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XYPN Questionnaire

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XYPN Questionnaire

Please be advised that coverage Cannot be bound or altered without confirmation from licensed agency personnel

XYPN Questionnaire

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URL

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PAS Code (DO NOT EDIT)*

FIRM NAME*

Contact Phone*

GENERAL QUESTIONS:

What are your expected gross revenues for 2026?*

Do you need to update your email address on record?*

Yes

No

If yes, please provide the email address you would like future correspondence to go to:*

Has your firm's name changed since 6/1/2025?*

Yes

No

If yes, please input your firms previous name and the name it is to be changed to.*

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Would you like to add any additional coverage options, such as Divorce Financial Planning, Tax Preparation Coverage, or Management Liability (D&O)?*

Yes

No

Please select the following additional coverage options you would like to add.*

Divorce Financial Consulting

Tax Preparation Coverage

Management Liability (D&O)

Please select which coverages you would like to add. Please note that the additional coverage options are priced at $22 per month and are subject to a $500k per claim limit. For Tier 3 firms, Management Liability will be a $1M per claim limit and the monthly charge will be $44.

Would you like to drop any of the following additional coverage options, such as Divorce Financial Consulting, Tax Preparation Consulting, or Management Liability (D&O)?*

Yes

No

Please select the following additional coverage options you would like to drop?*

Divorce Financial Consulting

Tax Preparation Coverage

Management Liability (D&O)

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60/70 Catamore Boulevard
East Providence, Rhode Island 02914

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PO Box 549
Providence, Rhode Island 02901

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LATEST NEWS

Kyle O’Neill of Starkweather & Shepley Named 2026 Private Client Power Broker
February 25, 2026
Starkweather & Shepley Welcomes Tiffany Tocco to the Financial Institutions Practice Group
February 23, 2026

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