General Information Full Legal Company Name
Street Address
DBAs & Subsidiaries (if applicable)
Website
List of Shareholders, Partners, Owners, and Officers
Underwriting Questions 1. What are the business risks that concern you the most?
2. In the last 5 years, has your business had any losses or potential losses including, but not limited to, property, liability, cyber, or business income?
3. Has your business been subject to losses or any litigation expenses not covered by standard commercial insurance? Please describe.
4. Does your business have any warranty / hold harmless contracts?
5. What is your average annual accounts receivable write-off?
6. Does your business have intellectual property (patents, trademarks, or copyrights) exposure? Please describe.
7. Do you have high reliance on a limited number of suppliers / vendors?
8. Do you provide medical benefits to your employees? If so, what is the annual premium?
9. Notes: Provide any additional notable details regarding your business, risks, and loss history.
