Can the application be signed electronically?

Yes. Electronic signatures are legally valid under federal ESIGN and state e‑signature laws where permitted. Ensure the carrier accepts e‑signatures and that any required consumer disclosures or higher authentication are completed before submission.

What supporting documents are required?

Typical attachments include declarations pages for underlying policies, three to five years of loss runs with reserves, audited financial statements if requested, and any corporate authorization for the signer.

Who must sign the application?

An authorized company officer or appointed broker can sign. Provide proof of authority when a signer is not a named corporate officer to prevent re-execution delays.

What if I discover an error after submission?

Notify the underwriter immediately, submit a corrected application or endorsement, and document the correction. Material misstatements may affect coverage and should be addressed promptly.

Do carriers require notarization?

Most routine applications do not require notarization, but some carriers or jurisdictions may require notarized signatures or RON for specific attestations. Confirm carrier requirements before notarizing.

How long before I receive a quote?

Preliminary quotes vary by complexity. Expect initial pricing indications in one to four weeks; complex placements or facultative reinsurance may take longer.

Electronic Signature
Templates
Insurance
Insurance Excess Loss Application

Insurance Excess Loss Application

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

INSURANCE EXCESS LOSS APPLICATION

Applicant / Insured Information

Applicant Name: Mailing Address:

Contact Phone:

Email Address:

Date of Birth (if individual):

Entity and Regulatory Details

Entity Type: Individual Corporation LLC Partnership Other:

Policy / Coverage Details Requested

Underlying Policy Type:

Requested Excess Limit:

Attachment Point / Retention:

Estimated Annual Premium:

Policy Period (Requested): From to

Coverage Requested (select all that apply)

Property Damage Business Interruption General Liability Fidelity / Crime Catastrophe Aggregate Other:

If Other, describe:

Loss History (most recent five years)

Provide complete loss history for the past five years. Attach loss run reports where available.

Loss 1 — Date of Loss: Description: Amount Paid or Reserved:

Loss 2 — Date of Loss: Description: Amount Paid or Reserved:

Loss 3 — Date of Loss: Description: Amount Paid or Reserved:

Exclusions & Limitations Acknowledgment

The following exclusions are customarily referenced for excess coverage. Applicant acknowledges these common exclusions and agrees any deviation or request for amendment must be expressly negotiated and endorsed:

Nuclear hazard War, hostilities, insurrection Pollution and contamination Intentional acts by insured Fraudulent acts or misrepresentation

If applicant requests modification of standard exclusions, describe proposed change:

Documentation Checklist

Provide the following with this application (check boxes and attach copies):

Loss runs for last five years Copies of underlying policy(ies) Most recent financial statements

Photographs, site surveys, or valuation reports Police/fire reports or independent adjustment reports Other documents:

Beneficiary / Payee Designation for Recoveries

Provide name and allocation for any designated beneficiary or payee for recovery payments under this excess arrangement.

Beneficiary Name:

Relationship to Applicant:

Allocation Percentage:

Declarations, Representations and Authorizations

The undersigned represents and warrants to the insurer that the information supplied in this application and in any attachments is complete, true and correct to the best of the undersigned's knowledge. The undersigned acknowledges that any material misstatement, omission or concealment in this application may entitle the insurer to deny coverage or rescind the policy in accordance with applicable law and policy terms.

The undersigned authorizes the insurer and its representatives to obtain claim, loss and underwriting information from prior insurers, claims administrators and other sources as reasonably necessary to evaluate this application. The undersigned agrees to provide promptly any additional documentation requested in connection with underwriting or placement of excess coverage.

Fraud Warning: Where applicable by law, any person who knowingly presents false or fraudulent information for the purpose of obtaining insurance coverage may be guilty of a criminal offense and civil penalties may apply.

By signing below the applicant certifies that all required attachments are true copies and that no facts material to the risk have been withheld.

I certify that the statements in this application are true, complete and accurately recorded.

