Real Estate Agents E&O Insurance Online Insurance Application

Name as it should appear on the policy (required)

What type of business formation would this insurance cover?

Street Address (required)

City

County

State

Zip Code

Contact Name (required)

Your Telephone (required)

Your Email (required)

Your website address

If you have multiple office locations, please list each location here.

List U.S. States where applicant sells property

Total number of FULL- TIME Real Estate Agents/Brokers/Property Managers/Independent Contractors

Total number of PART- TIME Real Estate Agents/Brokers/Property Managers/Independent Contractors

Total Annual Gross Revenue- Residential Sales

Total Annual Gross Revenue- Commercial Sales

Total Annual Gross Revenue- Residential Land Sales

Total Annual Gross Revenue- Commercial Land Sales

Total Annual Gross Revenue- Other Raw Land Sales

Total Annual Gross Revenue- Res. Prop. Mgmt. Sales

Total Annual Gross Revenue- Comm. Prop. Mgmt. Sales

Total Annual Gross Revenue- Appraisal/Broker Price Opinions

Total Annual Gross Revenue- Consulting

Is the applicant affiliated with a franchise?

If yes, please advise which one and branch name.

Has the applicant’s Principal or Managing Partner been either a licensed agent for a minimum of 5 years or a licensed broker for a minimum of 2 years?

If a broker, year licensed:

If an agent, year licensed:

Is more than 10% of the income is derived from construction/development activities?

Is more than 10% of the income is derived from the sale, management or leasing of properties constructed/developed by the applicant or any related entity?

Is more than 10% of the income is derived from the sale of agent owned properties?

Is more than 10% of the income is derived from foreclosure sales/REO sales/short sales?

Is more than 10% of the income is derived from the sale of real estate at any one location or development (subdivision)?

Is more than 10% of the income is derived from auctioneering, business brokering and/or referral services?

Do you derive income from any activity/profession other than from the scope of a real estate organization?

If yes, please advise details.

Do more than 50% of the applicant’s transactions involve services as a dual agent?

Does the average value of properties sold exceed $600,000?

Who is your current E&O carrier, if none, state NONE

Policy Expiration Date

Retroactive Date on current Policy

Current Deductible

Expiring Premium

What level of coverage are you interested in?

Which deductible are you interested in?

Has the Applicant, Predecessor Firm or any affiliated company at any time in the past or present engaged in any business venture outside the scope of a Property Management or Real Estate Organization, including but not limited to construction, property development or asset management?

If “Yes”, please provide full details including the amount of income from these activities.

Does the applicant have an ownership interest in the properties managed? .

If “Yes”, please provide full details including ownership %.

Is the applicant selling, managing or leasing property they or any related entity developed or constructed?

If “Yes”, what percentage of income is derived from these services?

Does the Applicant organize Real Estate Investment Trusts for the purpose of investing in real estate?

If “Yes”, please provide full details.

For all properties required to be in compliance, are all properties in full compliance with statutory and regulatory requirements for persons with a physical handicap?

Is a budget plan prepared for each property managed?

Has any person proposed for insurance had his/her license revoked, suspended, been fined, or been subject to any disciplinary action or investigation by any real estate association, state licensing board, or other regulatory body?

Is firm involved in space merchandising?

Are credit reports obtained on prospective tenants?

Are you responsible for negotiating, effecting or maintaining insurance coverage on properties managed?

Indicate percentage of management fees derived from commercial property.

Indicate percentage of management fees derived from residential property.

Is a budget plan prepared for each property managed?

If “Yes”, please provide full details.

Have you had any E&O claim(s) in the past 5 years?

If yes, please provide details here:

Has any Policy for Real Estate Agents E&O Insurance ever been cancelled or non-renewed?

If you do not currently carry E&O Insurance, please advise why (to explain to the underwriters).

If “Yes”, please provide full details of who cancelled and why cancelled.

Is any owner, partner, officer, director, employee, or independent contractor aware of any circumstance, allegation, contention, or incident which may result in a claim being made against the Applicant, its predecessor(s) in business, or any of its present or former partners, owners, officers, directors, employees, or independent contractors? If yes, provide details below.

Your Message or Comments

Disclaimer Notice – The premiums quoted are estimates based on information you provided. This quotation does not constitute a contract of insurance, nor does it provide coverage for any loss or claim. Coverage can only be bound by an agent with a signed application and a down payment.

Please utilize the “Send” Button to send your form to our office. If the website does not allow you to submit the form, please print the page and fax it to 732.334.0405 or scan it into your computer and send it to ben@allprocoverage.com. Do not “Refresh” the page because all data entered onto the form will be lost.

After you hit the “Send” button, please scroll back down to this area and if successfully sent, a message will appear below. If not successfully sent, a message will appear below which means you have to scroll back up and complete the missing information, which typically involves entering information into a highlighted box. Complete the missing information and then hit “Send” again. Thank you!

Real Estate Agents E&O Insurance Online Insurance Application

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