Can this form be signed electronically?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states, provided the parties consent to electronic records and the platform captures intent, attribution, and a retrievable record.

What supporting documents should I include?

Typically include audited or reviewed financial statements, board minutes, prior policy declarations, and loss runs. Attach exhibits as separate labeled files to avoid misplacement during underwriting review.

Who must sign the form?

An authorized corporate officer (CEO or CFO) or an authorized signatory designated by corporate resolution should sign. Verify signer authority internally to prevent binding errors or insurer challenges.

Is notarization required for D&O submissions?

Not generally required for D&O application forms. Notarization or RON may be requested for specific attestations; check carrier instructions and applicable state notarization rules.

How long before renewal should we submit?

Submit renewal packages 60–90 days before policy expiration to allow underwriting review and any negotiated changes to limits, retentions, or endorsements.

How is sensitive information protected during eSubmission?

Use platforms with TLS 1.2/1.3 and AES-256 encryption at rest, and require BAAs when PHI is exchanged to meet HIPAA obligations. Maintain audit trails and access controls for compliance.

Electronic Signature
Templates
Insurance
Insurance D&O Submission Form

Insurance D&O Submission Form

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Insurance D&O Submission Form

Applicant / Insured Information

Applicant Name:

Primary Contact Mailing Address

Entity Type (select all that apply)

Corporation LLC Partnership Nonprofit Other (describe below)

Policy / Coverage Requested

Requested Coverage Components (check all requested)

Side A (Directors & Officers Individual Coverage) Side B (Company Reimbursement) Side C (Entity Coverage)

Limit Requested (each wrongful act)

Retention / Deductible

Premium Estimate

Requested Retroactive Date (if applicable)

Corporate & Financial Information

Public / Private

Public Private

List of Current Directors and Officers (name, title, date appointed, tenure)

Prior Insurance / Loss History

Prior Insurance (most recent carrier)

Any claims or circumstances likely to give rise to a claim in the last five years? Yes No

If yes, provide loss history (date of loss, claimant, brief description, amount paid / reserved)

Pending / Material Litigation and Regulatory Matters

Provide details of any pending or threatened securities, derivative, regulatory, or governmental proceedings

Coverage Options & Endorsements

Optional Coverages:
Employment Practices Liability (EPLI) Fiduciary Liability Crisis Response Expense Cyber & Privacy Extension

Exclusions & Acknowledgements

The following are standard exclusions in D&O policies. Applicant acknowledges that these exclusions may apply and that coverage subjectivity and wording may vary by carrier. Applicant must initial acknowledgment of each exclusion below.

Fraudulent or intentionally wrongful acts Bodily injury / property damage Pollution ERISA / pension claims War / nuclear events

Insured versus Insured exclusion apply unless an Insured Versus Insured buy-back is requested: Acknowledged

Attachments / Documentation Checklist

Please indicate documents attached with this submission:

Most recent audited financial statements Articles / Bylaws Current D&O policy Loss runs (last 5 years) Complete list of directors & officers

Beneficiary / Payee Designation (If Applicable)

Beneficiary Name:

Declarations and Certification

The undersigned authorized representative of the applicant certifies, on behalf of the applicant and its directors and officers, that the statements and particulars contained in this submission form and the documents provided in support are true, complete and accurate to the best of the applicant's knowledge. The applicant understands that this submission is for underwriting consideration only and does not bind coverage. The applicant further authorizes the insurer, its representatives and legal advisors to make any inquiry and obtain any information deemed necessary for underwriting, including but not limited to claims history and financial information, and to share underwriting information with reinsurers for the purpose of risk transfer.

The applicant warrants that no fact, circumstance or situation has been suppressed, misstated or withheld which could materially affect the risk. Any material change to the information provided must be reported to the insurer as soon as practicable prior to policy inception.

