Title Agents, Abstractors & Escrow E&O Application

NOTICE

Title and escrow E&O policies are generally written on a claims-made basis: only claims first made during the policy period (and reported as the policy requires) are covered. This application is not a binder.

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Step 1 of 6 - Applicant & Owners

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Please type directly into the fields. Every question must be answered; respond "N/A" to any question that does not apply. If a whole section does not apply to your firm, choose its N/A option and skip to the next section. Title and escrow E&O policies are generally written on a claims-made basis: only claims first made during the policy period (and reported as the policy requires) are covered. This application is not a binder.

1. Applicant & Contact Information

Applicant legal name*

DBA(s) / trade names

Website

Physical street address*

Address City State Zip Code

County

Mailing address (if different)

Address City State Zip Code

Phone*

Email*

Contact name*

Contact title

Entity type

Corporation

LLC

Partnership / LLP

Sole Proprietor

Other

Year established

Please enter a number from 1800 to 2100.

FEIN (optional)

Past names / DBAs / entities (needed for prior acts)

Has the name or structure of the applicant ever changed, or has there been an acquisition, consolidation, merger, dissolution or reorganization?

Yes

Name or structure change: please give details

Does the applicant have branch or other office locations?

Yes

Branch / other office addresses

2. Owners, Affiliations & Staff

Owners, partners and officers

Name

Title

Ownership %

Active in daily business? (Y/N)

Is the applicant owned by, controlled by or affiliated with any other firm (including a title insurance underwriter)?

Yes

Does the applicant, a predecessor firm or any owner or officer own, or have an interest in, a financial institution, mortgage company, real estate brokerage, builder or developer, construction firm, law firm, title insurance underwriter or another title agency?

Yes

Name each firm and the relationship

States where the applicant performs services

Does the applicant perform services on property outside the U.S., or are any staff, owners or subcontractors located outside the U.S.?

Yes

Total number of professional employees

Please enter a number greater than or equal to 0.

Total employees (all staff)

Please enter a number greater than or equal to 0.

Current staff, other than clerical

Name

Activity code(s)

Licensed? (Y/N)

Years of experience

Activity codes: O = Owner / partner / officer, T = Title agent, A = Abstractor / searcher, E = Escrow agent, C = Closing agent, L = Attorney

Do all active owners, officers and key employees who perform professional services have more than 3 years' experience?

Yes

3. Coverage Requested & Insurance History

Desired effective date

E&O limits (per claim / aggregate; check each to quote)

$250K/$250K

$500K/$500K

$500K/$1M

$1M/$1M

$1M/$2M

$1M/$3M

$2M/$2M

Other

Other limits requested

Deductible (check each to quote)

$1,000

$2,500

$5,000

$10,000

$25,000

$50,000

$100,000

Other

Other deductible requested

Also quote (optional; check each that applies)

Theft of funds / fraudulent funds transfer

Crime, including social engineering

Cyber / data breach

Title agency (escrow / license) bond

Theft of funds limit wanted (choose one)

$25,000

$50,000

$100,000

Other

Bond: state(s)

Bond amount required ($)

Please enter a number greater than or equal to 0.

Does the applicant have E&O insurance in force now? (New firms: answer No.)

Yes

Current and prior E&O policies (last 5 years)

Insurer

Policy period (from - to)

Limits

Deductible ($)

Premium ($)

Retro date

Current policy first. Add one row per policy year; leave out years without coverage.

Does the applicant currently have a crime policy that includes social engineering coverage?

Yes

Does the applicant currently have a cyber policy?

Yes

Crime / cyber: insurer, limit and deductible

4. Revenue & Services

Gross revenue = your retained title commission after premium is paid to underwriters, plus all fees from closing, escrow, search and other services. If newly established, estimate the current year. Totals calculate automatically.

Gross revenue, past 12 months ($)

Please enter a number greater than or equal to 0.

Projected revenue, next 12 months ($)

Please enter a number greater than or equal to 0.

Title agent commissions (retained, after underwriter's share) - Revenue past 12 months ($)

Please enter a number greater than or equal to 0.

Title agent commissions (retained, after underwriter's share) - % of revenue

Please enter a number from 0 to 100.

Title agent commissions (retained, after underwriter's share) - Average monthly # of transactions

Please enter a number greater than or equal to 0.

Escrow / closing / settlement fees - Revenue past 12 months ($)

Please enter a number greater than or equal to 0.

Escrow / closing / settlement fees - % of revenue

Please enter a number from 0 to 100.

Escrow / closing / settlement fees - Average monthly # of transactions

Please enter a number greater than or equal to 0.

Abstract / title search fees - Revenue past 12 months ($)

Please enter a number greater than or equal to 0.

Abstract / title search fees - % of revenue

Please enter a number from 0 to 100.

