C34278 doc 2026

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The document provides detailed instructions for completing a renewal application for insurance coverage with Chubb Group Insurance Companies, specifically for health care organizations. It outlines the steps to save and fill out the application, verify its accuracy, and submit it through an agent or broker. The document also includes important legal information regarding electronic signatures, liability coverage, and fraud warnings. Additionally, it requests specific financial and operational information from the applicant related to various types of insurance coverage such as Directors & Officers Liability, Employment Practices Liability, and others.

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Click ‘Get Form’ to open the C34278 document in the editor.
Begin by entering your name and address in the designated fields. Use the tab key to navigate between fields for a smoother experience.
In Section II, indicate which Power SourceSM for Health Care coverages you are seeking renewal for by checking the appropriate boxes.
Provide financial information such as total revenue and assets in Section III. Ensure accuracy as this data is crucial for underwriting purposes.
If additional space is needed for any question, attach a separate document with your full response, just like you would on paper.
Review all entries for completeness and accuracy before applying your electronic signature at the end of the form.
Once completed, forward the application to your agent or broker via email, along with any necessary supporting materials.

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