Authorization to Bind Coverage (if applicable)

No binder of insurance is effective until accepted in writing by the insurer. Any verbal assurances of coverage are provisional and do not amend the terms of this application or create an obligation to provide coverage absent a formal acceptance and issuance of policy documentation.

Applicant Printed Name:

Signature:

Date:

What the Insurance Excess Loss Application Is

An Insurance Excess Loss Application is a document submitted to request or modify excess loss (stop‑loss or excess casualty) coverage above a primary policy. It collects insured-identifying information, coverage layers, retention/deductible amounts, historical loss data, and underwriting disclosures so carriers or reinsurers can assess exposure and price the excess layer. The application supports risk transfer between primary insurers, reinsurers, or third‑party administrators and initiates underwriting, actuarial review, and policy issuance when approved.

Why this application matters for coverage and underwriting

A clear, complete application speeds underwriting, reduces follow-up requests, and helps secure appropriate excess capacity and pricing. It documents material facts and establishes the record used for policy terms, exclusions, and premium calculation.

Who prepares and who signs the application

Ensure the person who signs has explicit authority to bind the organization and that supporting attachments are included to avoid processing delays.

Insurance brokers and agents completing underwriting packages on behalf of clients and coordinating with carriers.
Employer risk or benefits managers supplying payroll, stop‑loss attachments, and historical claims data for self‑funded groups.
Carriers and reinsurers reviewing, underwriting, and signing binding excess policies or reinsurance contracts.

Authorized signers and their roles

Company Officer

A corporate officer or authorized executive who has signatory authority for insurance contracts. Their signature binds the insured and confirms representations made on the application; carriers may request proof of authority.

Broker/Agent

An appointed broker or agent may complete and submit the application on the insured's behalf. Documentation of appointment and any broker-of-record letters should be attached when required by the carrier.

Key data elements required on the form

Insured Name: Full legal name

Policy Details: Primary carrier and policy number

Coverage Layer: Excess limit and attachment

Retention: Retention/deductible amount

Loss History: Prior 3–5 years

Signatory: Name, title, date

Consequences of errors or omissions

Coverage denial: Claims may be denied

Policy rescission: Carrier may void coverage

Premium adjustments: Retroactive rate changes

Delayed issuance: Longer underwriting time

Regulatory exposure: Compliance reviews possible

Data privacy: PHI requires BAA

Common issues that slow processing

Incomplete loss runs lacking claim details force underwriters to request supplemental documentation and delay decisions.
Mismatched named insured or subsidiary information can create coverage gaps or require endorsement changes.
Missing signatures or improper authority proof often require re-execution and extend the effective date for coverage.
Unclear retention definitions or ambiguous attachment points lead to differing interpretations between primary and excess carriers.

Step-by-step: completing the Insurance Excess Loss Application

Follow a clear sequence when filling and submitting the application to minimize underwriting queries and speed issuance.

01

Collect documents: Gather policy, loss runs, and payroll or exposure data.
02

Complete fields: Enter insured data, limits, and retention precisely.
03

Attach exhibits: Include loss runs and schedule of locations as attachments.
04

Sign and submit: Authorized signer executes and sends to underwriter.

How the submission moves through underwriting

Understand each stage from submission to policy issue to coordinate attachments and approvals efficiently.

Submission: Broker or insured submits completed application and attachments.
Underwriting review: Carrier assesses exposures, loss history, and pricing.
Negotiation: Underwriter may request clarifications or endorsements.
Issuance: Policy or binder issued when underwriting and approvals are complete.

Digital workflow configuration for eSubmission

Configure your electronic workflow to capture required fields, attachments, and signer authentication before sending.

Field	Configuration
Required fields	Make insured name, limit, retention, and signature mandatory
Attachments	Require loss runs and primary policy declarations
Authentication	Use email plus SMS or KBA for higher assurance
Audit trail	Enable capture of IP, timestamp, and activity log

Technical considerations for electronic filing and signatures

Confirm carrier acceptance of electronic documents and whether a carrier requires specific authentication or notarization steps before filing.