Abstract / title search fees - Average monthly # of transactions

Please enter a number greater than or equal to 0.

Witness closer / signing agent fees - Revenue past 12 months ($)

Please enter a number greater than or equal to 0.

Witness closer / signing agent fees - % of revenue

Please enter a number from 0 to 100.

Witness closer / signing agent fees - Average monthly # of transactions

Please enter a number greater than or equal to 0.

Other - Revenue past 12 months ($)

Please enter a number greater than or equal to 0.

Other - % of revenue

Please enter a number from 0 to 100.

Other - Average monthly # of transactions

Please enter a number greater than or equal to 0.

Other service - describe

TOTAL - Revenue past 12 months ($)

Calculated

TOTAL - % of revenue

Calculated

% of revenue by property type (should total 100%)

Residential / farm / vacant lots %

Please enter a number from 0 to 100.

Commercial / industrial %

Please enter a number from 0 to 100.

Agricultural %

Please enter a number from 0 to 100.

Oil, gas & minerals %

Please enter a number from 0 to 100.

Other property type %

Please enter a number from 0 to 100.

Other property type - describe

% of revenue by client type (should total 100%)

Title companies %

Please enter a number from 0 to 100.

Real estate agents / brokers %

Please enter a number from 0 to 100.

Builders / developers %

Please enter a number from 0 to 100.

Banks / lenders %

Please enter a number from 0 to 100.

Attorneys %

Please enter a number from 0 to 100.

Consumers / other %

Please enter a number from 0 to 100.

Is 20% or more of the applicant's work directly from builders during construction or development of property?

Yes

% of revenue from the two largest clients combined

Please enter a number from 0 to 100.

Services performed in-house (check all that apply)

Title agent

Abstractor / searcher

Escrow agent / closer

Witness closer / signing agent

Other (describe in comments)

Services performed by outside parties (leave blank if none)

Escrow agent / closer - % by independent contractor / subcontractor

Please enter a number from 0 to 100.

Escrow agent / closer - % by title underwriter

Please enter a number from 0 to 100.

Abstractor / searcher - % by independent contractor / subcontractor

Please enter a number from 0 to 100.

Abstractor / searcher - % by title underwriter

Please enter a number from 0 to 100.

Witness closer / signing agent - % by independent contractor / subcontractor

Please enter a number from 0 to 100.

Witness closer / signing agent - % by title underwriter

Please enter a number from 0 to 100.

Are all subcontractors required to carry their own E&O insurance?

Yes

N/A

Do you collect updated certificates of insurance or declarations pages from them every year?

Yes

N/A

If not required, % of subcontractors that carry E&O

Please enter a number from 0 to 100.

5. Title Agent Services

Does the applicant provide title agent services (issue title insurance policies)?*

Yes

N/A - no title agent revenue or services

Choose N/A to skip the rest of this section.

Title underwriters you issue policies for (largest first)

Title underwriter

% of title agent revenue

Years with underwriter

During the last 10 years, other than for lack of premium production, has the applicant's contract with any title underwriter been cancelled, non-renewed or terminated?

Yes

Is the applicant ALTA Best Practices certified?

Yes

Does the applicant have any Marketing Services Agreement (MSA) or affiliated business arrangement?

Yes

Underwriter cancellation or MSA: please explain

6. Title Search & Abstract Services

Does the applicant perform title search or abstract services?*

Yes

N/A - no title search or abstract services

Choose N/A to skip the rest of this section.

Who performs the title searches?

In-house staff

Subcontractor

Title underwriter

Other

7. Escrow, Closing & Settlement Services

Does the applicant perform escrow, closing or settlement services?*

Yes

N/A - no escrow, closing or settlement services

Choose N/A to skip the rest of this section.

Who performs closings - % employees

Please enter a number from 0 to 100.

% independent contractors

Please enter a number from 0 to 100.

% underwriter / other

Please enter a number from 0 to 100.

Does the applicant perform transactions where closing and/or settlement is the only service provided?

Yes

Are written closing instructions obtained for every closing?

Yes

Are all closing funds required to be received by wire transfer or cashier's check?

Yes

Are signatures of all parties required for any change to a closing or settlement?

Yes

Is closing / escrow software used for all escrow and closing work?

Yes

Closing / escrow software name

Are independent witness closers or signing agents allowed to disburse funds?

Yes

Does the applicant obtain a "gap" or "date down" search for liens before recording documents or disbursing funds?

Yes

Has the applicant ever closed a transaction without a title insurance commitment or an attorney's title opinion?

Yes

Does the applicant, any owner or any employee ever act as buyer, seller or borrower on a transaction the applicant closes?

Yes

Does the applicant handle 1031 (like-kind) exchanges?

Yes

1031 - % of revenue as escrow agent

Please enter a number from 0 to 100.

1031 - % of revenue as qualified intermediary

Please enter a number from 0 to 100.

