EXPRESS APPLICATION FOR FLORIDA  Logo
  • EXPRESS APPLICATION FOR FLORIDA

    EXPRESS APPLICATION FOR FLORIDA

    Real Estate Professional Errors and Omissions Insurance

  • IMPORTANT! To be eligible for the Express Application, you must be able to answer "True" to Eligibility Statements 1-9 below. If you are not eligible for this program, please use the Standard Application.

  •  / /
  •  / /
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancelof

  • TRUE/FALSE ELIGIBILITY STATEMENTS (1-9)

    To be eligible for the Express Application, you must be able to answer "True" to Eligibility Statements 1-9 below. If you are not eligible for this program, please use the Standard Application.

  • IMPORTANT!

    Do not continue this application. DO NOT PAY on the next screen.

    If you answered "False" to any of the True/False Eligibility Statements 1 through 9 on the previous page, then you are NOT eligible for the Express Program and you must apply using the Standard Application.

  • SELECT YOUR DESIRED ANNUAL PREMIUM OPTION

    AND REMIT PAYMENT WITH YOUR APPLICATION

  • Florida Taxes and Surcharges

    Premium includes FLORIDA FIGA ASSESSMENT Surcharges. Please see notes below regarding FL state taxes or surcharges required.

  • Claim Expenses are Outside the Limits of Liability

    Deductible Loss & Expense.

  • FLORIDA STATE TAXES AND SURCHAGES

    *** PREMIUM INCLUDES FLORIDA FIGA ASSESSMENT SURCHARGE OF 1%***

  • Florida Residents:

    Companies writing property and casualty insurance business in the State of Florida are required to collect a Florida Hurricane Catastrophe surcharge. This is total premium and surcharge due is included in your total.

  • DISCLAIMER:

    COMPLETION OF THIS FORM DOES NOT BIND COVERAGE. THE APPLICANT AND FIRM ACCEPTS NOTICE THAT ANY POLICY ISSUED WILL APPLY ON A “CLAIMS-MADE” BASIS. THE APPLICANT AND FIRM ACCEPTS NOTICE THAT THEY ARE REQUIRED TO PROVIDE WRITTEN NOTIFICATION TO THE COMPANY OF ANY CHANGES TO THIS APPLICATION THAT MAY HAPPEN BETWEEN THE SIGNATURE DATE BELOW AND ANY PROPOSED EFFECTIVE DATE. THE APPLICATION MUST BE SIGNED BY AN ACTIVE OWNER, PARTNER, PRINCIPAL, OFFICER, OR MEMBER OF THE APPLICANT.

     

    The undersigned is authorized by, and acting on behalf of, the Applicant and represents that all statements and particulars herein are true, complete and accurate to the best of their knowledge and that there has been no suppression or misstatements of fact and agrees that this application shall be the basis of, and becomes part of, the Applicant’s professional liability coverage.

  • Clear
  •  / /

  • Your application will not be submitted until you click the green button below.

    REMEMBER YOUR TOTAL!

  • ATTENTION! 

    • Payment and completion of this form does NOT bind coverage. Coverage is not bound until the application is reviewed and accepted by underwriting.
    • Please note: ACH/Credit Card fees are charged by the payment processor and fully earned.
    • IF YOU DID NOT ANSWER "TRUE" TO ALL ELIGIBILITY STATEMENTS 1-9, DO NOT PAY ON THE NEXT PAGE!

    Insurance Agent/Producer Name: RealCare Insurance Marketing, Inc., License #: L088539

  • Heading

  •  
  • Should be Empty: