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How to use or fill out NOTICE: THIS IS CLAIMS MADE AND REPORTED COVERAGE PLEASE
- Click ‘Get Form’ to open it in the editor.
- Begin with Section 1, Applicant Information. Fill in your name, business name (if applicable), and address details accurately.
- Continue by providing contact information including phone number and website. Ensure the proposed effective date is clearly stated.
- In Section 2, Prior Insurance Information, list any previous insurance coverage and provide requested limits and deductibles.
- Move to Section 3, Operations Information. Detail your personnel structure and annual premium volumes for various lines of coverage.
- Complete Section 4 on Risk Management by answering questions about your operational procedures and compliance measures.
- Finally, in Section 5, Claims History, disclose any claims or proceedings against you or your firm over the past five years.
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