Integrations: Salesforce, NetSuite, Google Workspace, and Box are commonly supported
File formats: Accept PDF and DOCX with embedded attachments
Security: TLS encryption and AES‑256 storage

What a professional excess loss application includes

A complete application organizes underwriting information for quick review: clearly labeled sections, consistent attachments, and signed authorizations.

Cover page

Single-page summary showing insured, primary carrier, requested excess limits, retention, and the name of the submitting broker or TPA.

Insured details

Full legal name, DBA if applicable, federal tax ID or employer identification number, principal address, and contact information for underwriting inquiries.

Exposure schedule

List locations, payroll or exposure bases, and values by class or location to support limit and rate calculations.

Loss runs

Detailed paid and reserved claims for the prior three to five years with dates, descriptions, and amounts, in carrier‑acceptable format.

Coverage history

Summary of prior carriers, limits, and any mid-term changes or material transactions affecting risk during the lookback period.

Declarations and signature

Completed declarations page with explicit representations, signature, printed name, title, and date to validate the application.

Practical tips to avoid underwriting delays

Follow these practices to reduce questions and speed excess layer placement.

Standardize attachment formats

Provide loss runs and declarations as machine‑readable PDFs with consistent column headers to reduce manual review and data entry errors by underwriters.

Confirm signer authority in advance

Attach corporate authorization or power of attorney documents if the signer is not the named corporate officer to prevent re-execution requests.

Document material changes clearly

If exposures or operations changed during the loss run period, add a cover memo explaining the change and its effective date to maintain transparency.

Opt for secure eSubmission

Use an electronic platform that preserves an audit trail and supports stronger signer authentication when submitting applications that include sensitive personal health information.

Typical timelines and processing expectations

Timelines vary by carrier and complexity; plan submissions with adequate lead time for underwriting and binding decisions.

Initial response:

Carrier acknowledges receipt within 2–5 business days

Underwriting review:

Standard review may take 7–21 business days

Clarification requests:

Expect supplemental information requests within 10 business days

Conditional quotes:

Preliminary pricing typically issued within 2–4 weeks

Policy issuance:

Binding and policy documents issued after final approval

eSignature vendor comparison for submitting applications

Key plan and feature differences among common eSignature vendors. signNow is listed first per platform comparison 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	Varies	Varies	Varies
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 application use

These excerpts show how organizations use electronic submission and thorough documentation to streamline excess placements.

Tech Data

Tech Data centralized submissions through a single portal for excess placements, reducing duplicate requests.

Broker coordination enabled consistent loss history formatting.
The approach improved internal response times and simplified carrier reconciliation during audits and renewals.

Fertility Centers of Illinois

The organization standardized its loss run attachments for excess inquiries, ensuring data completeness on first submission.

Clear signatory authority avoided re-execution.
Standardization reduced underwriter follow-up and shortened the timeline to bind renewal layer coverage.

FAQs and troubleshooting for common application problems

Answers to frequent questions about completing, signing, and submitting the Insurance Excess Loss Application.

Need help? Contact support

Can the application be signed electronically?
Yes. Electronic signatures are legally valid under federal ESIGN and state e‑signature laws where permitted. Ensure the carrier accepts e‑signatures and that any required consumer disclosures or higher authentication are completed before submission.
What supporting documents are required?
Typical attachments include declarations pages for underlying policies, three to five years of loss runs with reserves, audited financial statements if requested, and any corporate authorization for the signer.
Who must sign the application?
An authorized company officer or appointed broker can sign. Provide proof of authority when a signer is not a named corporate officer to prevent re-execution delays.
What if I discover an error after submission?
Notify the underwriter immediately, submit a corrected application or endorsement, and document the correction. Material misstatements may affect coverage and should be addressed promptly.
Do carriers require notarization?
Most routine applications do not require notarization, but some carriers or jurisdictions may require notarized signatures or RON for specific attestations. Confirm carrier requirements before notarizing.
How long before I receive a quote?
Preliminary quotes vary by complexity. Expect initial pricing indications in one to four weeks; complex placements or facultative reinsurance may take longer.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now