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Insurance Excess Application

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INSURANCE EXCESS APPLICATION

Applicant / Insured Information

Applicant Name:

Date of Birth:

Contact Person:

Contact Phone:

Proposed Excess Coverage

Proposed Limit:

Retention / Self-Insured Retention:

Proposed Annual Premium:

Policy Period From:

To:

Proposed Effective Date:

Underlying Insurance Information

Primary / Underlying Insurer Name:

Underlying Policy No.:

Underlying Limit:

Underlying Deductible:

Coverage Selection

Please indicate requested coverages (check all that apply):

Prior Loss / Claims History (Last 5 Years)

Provide all losses over the last five years. If none, state "None" in description.

Amount Paid / Reserved for Loss 1:

Amount Paid / Reserved for Loss 2:

Amount Paid / Reserved for Loss 3:

Attachments / Documentation Checklist

Please attach the following documents where applicable (check all attached):

Exclusions and Limitations (Standard Acknowledgment)

The undersigned acknowledges that any excess policy issued will contain exclusions, conditions and limitations, including but not limited to exclusions for war, nuclear hazard, pollution (except where endorsed), asbestos, mold, and intentional acts. Coverage will follow the terms and conditions of the underlying policy only to the extent specifically endorsed; in the event of a conflict between the excess policy and the underlying policy, the excess policy's terms prevail as applied to excess coverage. The insurer reserves the right to add specific exclusions based on underwriting review.

Declarations and Certification

I certify that the statements and particulars contained in this application and any attachments are true, complete and correctly recorded to the best of my knowledge. I understand that this application, including any material submitted herewith, will be relied upon by the insurer in determining whether to provide the requested excess insurance and in setting premiums. I further understand that any misrepresentation, omission or material change in the risk, whether made intentionally or otherwise, may result in denial of coverage, rescission of the policy, or adjustment of coverage terms as permitted by law.

The applicant authorizes the insurer and the insurer's agents to obtain claim and underwriting information from prior insurers, claims administrators, and other third parties. This authorization shall remain valid for the underwriting and any audit periods applicable to any policy issued as a result of this application. I understand that no binder or coverage is in effect unless confirmed in writing by the insurer or its authorized representative.

I further declare that all known facts that might influence the underwriting of this risk have been disclosed. If there are any material changes to the information provided prior to inception of coverage, I will notify the insurer in writing immediately. I understand that coverage, if issued, is subject to the terms, conditions, exclusions and endorsements of the policy form.

Producer / Broker Information

Broker License No.:

Broker Contact Phone:

Broker Email:

Signature and Authorization

By signing below, the undersigned represents and warrants that he/she is authorized to complete and submit this application on behalf of the applicant and certifies the truth of the statements contained herein. The undersigned acknowledges that signing this application does not bind the insurer to provide coverage until a policy is issued and premium acceptance is confirmed in writing.

Applicant Name:

Title / Capacity:

Signature:

Date:

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What the Insurance Excess Application Is

An Insurance Excess Application is a document used to request coverage above the limits of a primary insurance policy or to apply for an excess liability layer. It collects policyholder details, underlying policy limits, loss history, exposure metrics, and the specific excess limits requested. Insurers use the form to underwrite additional capacity, assess aggregate exposures, and price the excess layer. The application can exist as a stand-alone form, part of a broker submission, or as a digital form for eSubmission and electronic signature workflows.

Why a Clear Excess Application Matters

A complete, well-structured application speeds underwriting decisions, reduces follow-up requests, and helps ensure the excess layer is offered at appropriate pricing. Accurate disclosures protect both the insured and carrier by aligning expectations on limits, sub-limits, and exclusions.

Why a Clear Excess Application Matters

Who typically completes an Insurance Excess Application

Signature lines are completed by authorized signers or delegated representatives; witness or notary requirements depend on jurisdiction and carrier policy.

  • Insurance Brokers and Agents who package primary and excess layers and submit underwriting information to carriers.
  • Risk Managers and Corporate Insurance Departments responsible for accuracy of loss runs and exposure schedules.
  • Independent Underwriters or MGA staff who gather supplemental details for excess-layer binding.

Step-by-step: preparing and submitting the application

Follow a consistent sequence to gather documents, complete the form, obtain signatures, and deliver to underwriters.

  • 01
    Collect Documents: Assemble declarations, full policy wording, and five years of loss runs.
  • 02
    Complete Form: Enter requested fields, check accuracy, and attach schedules.
  • 03
    Sign and Date: Authorized signer signs; date in MM/DD/YYYY format.
  • 04
    Submit to Carrier: Send to insurer or broker via secure channel with attachments.

Typical electronic submission workflow

An efficient eSubmission lifecycle reduces manual handoffs and preserves an audit trail for the excess layer review.

