Tax Preparer/Bookkeeper Supplement Tax Preparer:Bookkeeper Supplement PDF Download Tax Preparer / Bookkeeper Supplement Specified Professions Professional Liability Product SUPPLEMENT TO THE SPECIFIED PROFESSIONS PROFESSIONAL LIABILITY APPLICATION FOR TAX PREPARERS & BOOKKEEPERS1. Name of Applicant:* Prefix First Last Suffix 2. Please provide a percentage breakdown of the Applicant’s Gross Receipts from the following areas for the current 12-month period. If applicant is newly established, please advise best estimatesa. Tax Returns %*b. Bookkeeping %*c. Compilations/Reviews %*d. Auditing – Public Companies %*e. Auditing – Non-Public Companies (Private, Non Profit, Government Entity) %*f. Auditing – For Private Placements or IPOs %*3. Does the Applicant provide services as an investment advisor, as a fiduciary or have access to client accounts?*YesNo4. Does the Applicant provide services as a benefit administrator or subcontract these services to others?*YesNo5. Does the Applicant derive more than 10% of revenue from payroll-processing services (i.e. managing accounts, issuing checks, withholding taxes etc.) or subcontract these services to others?”*YesNo6. Does the Applicant provide services to corporate clients with assets exceeding $5 million?*YesNo7. Does the Applicant provide audit services to governmental entities with assets exceeding $1 million?*YesNoThis application is a supplement to the Specified Professions Professional Liability Application submitted by the applicant. All representations, fraud statements, acknowledgments, understandings and agreements set forth in the Specified Professions Professional Liability Application are incorporated by reference as though fully set forth herein.Applicant's Signature:*Title:*Date:* Date Format: MM slash DD slash YYYY Print Name:(Please type full name in space provided) This iframe contains the logic required to handle Ajax powered Gravity Forms.