Insurance Proposal Form Template for United States

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Key Requirements PROMPT example:

Insurance Proposal Form

"I need an Insurance Proposal Form for a retail chain operating in California, Texas, and Florida, requiring comprehensive coverage for property, liability, and business interruption, with specific sections addressing multi-state compliance requirements and natural disaster risks."

Document background
The Insurance Proposal Form is a fundamental document in the U.S. insurance industry, designed to initiate the insurance application process and gather comprehensive information necessary for risk assessment and policy underwriting. This document is utilized when an individual or organization seeks new insurance coverage or reviews existing coverage for renewal. The form must comply with both federal insurance regulations and state-specific requirements, as insurance is primarily regulated at the state level in the United States. It typically includes detailed sections covering applicant information, risk details, claims history, and various declarations required by law. The information provided in this form serves as the basis for the insurer's evaluation of risk and determination of coverage terms and premium rates.
Suggested Sections

1. Applicant Information: Basic details of the individual or entity seeking insurance, including legal name, address, contact information, and business details if applicable

2. Type of Coverage Requested: Specification of the type and amount of insurance coverage being sought

3. Risk Details: Detailed information about the subject matter to be insured (property, liability, life, etc.)

4. Claims History: Disclosure of previous insurance claims, losses, or incidents

5. Current Insurance Information: Details of existing or previous insurance coverage

6. Risk Management Measures: Information about safety measures, security systems, or risk mitigation procedures in place

7. Financial Information: Relevant financial details that may impact the insurance risk assessment

8. Declarations: Statements confirming the truth and accuracy of provided information

9. Authorization: Consent for information verification and processing of the application

10. Payment Information: Preferred payment method and frequency for premium payments

Optional Sections

1. Additional Insured: Section for listing other parties to be covered under the policy, used when multiple entities need coverage

2. International Operations: Details about overseas activities or exposures, required for businesses with international operations

3. Professional Qualifications: Information about professional credentials and certifications, necessary for professional liability insurance

4. Vehicle Schedule: Details of vehicles to be insured, used for commercial auto or fleet insurance

5. Property Schedule: Detailed list of properties to be insured, used for commercial property insurance

6. Employee Information: Details about employees and employment practices, needed for workers' compensation or employment practices liability insurance

7. Environmental Risk Assessment: Information about environmental exposures and controls, required for environmental liability coverage

Suggested Schedules

1. Schedule A - Property Details: Detailed listing of property values, construction details, and security measures

2. Schedule B - Claims History Details: Comprehensive list of past claims with dates, amounts, and claim resolution details

3. Schedule C - Risk Management Procedures: Detailed documentation of safety protocols and risk management systems

4. Schedule D - Additional Locations: List of all locations to be covered under the policy with detailed information about each

5. Appendix 1 - Supporting Documents Checklist: List of required documents to be submitted with the proposal form

6. Appendix 2 - Privacy Notice: Detailed information about how the applicant's personal information will be used and protected

7. Appendix 3 - State-Specific Declarations: Additional declarations or requirements specific to the state where the insurance is being sought

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Clauses
Relevant Industries

Financial Services

Healthcare

Manufacturing

Real Estate

Construction

Retail

Technology

Transportation

Professional Services

Education

Hospitality

Agriculture

Energy

Non-Profit Organizations

Government Entities

Relevant Teams

Risk Management

Finance

Legal

Compliance

Operations

Facilities Management

Safety and Security

Corporate Insurance

Claims Administration

Property Management

Relevant Roles

Risk Manager

Insurance Broker

Underwriter

Compliance Officer

Chief Financial Officer

Chief Risk Officer

Insurance Agent

Claims Manager

Legal Counsel

Business Owner

Facility Manager

Operations Director

Safety Manager

Property Manager

Financial Controller

Industries
McCarran-Ferguson Act of 1945: Federal law that establishes state regulation of insurance as the primary regulatory authority, confirming that states have the main responsibility for insurance regulation
Gramm-Leach-Bliley Act (GLBA): Requires financial institutions, including insurance companies, to explain their information-sharing practices and protect sensitive customer data
Fair Credit Reporting Act (FCRA): Regulates the collection and use of consumer information, including insurance applications and underwriting decisions
Americans with Disabilities Act (ADA): Prohibits discrimination based on disability in insurance applications and coverage decisions
State Insurance Laws: State-specific insurance regulations that govern insurance contracts, required disclosures, and form filing requirements
Unfair Trade Practices Act: State laws that prohibit deceptive practices in insurance transactions and require fair treatment of consumers
Health Insurance Portability and Accountability Act (HIPAA): If health insurance is involved, HIPAA regulations govern privacy and security of health information
Genetic Information Nondiscrimination Act (GINA): Prohibits discrimination in health insurance based on genetic information
Consumer Protection Laws: Both federal and state consumer protection laws that require clear disclosure of terms, conditions, and material facts
Electronic Signatures in Global and National Commerce Act (E-SIGN): Federal law governing the use of electronic signatures in insurance contracts and forms
Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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