Limited Partnership/Private Placement Supplement
Firm:
Policy No.:
1. Is the Firm applying for a new policy with ISBA Mutual?
○ Yes
○ No
If Yes, then provide the information requested below the period of the past 3 years.
If No, then provide the information requested below for the period of the past 12 months.
2. Complete the following information for each limited partnership or private placement that the Firm or any lawyer of the Firm formed, syndicated, promoted or managed.
Date Filed
Name of the Limited Partnership (LP)/Private Placement (PP)
LP or
PP?
Total Value
Length of time the
Client has been a
Client of the Firm
Nature of Legal Services Rendered
I/We affirm that after an inquiry of all lawyers of the Firm, the information contained herein is true and complete to the best of my/our knowledge and that it shall be the basis of the policy
of insurance and deemed incorporated therein.
Signature of Owner, Partner, or Officer (Lawyer Only) ____________________________________________________ Date _______________________________
Print Name _______________________________________________________________________________ Title _______________________________
SUP LP-PP 2/2016
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