedings or investigation relating to a possible or actual infingment of your intellectual property?

If yes

Have any of your declared Intellectual Property Rights ever been the subject of any revocation, invalidation, re-examination or decleration of non-infingment proceedings?

If yes

After full enquiry, are you aware of any cause, event, circumstances (including any prior art or rights in application), which may give rise to a claim being made under this Policy?

If yes

- Step 1 of 3

About the Applicant

Company name *

Address *

Website *

Contact name *

Contact Number * *

Contact Email *

Brief description of product/service offered *

Financial information

Last year’s turnover: *

Jurisdictions where it was generated (%)

United Kingdom % *

Asia % *

Australia % *

Europe - Non EU % *

USA % *

ROW % *

Europe % *

Canada % *

12 month revenue forecast

United Kingdom % *

Asia % *

Australia % *

Europe - Non EU % *

USA % *

ROW % *

Europe % *

Canada % *

From Inception have you raised £5m or more in funding for the business? *

Have you ever needed to take legal advice in relation to an IP dispute. If so, please provide details below. *

After full enquiry, are you aware of any cause, event, circumstance, which may give rise to a claim being made under this Policy? If so, please provide details below.

Alternatively call us now for a no obligation quote

Location

3 Lloyd’s Avenue London
EC3N 3DS

Email

info@safeguardip.com

Phone

0203 036 0551

Company Name

Address

Website

Contact Name

Contact Number

Contact Email

Brief description of product/service offered

Last Year’s Turnover

Jurisdictions where it was generated (%)

Please enter a 0/zero for any Jurisdictions where no revenue was generated.

United Kingdom %

Asia %

Australia %

Europe - Non EU %

USA %

ROW %

Europe %

Canada %

12 Month Revenue forecast

12 Month Revenue Forecast

United Kingdom %

Asia %

Australia %

Europe - Non EU %

USA %

ROW %

Europe %

Canada %

From Inception have you raised £5m or more in funding for the business? No Yes

Have you ever needed to take legal advice in relation to an IP dispute. If so, please provide details below.

After full enquiry, are you aware of any cause, event, circumstance, which may give rise to a claim being made under this Policy? If so, please provide details below.

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3 Lloyd’s Avenue
London
EC3N 3DS
0203 036 0551
info@safeguardip.com

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Home
IP Insurance
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Get a quote

Company

3 Lloyd’s Avenue London
EC3N 3DS
0203 036 0551
info@safeguardip.com

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3 Lloyd’s Avenue London EC3N 3DS
0203 036 0551
info@safeguardip.com

Get In Touch

63 St Mary Axe, London, EC3A 8AA
0203 633 0766
info@safeguardip.com

11th Floor, Beaufort House, 15 St Botolph St, London EC3A 7DT
0203 036 0551
info@safeguardip.com

Safeguard IP Limited is an Appointed Representative of HISL Brokers Limited which is authorised and regulated by the Financial Conduct Authority under firm reference number 505452 for general insurance intermediation only. Safeguard iP Ltd is registered as a company in England: No 09048290. Registered office: 7th Floor 1 Minster Court, Mincing Lane, London, EC3R 7AA

Whilst every effort is made to ensure that the information provided on this website is accurate at the time of writing, the information provided is for general guidance only. Whilst members of our team are legally qualified any advice given is not legal advice and is not a substitute for professional legal advice. You should always consult a law firm for legal advice about your intellectual property. If you need assistance finding a specialist in your area, we are happy to help.

Application Form

About the Applicant

Financial information

Jurisdictions where it was generated (%)

Jurisdictions where it was generated (%)

Risk Management

During the past 5 years have you

About the Applicant

Financial information

Jurisdictions where it was generated (%)

12 month revenue forecast

Alternatively call us now for a no obligation quote

Location

Email

Phone

As Seen In

Complete a proposal form now for a free quote

Follow us on Twitter

Follow us on Facebook

Follow Us

Follow Us

Company

Company

Quick Links

Get In Touch

Quick Links

Get In Touch