Title Insurance Application

TITLE INSURANCE APPLICATION

Applicant / Insured Information

Date of Birth:

Individual   Corporation   LLC   Trust   Partnership   Other:

Policy & Transaction Details

Owner's Policy   Lender's Policy   ALTA Loan Policy   Simultaneous Issue

Policy Effective Date:    Policy Expiration Date (if applicable):

Proposed Closing / Settlement Date:

Coverage Options & Endorsements

Coverage requested (check all that apply):
Standard coverage against recorded liens and encumbrances
Recorded easements and rights-of-way
Restrictive covenants and conditions
Unrecorded easements (specify details below)
Zoning and land use limitations (limited coverage)
Survey coverage requested (if checked attach survey)

ALTA 9 (Restrictions, Encroachments, Minerals)    ALTA 3 (Zoning)    Subdivision Endorsement    Tax Parcel ID Endorsement

Exclusions & Acknowledgements

The policy issued will be subject to standard printed exclusions and exceptions, including but not limited to: matters not of record, rights of parties in possession unless specifically insured, taxes or assessments not yet due and payable, unrecorded easements or encroachments, and matters created, suffered or agreed to by the insured. Endorsements may be required to provide coverage for certain matters.

Applicant acknowledges receipt of and consents to processing under the standard exclusions and understands that this application does not alter exclusions unless expressly endorsed.

Beneficiary / Mortgagee Information

Documentation Checklist

Please indicate which documents will be provided with this application:
Current Deed / Conveyance    Preliminary Title Report    Mortgage / Deed of Trust    ALTA/Boundary Survey    Closing Statement / HUD-1    Tax Certificates / Paid Receipts

Declarations, Authorizations & Indemnity

The undersigned applicant certifies that the information contained in this application is true and complete to the best of applicant's knowledge. Applicant authorizes the title company and its agents to obtain public records and other information, to order payoff demands and tax information, and to take such actions as necessary to issue the requested policy and endorsements.

Applicant agrees to notify the title company promptly of any changes to the facts contained herein. Applicant agrees to indemnify and hold the title company harmless from any loss, liability, cost or expense resulting from any false statement, omission or failure to disclose information material to the issuance of the title policy.

Applicant expressly authorizes the title company, its agents and representatives to disclose information contained in this application to persons and entities reasonably necessary to obtain documents and to complete the title examination, issuance of the policy, endorsements, and closing. This authorization remains in effect until the title company has completed issuance of the policy.

Additional Information

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