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*Phone:
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Fax:
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*Effective Date:
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Lawyer(s) Name: Bar Admit Number: Bar Admit Date: Part Time/Hours per Week: Received 20 CLE credits
in preceding KBA year:
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What percentage of time, not income, do you spend in the following practice areas? Total must equal 100
Admiralty:
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Foreign Practice:
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Anti-Trust/Trade Regulations:
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Immigration Law:
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Banking:
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International Law:
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Bankruptcy:
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Labor/Employment Law:
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BI/PI Defendants:
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Litigation (General Civil):
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BI/PI Plaintiffs:
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Mediation/Arbitration:
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Class Action/Mass Tort:
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Money Management:
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Collection/Repossession:
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Municipal Law:
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Communications:
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Natural Resources:
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Copyright/Patent/Trademark: Private Placement Memorandum:
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Corporate/Business Organization:
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Public Utilities:
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Criminal:
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Real Estate:
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Domestic Relations/Family Law:
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Securities (S.E.C):
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Entertainment Law:
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Social Security/Disability:
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Environmental Law:
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State Law Securities:
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Equine Law:
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Taxation:
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Estate Planning/Trust:
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Workers Compensation/Defendants:
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Estate Probate Administration:
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Workers Compensation/Plaintiffs:
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Other, Please Describe:
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*Claims History:
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If Yes: Date Reported & Amount Paid, including defense expenses (if closed) Claim One:
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Claim Two:
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Claim Three:
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323 West Main Street, Suite 600  |  Louisville, KY 40202  |  Ph. 502-568-6100  |  Fax 502-568-6103

Disclaimer: The contents of this Web site are intended for general information purposes only and should not be construed as legal advice or legal opinion on any specific facts or circumstances. It is not the intent of this Web site to establish an attorney’s standard of due care for a particular situation. Rather, it is our intent to advise our policyholders to act in a manner which may be well above the standard of due care in order to avoid claims having merit, as well as those without merit. In the event any statement on the Web site differs from a statement in an issued policy the policy will control.

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