Company Name Next Address Next Website Next Contact Name Next Contact Number Next Contact Email Next Brief description of product/service offered Next Last Year’s Turnover Next 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 % Next 12 Month Revenue forecast 12 Month Revenue Forecast United Kingdom % Asia % Australia % Europe - Non EU % USA % ROW % Europe % Canada % Next From Inception have you raised £5m or more in funding for the business? No Yes Next Have you ever needed to take legal advice in relation to an IP dispute. If so, please provide details below. Next 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.