Authorized Signatory Name Title Telephone

Print Name:

Signature:

Date:

What the Insurance D&O Submission Form Is

The Insurance D&O Submission Form is a standardized application used to request Directors & Officers liability coverage or to update underwriting information for renewals and endorsements. It collects corporate identity, ownership and governance details, executive rosters, financial statements, disclosures of pending litigation or regulatory matters, and prior claims history. Underwriters use the responses to assess exposures, set limits and premiums, and determine exclusions or prior-acts dates. Brokers, risk managers, and legal teams typically assemble the form and supporting exhibits before submission to carriers.

Why a Complete Submission Matters for Underwriting and Compliance

A thorough, accurate D&O submission speeds underwriting, reduces follow-up requests, and creates a clear disclosure record that supports coverage decisions and claim handling. Proper documentation helps avoid coverage disputes and supports compliance with insurer application warranties and representations.

Who Prepares and Reviews the Insurance D&O Submission Form

Multiple parties typically prepare, review, or rely on the D&O submission depending on organization size and distribution channel.

Corporate risk managers and general counsel — prepare governance responses and verify litigation disclosures.
Brokers and agents — assemble supporting exhibits, request quotes, and submit to underwriters on behalf of clients.
Underwriters and underwriting assistants — analyze exposures, request additional information, and determine pricing and terms.

Coordinate internal reviewers to confirm consistency across legal, finance, and risk sections before sending to brokers or carriers.

Typical Signatories and Their Roles

Primary Signer

Chief Financial Officer or Chief Executive Officer. Signs to confirm financial disclosures and corporate statements are accurate and complete under penalty of misrepresentation and to bind the organization to the application.

Secondary Signer

Corporate secretary or authorized risk officer. Provides administrative attestation, certifies board composition, and executes signature blocks when the primary signer delegates authority.

Key Sections to Include in a Professional Submission

A complete Insurance D&O Submission Form organizes required data into consistent sections so underwriters can evaluate risk quickly and compare submissions across accounts.

Corporate Details

Legal entity name, FEIN, incorporation state, business description, and ownership structure. Accurate entity data ensures correct policy declarations and insurer background checks.

Executive Roster

List current and recent officers and directors, titles, and tenure. Include resumes or bios for key executives when requested by underwriters.

Claims & Litigation

Full history of claims, suits, and regulatory actions with dates, reserves, and outcomes. Omitted claims create material risk of rescission or denial.

Financial Information

Recent financial statements, revenue, assets, and debt schedules. Underwriters use this to gauge company stability and premium exposure.

Risk Controls

Board practices, audit committee structure, compliance programs, cyber controls, and indemnification arrangements that mitigate director/officer exposures.

Coverage Request

Desired limits, retention/deductible, prior acts date, and any requested endorsements or exclusions to be considered by the carrier.

Types of Information Collected on the Form

Entity Identifiers: FEIN, legal name

Executive Personal Data: Names, titles, contact

Financial Metrics: Revenue, assets

Claims Details: Dates, outcomes

Regulatory Notices: Investigations, fines

Governance Records: Minutes, policies

Step‑by‑Step: Completing the Submission Form

Follow these sequential steps to compile, verify, and send a complete D&O submission to underwriters.

01

Collect Documents: Gather financials, board minutes, and prior claims files.
02

Populate Form: Enter entity, executive, and claims information accurately.
03

Internal Review: Have legal and finance confirm disclosures and consistency.
04

Submit to Broker: Provide completed form and exhibits to broker for underwriter delivery.

How to Configure an Online Submission Workflow

When submitting electronically, configure the workflow to ensure correct routing, authentication, and auditable recordkeeping.

Field	Configuration
Upload Template	Use a locked PDF or template to preserve field layout.
Notifications	Enable email alerts for broker and underwriter actions.
Signer Auth	Require email validation or SMS code for signatures.
Conditional Fields	Show follow-up questions only when relevant answers are selected.

Where to Send the Completed Submission

Route the completed D&O Submission Form using a clear chain so underwriters receive documents and auditors can trace decisions.