Does the applicant hold and disburse escrow funds for construction projects?

Yes

Is a signed escrow agreement always used to set how and when construction funds will be paid?

Yes

N/A

Are signed lien waivers or releases always obtained from the contractor and subcontractors before funding?

Yes

N/A

% of revenue from construction escrow

Please enter a number from 0 to 100.

Please explain any "Yes" to the disbursing, no-title or buyer/seller questions

8. Funds Transfer, Cyber & Risk Controls

Does the applicant send or receive wire / electronic fund transfers for clients?

Yes

Transfer instructions accepted by

Phone

Fax

Text

In person

Other

Are changes to funding instructions (bank, account, method) always verified by phone, using a known number, before funds are released?

Yes

Must a second employee verify transfers above a set amount?

Yes

Amount above which a second employee verifies ($)

Please enter a number greater than or equal to 0.

Daily # of transfers - average

Please enter a number greater than or equal to 0.

Daily # of transfers - maximum

Please enter a number greater than or equal to 0.

Largest single transfer ($)

Please enter a number greater than or equal to 0.

Controls in place (check all that apply)

Multi-factor authentication (email / remote)

Spam and phishing email filtering

Regular backups kept offline / separate

Firewall and anti-virus / anti-malware

Encryption of laptops and mobile devices

Annual information-security training

Annual wire-fraud / social engineering training

Background checks on employees

If contracts are used, are they reviewed by legal counsel?

Yes

N/A

Does the applicant have written procedures to ensure compliance?

Yes

Does the applicant have formal in-house training procedures?

Yes

Does the applicant have a business process audit policy and procedures?

Yes

Does the applicant have a formal disaster recovery plan?

Yes

Is continuing education required for all licensed employees?

Yes

Describe your wire-fraud controls (optional)

9. Claims & Disciplinary History (past 5 years)

During the past 5 years, has the applicant or anyone proposed for insurance had any inquiry, investigation, complaint or disciplinary action by a state or federal authority?

Yes

Has anyone in the firm ever had a professional or business license suspended or revoked?

Yes

During the past 5 years, has any professional liability claim or suit been made against the applicant, a predecessor firm or anyone proposed for insurance?

Yes

Does the applicant or anyone proposed for insurance know of any act, error, omission or circumstance that could result in a claim?

Yes

During the past 5 years, has any insurer declined, cancelled or non-renewed similar insurance for the applicant (other than an insurer leaving the market)?

Yes

Claim / incident details

Date of error

Date reported

Insurer reported to

Claimant / what happened

Status (open / closed)

Paid / reserved ($)

One row per claim or incident. You can also attach loss runs on the next page.

What happened, and what steps have been taken to prevent a similar claim

Disclosing a claim does not mean it is covered. Circumstances that could lead to a claim must also be reported to your current insurer before its reporting period ends.

10. Comments, Applicant Statement & Signature

Please attach, if available: the current E&O declarations page; 5 years of loss runs; and certificates of insurance for subcontractors.

Attachments (optional)

Drop files here or

Accepted file types: pdf, jpg, jpeg, png, doc, docx, xls, xlsx, Max. file size: 10 MB, Max. files: 10.

Additional comments or details for any "Yes" answer

Applicant Statement & Signature

The undersigned, an authorized owner, partner or officer of the applicant, declares that the statements in this application and any attachments are true and complete to the best of his or her knowledge after reasonable inquiry of all persons proposed for this insurance. If any information changes before the policy effective date, the applicant will promptly notify us, and any quote or binder may be changed or withdrawn. Signing this application does not bind the applicant or any insurer to complete the insurance, but if a policy is issued, the insurer will rely on this application and it will become part of the policy. Nothing in this application is notice of a claim or potential claim under any policy. The applicant authorizes this information to be shared with insurance companies for the purpose of obtaining quotes.

FRAUD WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false, incomplete or misleading information, or conceals for the purpose of misleading any fact material thereto, commits a fraudulent insurance act, which is a crime and may subject the person to criminal and civil penalties, including fines, imprisonment and denial of benefits. Additional state-specific fraud notices may apply and will be provided by the insurer where required.

Applicant statement*

I have read and agree to the Applicant Statement and Fraud Warning above.

Signature*

Your Name
Your Name
Your Name

Date*

Printed name*

Title

How did you hear about us?

Title Agents, Abstractors & Escrow E&O Application

NOTICE

1. Applicant & Contact Information

2. Owners, Affiliations & Staff

3. Coverage Requested & Insurance History

4. Revenue & Services

5. Title Agent Services

6. Title Search & Abstract Services

7. Escrow, Closing & Settlement Services

8. Funds Transfer, Cyber & Risk Controls

9. Claims & Disciplinary History (past 5 years)

10. Comments, Applicant Statement & Signature

Applicant Statement & Signature

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