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Insurance Due Diligence Form

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INSURANCE DUE DILIGENCE FORM

Applicant / Insured Information

Applicant Name:

Date of Birth / Formation Date:    Primary Contact:

Policy Details

Policy Period From:    To:

Coverage Types & Limits

Please indicate requested coverage types and proposed limit for each selected coverage.

Exclusions, Conditions & Material Facts

Applicant must disclose known exclusions, material facts, or circumstances that may affect underwriting. Failure to disclose material information may result in rescission or denial of coverage.

Loss History and Claims Information

Number of claims in past 5 years:    Total paid and reserved amounts:

Documentation Checklist

Please indicate enclosed documentation (attach true and complete copies where applicable).

Beneficiary / Loss Payee Information

Beneficiary Name:    Relationship:

Percentage of Proceeds:

Beneficiary Name:    Relationship:

Percentage of Proceeds:

Declarations, Authorization, and Certification

The Applicant hereby represents and warrants that all information and documents submitted in connection with this Insurance Due Diligence Form are true, complete and accurate to the best of Applicant's knowledge. Applicant acknowledges that any material misrepresentation, omission, or concealment of fact may constitute grounds for rescission, denial of coverage, or other remedies available to the insurer under law or contract.

Applicant authorizes the insurer, its representatives and designated agents to obtain underwriting information, loss histories, claim files, financial information, and other information necessary for underwriting and administration of insurance coverage, and to disclose information to reinsurers and service providers as required. Applicant further authorizes third parties to release such information to the insurer upon request.

Certification: By signing below, the Applicant certifies under penalty of perjury and attests that the foregoing statements and disclosures are true and correct and acknowledges that this form and any attachments will be relied upon by the insurer in determining eligibility for coverage and premiums.

Applicant Printed Name:

Signature:

Date:

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What the Insurance Due Diligence Form Is and when it’s used

The Insurance Due Diligence Form is a standardized document used to collect and verify insurance-related information during transactions, acquisitions, contracts, or risk assessments. It centralizes insurer names, policy numbers, coverage limits, effective and expiration dates, endorsements (including additional insured language), and any exclusions or self-insured retentions. The form helps contracting parties confirm that required coverages are in force and meet contractual requirements before closing deals, issuing permits, or accepting exposure. It is typically used by procurement, risk management, brokers, lenders, and legal teams to document proof of insurance in a clear, auditable format.

Why documenting insurance diligence matters

A clear Insurance Due Diligence Form reduces contract risk by capturing insurer, policy, and endorsement details in a single record and by providing an auditable chain of evidence for claims or disputes.

Why documenting insurance diligence matters

Typical users and stakeholders

Teams that routinely request, review, or rely on insurance proof will use this form as part of onboarding, contracting, or closing workflows.

  • Risk managers and insurance brokers who verify coverage limits and endorsements before acceptance of a contract.
  • Procurement and contracting officers who require consistent certificates and endorsements for vendor onboarding.
  • Legal and compliance teams who need recorded evidence of required insurance terms for audits or disputes.

Use controlled templates and versioning to ensure consistent responses and reduce follow-up questions when certificates or policies differ from requirements.

Core components of a professional Insurance Due Diligence Form

A well-designed form groups information for quick verification, supports attachments of certificates and endorsements, and records reviewer actions and dates for auditability.

Insurer Details

Name, NAIC number, contact details and insurer rating. Identifies the carrier and a point of contact for verification and claims.

Policy Information

Policy number, policy type (GL, Auto, WC, EPLI), effective and expiration dates, and aggregate limits where applicable for quick validity checks.

Coverage Limits

Per-occurrence and aggregate limits listed per coverage type, including sublimits, self-insured retentions, and any aggregate erosion notes.

Endorsements & Conditions

Additional insured endorsements, waiver of subrogation, primary and noncontributory clauses, and any policy provisos relevant to the contract.

Exclusions & Notes

Material exclusions, pending claims, or prior losses flagged for underwriter review and contracting risk assessment.

Attachments

Certificate of Insurance (COI), relevant policy endorsements, binder documents, and signed attestations supporting the entries on the form.

Step-by-step completion workflow

Follow these sequential steps to gather, verify, and record insurance information consistently across transactions.

  • 01
    Gather Documents: Collect COI, endorsements, and policy declarations from the vendor or broker.
  • 02
    Enter Data: Populate insurer, policy, dates, and limits on the form in MM/DD/YYYY and whole-dollar format.
  • 03
    Verify Coverage: Confirm endorsements and limits meet contract requirements with the insurer or broker.
  • 04
    Sign and Archive: Obtain required signatures, store attachments, and record reviewer name and date for audit.

How electronic completion and routing typically operate

Digital workflows speed verification by routing the form, collecting attachments, and preserving an audit trail for reviewers and signers.

  • Upload: Sender uploads the form and required attachments into the system.
  • Assign Reviewers: Routing order set for broker, risk manager, and legal reviewer.
  • Sign: Authorized signers apply eSignatures and dates to confirm accuracy.
  • Archive: Signed form and audit trail saved in the document repository.