Broker Delivery: Broker compiles package and transmits to chosen carriers or broker submission portals.
Underwriter Review: Underwriter reviews form, requests supplemental materials if needed, and issues terms or declination.
Carrier Binding: If acceptable, carrier issues binders, endorsements, and policy forms to the broker.
Archive: Store signed submissions with policy files for compliance and future renewals.

Digital Submission and File Format Requirements

Use file formats and integrations that preserve data fidelity and create an auditable record when submitting electronically.

File Formats: PDF, DOCX, Excel
Integrations: Salesforce, NetSuite, Google Workspace
Audit Trail: Timestamp, IP, signer logs

Common Timelines and Processing Expectations

Timing expectations vary by carrier and transaction type; plan ahead to allow underwriting review and any follow-up due diligence.

Renewal Submissions:

Submit 60–90 days before expiration to allow full review.

Claims Reporting:

Report potential claims promptly per policy notice provisions.

Insurer Requests:

Respond to additional information requests within 10–30 days.

Underwriting Response:

Typical quote window ranges from 7–21 business days.

Binding Coverage:

Coverage binds once terms are accepted and premium paid.

Common Mistakes to Avoid When Preparing the Form

Incomplete claims histories — leaving out prior suits or notice letters can lead to rescission or claim denial during policy period.
Mismatched entity names or FEINs — inconsistent legal names cause processing delays and may affect policy declarations.
Insufficient supporting exhibits — omitting audited financials or board minutes often triggers follow-up requests and slows issuance.
Underspecifying coverage needs — vague limit requests or undefined retention preferences result in non-comparable quotes from underwriters.

Consequences of Inaccurate or Omitted Information

Coverage Denial: Claim may be denied

Policy Rescission: Insurer can rescind policy

Premium Adjustment: Higher premiums charged

Regulatory Scrutiny: Fines or inquiries possible

Contractual Breach: Warranty breaches trigger remedies

Reputational Risk: Board exposure increases

Real‑world Submission Scenarios

These example scenarios illustrate common packaging approaches and information priorities for D&O submissions across organizational types.

Case Study — Mid‑size Tech

A growth-stage technology company assembled audited financials and a board minutes summary

quick follow-up questions from underwriters required
timely internal review and complete exhibits produced a competitive quote within two weeks and avoided extended underwriting conditions.

Case Study — Nonprofit Board

A nonprofit preparing for renewal documented governance changes and recent claims

underwriter requested detailed incident reports
providing organized exhibits and an executive roster reduced clarification requests and led to prompt renewal terms.

eSignature Platform Pricing and Feature Snapshot for D&O Submissions

Typical eSignature vendors vary by price, enterprise features, and compliance offerings; signNow is listed first for comparison of core plan attributes.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Trial varies	Trial varies	Free tier available	Free tier available
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently Asked Questions About the Insurance D&O Submission Form

Answers to common questions about e-signing, supporting documents, and legal validity when preparing or submitting a D&O application.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states, provided the parties consent to electronic records and the platform captures intent, attribution, and a retrievable record.
What supporting documents should I include?
Typically include audited or reviewed financial statements, board minutes, prior policy declarations, and loss runs. Attach exhibits as separate labeled files to avoid misplacement during underwriting review.
Who must sign the form?
An authorized corporate officer (CEO or CFO) or an authorized signatory designated by corporate resolution should sign. Verify signer authority internally to prevent binding errors or insurer challenges.
Is notarization required for D&O submissions?
Not generally required for D&O application forms. Notarization or RON may be requested for specific attestations; check carrier instructions and applicable state notarization rules.
How long before renewal should we submit?
Submit renewal packages 60–90 days before policy expiration to allow underwriting review and any negotiated changes to limits, retentions, or endorsements.
How is sensitive information protected during eSubmission?
Use platforms with TLS 1.2/1.3 and AES-256 encryption at rest, and require BAAs when PHI is exchanged to meet HIPAA obligations. Maintain audit trails and access controls for compliance.

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