In order to provide you with the best response, please complete the following application with the most specific and accurate information available.

Before you start
Please make sure you have all relevant information on hand (i.e., membership ID#, partners/employees information, claims information -- if applicable), so that you will not be interrupted before completion.

Once you begin
If you are inactive for over 30 minutes, the application will time-out, and you will lose the data you have entered.

We will process your application as soon as possible.

				= current step
				= step complete
				= step incomplete

1. Applicant or Company Name Name
Applicant Email Address
2. Full Name of individual(s) or firm involved in claim
First Name	Middle Initial	Last Name
3. Full Name of Claimant First Name	Middle Initial	Last Name
4. Indicate whether this application is for a Claim/SuitIncident
5. Date of Alleged Error		6. Date of Claim
7a. Description of Claim (provide enough information to allow evaluation).
Please email a copy of the claim form to skennington@resolutionre.com, or fax to (803) 782-0232.
7b. Description of case and events
8. Additional defendants