Recommended digital workflow settings for reliable processing

Configure template and authentication settings to minimize friction while meeting verification and audit requirements.

Field Configuration
Authentication Email link or SMS code; use stronger 2FA for high-risk contracts
Template Lock required fields, include attachment prompts, and use conditional fields for coverage types
Bulk Processing Enable bulk send for onboarding multiple vendors with the same requirements
Audit Trail Record IP, timestamp, signer identity, and attachment checks for compliance

Platform and file requirements for reliable eSubmission

Ensure your platform supports common file types, audit logging, and the authentication level you need before sending the form electronically.

  • Supported Formats: PDF and DOCX preferred for certificates and endorsements
  • Integrations: Salesforce, NetSuite, Microsoft 365, and Google Workspace integrations
  • Security Options: SSO, API access, and conditional signer authentication

Choose a platform that preserves the signed document and audit trail in a compliant format, and that can export to your records system for long-term retention.

Security and compliance details to consider

Encryption: TLS 1.2/1.3 in transit
Encryption-at-Rest: AES-256 encrypted storage
Regulatory Standards: ESIGN and UETA compliance
Healthcare Compliance: HIPAA support with BAA
Audit Trail: Immutable timestamps and logs
Certifications: SOC 2 Type II and ISO 27001

Comparing eSignature vendors for Insurance Due Diligence workflows

This vendor comparison highlights common decision criteria and representative starting prices for annual billing; signNow appears first per platform conventions.

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 Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

Real-world examples of the form in use

The following examples illustrate how organizations use documentation and e-sign workflows to centralize risk assessment and compliance.

Martin Properties

We process documents online for compliance and speed.

  • Centralized attachment of COIs reduces follow-ups.
  • Using a template to require endorsements and signatures ensured leases closed on schedule while preserving a searchable audit trail for later landlord claims resolution.

BIS

SOC 2 and ESIGN compliance were priorities for digitization.

  • Security certifications reassured internal counsel.
  • Implementing structured forms and audit trails reduced manual verification time and supported consistent insurance acceptance across multiple contracts and jurisdictions.

Practical tips for accurate, efficient completion

Adopt consistent templates, automation, and verification checklists to reduce errors and speed approvals while documenting reviewer actions.

Use locked templates consistently
Lock required fields and attach sample endorsements so submitters provide the exact pages reviewers need rather than partial or ambiguous documents.
Validate policy numbers before approval
Cross-check policy numbers and insurer contacts with the issuing broker to prevent acceptance of lapsed or misattributed coverage.
Require specific endorsement text
Specify the exact additional-insured or waiver of subrogation language required in the contract to avoid interpretation disputes.
Keep a documented audit trail
Record who reviewed each item, verification steps taken, and the final acceptance decision to support later claims or audits.

Common preparation and review pitfalls

  • Submitting low-resolution or partial scans of certificates that omit endorsement pages, causing repeated requests and delayed acceptance.
  • Entering abbreviated insurer names or policy numbers that do not match carrier records, which prevents automated verification and triggers manual follow-up.
  • Failing to record the reviewer’s name, decision, and date on the form, leaving audit gaps for later disputes or regulator inquiries.
  • Relying on verbal confirmations from brokers without attaching written endorsements, increasing the risk of misinterpretation at claim time.

Key risks and consequences from inaccurate forms

Claims Denial: Incorrect coverage details can lead to denied claims
Contract Exposure: Unmet insurance requirements create uninsured liability
Regulatory Action: Noncompliance in regulated sectors risks fines
Data Breach Risk: Improper handling of PHI may trigger HIPAA penalties
Financial Penalty: Backup withholding or tax issues may apply
Invalid Acceptance: Missing notarization or witness may void acceptance

Typical timing expectations and internal deadlines

Establish clear internal deadlines so insurance verification does not delay contracting or closing.

Request Timing:

Request completed form at contract negotiation start to avoid last-minute issues

Submission Window:

Require COI and endorsements within 5 business days of request for onboarding

Annual Renewal:

Require updated certificates on or before policy renewal dates each year

Change Notification:

Vendors must notify within 30 days of material policy changes

Record Update:

Update internal records within 3 business days of receiving confirmation

Key milestones from request to archival

Track these milestones to ensure the form is requested, verified, approved, and retained with clear ownership at each stage.

01

Initiation

Request form and attachments at contract kickoff

02

Verification

Underwriter or broker confirms policy validity and endorsements

03

Approval

Contracting or risk team accepts coverage or documents exceptions

04

Archival

Store signed form and attachments with audit trail

Who typically signs and approves this form

Approving Officer

Risk managers or procurement leads typically approve insurance forms after verifying COIs and endorsements. They confirm policy limits align with contract terms and document any exceptions or required corrective actions for the record.

Authorized Signer

An authorized officer of the vendor or broker signs to attest accuracy. That signer is responsible for ensuring attachments are current and for notifying counterparties of material policy changes during the contract term.

Frequently asked questions about the Insurance Due Diligence Form

Answers to common questions about validity, signatures, retention, and electronic submission for the Insurance Due Diligence Form.


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