FoxPro Defender Abstractors & Title Searchers Application

7. LIMIT / DEDUCTIBLE OPTIONS

8. CURRENT / PRIOR INSURANCE

9. CLAIMS EXPERIENCE

10. ASSOCIATIONS

SIGNATURES

1. GENERAL INFORMATION

2. SUBSIDIARIES, ACQUISITIONS, MERGERS, OR CONSOLIDATIONS

3. ABSTRACT SEARCH REQUESTS

4. CORPORATE GOVERNANCE

5. SUBCONTRACTORS

6. FINANCIAL AND BUSINESS INFORMATION

PRODUCER SUBMITTING ON BEHALF OF THE INSURED

1. GENERAL INFORMATION
a. Applicant/Company Name*
As it should appear on the policy; name should match current policy information, unless endorsed otherwise
D/B/A Name:
If applicable
Address*

Street Address

Street Address Line 2

CityState

Zip Code
c. Contact Person & Title*
Email Address*
example@example.com
Website Address
Telephone Number*
Fax Number
d. Nature of Business*
Year Established*
e. Are any of the principals involved in any other business/activity other than what is shown in 1d?*

YesNo
If "Yes" please explain below:*

f. Please complete the chart below*

Rows	Owner/Officer Name	Title	Years of Experience	Active in this operation	Not active in this operation
a.
b.
c.

g. Are employees with fewer than 3 years experience supervised by senior staff/officers?*

YesNo
2. SUBSIDIARIES, ACQUISITIONS, MERGERS, OR CONSOLIDATIONS
a. Is the applicant affiliated with any organization through common ownership, operation or control?*

YesNo
b. During the past five years has the Applicant been engaged in any business or professional services other than the "Nature of Business" described in Question 1d above?*

YesNo
If "Yes" please explain below:*
3. ABSTRACT SEARCH REQUESTS
a. Does applicant use contracts / written agreements with their clients?*

YesNo
b. How does applicant receive a request for a title search?*

c. Does the applicant:*

Rows	Yes	No
i) Keep / maintain a record of each title search request ?
ii) Reply to search request with confirmation of receipt and I or acceptance ?

d. Does applicant receive written confirmation from their client if the standard number of years required for a full title search is less than 40 years ?*

YesNo
If "No" please provide full explanation:*
e. Does applicant have procedures in place to keep record of their titles searches (i.e.; screen shot of search terms and search results)?*

YesNo
f. Does the applicant use limitation of liability clauses?*

YesNo
If "No" is applicant willing to use limitation of liability clauses moving forward to stay current with best practices?*

YesNo

Rows	Yes	No
g. Does the applicant stay current on legislative / statutory changes in the jurisdiction they perform searches?
h. Does the applicant perform post-closing title search to ensure that all filings have been officially recorded and appear in public record?
i. If applicant relies on online searches, does the applicant perform manual searches at the county to confirm in state and out of state search results (if applicable)?
j. Does the insured determine “insurability of title”?

k. Does applicant provide title opinions for closings when title insurance is not the end product?*

YesNo
If "Yes" please provide full explanation:*
l. Has a title company ever cancelled or nonrenewed their agency contract with you?*

YesNo
If "Yes" please explain:*
m. If Applicant provides public notary services - do they always require signer(s) to be present?*

YesNoN/A
4. CORPORATE GOVERNANCE
a. Does the Applicant have a process in place to handle and resolve client complaints?*

YesNo
5. SUBCONTRACTORS
a. Does the Applicant use subcontractors?*

YesNo

b. Please indicate percentage of work performed by independent contractors below. Any work performed by independent contractors must also be reflected in Revenue in Question 6a.*

Rows	%
Abstracting/Searching
Notary Public
Other

c. Does the Applicant require its subcontractors to maintain professional liability insurance?*

YesNoN/A
d. Please indicate percentage of work performed by employees or independent contractors located outside the US:*
6. FINANCIAL AND BUSINESS INFORMATION
a. Provide Applicants Gross Annual Revenue breakdown below:
(If no revenue in the last 12 months, provide estimate for next 12 months)
Previous 12 months*
Projected Next 12 months*

b. Provide a Revenue Breakdown (by percent/by service) below for amount shown in 6a above (Must equal 1OO%):*

Rows	%
Abstracting/Searching Commissions/Fees
Notary/Witness Closing Commission/Fees
Other

Specify 'Other'*
Total*
Do not proceed until the total is 100%

c. Provide a Revenue Breakdown (by percent) below for projected next 12 months shown in 6a above (Must equal 1OO%):*

Rows	%
Residential
Commercial/Industrial
Agricultural
Oil/Gas/Precious Metals or Minerals
Other

Specify 'Other'*
Total*
Do not proceed until the total is 100%
d. Do you anticipate any material changes to the nature of the Applicant’s business in the next 12 months?*

YesNo
If "Yes" please explain:*
The total in questions 6b and 6c must each equal 100% before you can proceed.

Company
(Full Name)

Limits of Liability
(Per Claim/Aggregate)

Deductible

Policy Period

Retro Date
(MM/DD/YYYY)