  • Upload: Sender uploads the completed application and attachments into the eSigning platform.
  • Field Placement: Place signature, date, and conditional fields for additional signers.
  • Authentication: Choose signer authentication (email, SMS code, or stronger methods).
  • Delivery: Distribute the signed packet to insurer, broker, and insured with audit trail.

What a professional Insurance Excess Application includes

A premium-quality application is precise, evidence-backed, and organized to facilitate underwriting review without repeated clarifying requests.

Declarations

Clear insured identity, policy period, and primary carrier details so underwriters can confirm the attachment point and verify excess eligibility quickly.

Exposure Schedule

Detailed exposure breakdown (locations, payroll, revenue, limits) to allow loss modeling and concentration assessment by excess carriers.

Loss Runs

Five years of loss history with dates, amounts, and reserves presented in chronological order for accurate actuarial review.

Prior and Pending Litigation

Summary of outstanding suits, potential large losses, and case statuses enabling underwriters to screen for catastrophic exposure.

Special Limits / Exclusions

Any policy endorsements, sub-limits, or exclusionary language that affects coverage scope and the excess attachment point.

Signatures & Authority

Authorized signature blocks with printed name, title, date, and contact details to establish execution authority and aid communications.

Security and compliance details to include

Encryption in transit: TLS 1.2/1.3
Encryption at rest: AES-256
Audit trail: Timestamped event logs
HIPAA support: BAA available
ESIGN / UETA: Legal compliance
21 CFR Part 11: Support for FDA-regulated records

Risks and consequences of incomplete or incorrect applications

Coverage delay: Underwriting holds pending clarifications
Declination risk: Carrier may refuse excess layer
Material misstatement: Potential coverage rescission
Premium adjustment: Retroactive rate increases possible
Claims denial: Unreported exposures may be excluded
Regulatory fines: Jurisdictional penalties may apply

Common preparation errors to avoid

  • Submitting abbreviated loss runs without detail (dates, reserves) which forces underwriters to request supplemental information and delays decisions.
  • Listing incorrect underlying limits or attachment points, creating misaligned expectations and possible coverage gaps if left uncorrected.
  • Using inconsistent named insured names across documents, causing identity verification failures and contractual ambiguity at bind stage.
  • Omitting material changes in operations (new locations, acquisitions) that increase exposure and could lead to declination or surcharge.

Recommended digital workflow settings for eSubmission

Configure these settings to maintain compliance, authentication, and an auditable record for the excess application.

Field Configuration
Signer authentication Email + optional SMS code
Conditional fields Show loss detail fields when answer is 'Yes'
Document retention Retain signed packet and audit trail
Access controls Role-based permissions for reviewers

Technical requirements for eSigning and delivery

Use a platform that records timestamps, IP addresses, and signer actions to satisfy carrier and regulatory audit requirements.

  • File types: PDF and DOCX supported
  • Integrations: Salesforce, NetSuite, Google Workspace
  • Authentication: Email, SMS, or advanced methods

Typical timing and processing expectations

Timelines vary by carrier and complexity; use these common benchmarks to set expectations with brokers and insureds.

Initial Acknowledgement:

Carrier acknowledges receipt within 3–5 business days

Underwriting Review:

Standard review window 10–30 business days depending on complexity

Request for Info:

Supplemental questions usually issued within first review week

Pricing Decision:

Indicative terms provided 2–6 weeks after complete submission

Binding / Endorsement:

Binding occurs after payment and final underwriting approval

Key milestones in the excess application lifecycle

Track these sequential milestones from preparation through binding to monitor progress and intervene when delayed.

01

Prepare Submission

Assemble declarations, loss runs, and exposure schedules before sending.

02

Submit to Carrier

Deliver complete packet via secure eSubmission channel.

03

Underwriter Review

Carrier evaluates risk, requests clarifications as needed.

04

Issue Terms

Carrier provides price, conditions, and any endorsement language.

Comparing eSignature vendors for Insurance Excess Application workflows

Platform capabilities and price models vary; this table summarizes starting price and common features for quick vendor comparison.

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 trial, no CC Yes, trial varies Yes, trial varies Yes, trial varies Yes, trial varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA / Envelope Cap Yes / No cap Yes / 100 envelopes/user/yr Yes / Varies by plan No / Varies No / Varies

Real-world examples of excess application use

These short examples show how organizations use completed applications in practice and the benefits realized.

Optica Ventures (Brokered Submission)

A broker prepared a structured excess packet to reduce follow-up.

  • The insurer required one supplemental schedule.
  • The streamlined package shortened the underwriting cycle, allowing the client to secure capacity within the desired timeline and avoid coverage gaps.

Martin Properties (Real Estate Risk)

A property owner supplied location-level exposure schedules upfront.

  • Loss runs were comprehensive.
  • The carrier priced the excess layer accurately without multiple requests, enabling a timely binding and consistent premium terms across renewals.

Frequently asked questions about the Insurance Excess Application

Answers to common questions on eSigning, notarization, authority to sign, and what triggers underwriting follow-up.


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