PST (Personal Auto)

PST (Personal Auto)

Policy Service Transaction (RT)
Today's Date*

MonthDayYear
Date
Today's Time*

:HourMinutesAM/PM Option
Completed by:*
Requested by:
Requested by:*
Requested by:
Name of Person:
First and Last Name
Contact Phone:
Contact Email:
Name of Insured:*
First and Last Name
Policy Number:
Only ask the client if you can't locate by name
Effective Date of Transaction:*

MonthDayYear
Date
Choose the Type of Change on the Policy:

Contact Info (Phone, Email Only)Mailing/Garaging AddressDrivers/Excluded Drivers (DRV)Vehicle ChangesCoverage Change (Policy Limits Only)
Choose the Type of Policy Transaction:

AMV (Annual Mileage Verification)BPI (Billing-Payment Issue)Cancellation RequestCanc. Und. (Underwriting Cancellation)Claims HandlingEzlynx Policy EntryFPR (Full Policy Review)PHD (Possible Household Drivers)R-Mail (Return Mail Only)TLV (Total Loss Vehicle)Request for DocumentsAll Other
Update Contact Info

(Phone, Email Only)

A13
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered from Download
Update Info for:*

1st Named Insured2nd Named Insured
Phone Type

HomeWorkMobileOther
Phone Number

Area CodePhone Number
E-mail
Update Info for:

1st Named Insured2nd Named Insured
Phone Type

HomeWorkMobileOther
Phone Number

Area CodePhone Number
Email
A-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

A25
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Changes to Mailing/Garaging Address

A29
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered from Download
New Address*

Street Address

Street Address Line 2

CityState

Zip Code
This is the New Mailing Address OnlyThis is the New Mailing & Garaging Address
Garaging Address (if different then Mailing)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does this garaging address apply to all Vehicle on the policy?*

YesNo
Identify which Vehicle does not apply:*
Vehicle Year- Make - Model
Garaging Address for this Vehicle*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
B-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Note: The client can only have 1 Mailing address. (We must change all personal lines policies to this new mailing address)

(You must complete a seperate Amendment for each Policy)

A39
Completed Additional Amendment form for Other Policies*

YesN/a - no other policies
Amendment Guide (Page 0)

A41
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Changes to

(Drivers/Excluded Drivers)

A45
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered from Download
Driver Change (mark all that Apply)*

Add a DriverRemove DriverUpdate Info (Existing Driver)
Name (Additional Driver 1)*
First & Last Name as Listed on Driver License
Date of Birth*

MonthDayYear
Date
Relationship to First Named Insured:*

SelfSpouse/Registered Domestic PartnerSon/DaughterBrother/SisterParentFiance (engaged)Boyfriend/GirlfriendOther Relative
Driver License Number *
License State*
Employment Status*

EmployedStudentRetiredDisabledHomemaker
Group Discount*

Engineering DegreeScience DegreeEducator's DegreeCa. Licensed PhysiciansRegistered NurseVeterinarianPharmacistDentistAccountantFirefighterParamedicPilotPolice OfficerBusiness OwnerCollege Alumni /Any 4 yr DegreeNone / Not Applicable
Verify Group Discount

A56
Name of School/College*
Occupation/ Job Title*
Self-Employed?*
Nature of work/business*
If Self-Employed, describe the exact type of Work/Business the client performs.
Name of Employer*
Work Location*

Works from HomeSeperate LocationNot Set-Mutiple Locations
Address of Business/Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address of School/College*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Good Student (Discount)*
Must have 3.0 or better GPA with 12 Units or More
Notes:
C-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
License Status*
How to Run MVR (Page 15)

A71
Does Driver have a Suspension in last 3 years :*
Idenitify (Page 26)

A73
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A74
Does this Driver have a DUI in the last 10 years:*
Idenitify (Page 25-26)

A76
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A77
Full Driving Experience licensed from Age 16:*
Idenitify (Page 25-26)

A79
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A80
Driving Experience from Actual Date Licensed:*
Idenitify (Page 25-26)

A82
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A83
Number of Minor Violations (1 point for each):*
(Only within the Last 3 Years)
Idenitify (Page 22,25,26)

A85
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A86
Number of Major Violations (2 point for each):*
(Only within the Last 3 Years)
Idenitify (Page 22,25,26)

A88
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A89
# of Non-Fault Accidents (0 points for each):*
(within the Last 3 Years)
Idenitify (Page 22-26)

A91
# of At-Fault Acc. PD Only (1 point for each):*
(Only within the Last 3 Years)
Idenitify (Page 22-26)

A93
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A94
# of At-Fault Acc. with BI (2 point for each):*
(Only within the Last 3 Years)
Idenitify (Page 22-26)

A96
* Driver is not a Ca. Good Driver but

may still disqualify with Nationwide.

A97
Are we adding a Spouse/Registered Domestic Partner*
Note: Spouse or Registered Domestic Partner

can be added as a 2nd Named Insured.

A99
Driver Qualification: Technically Nationwide will accept a driver with a total of 3 dmv points in last 3 years. However, even if a driver has no points but has activity like suspension or non-fault accidents or many comprehensive claims then we will take it all into consideration for placing with Nationwwide which is why a manager approval is required prior to binding. (4 points or more automatically disqualified). Do no confuse with Carrier points, must be DMV points only.

B1
Amendment Guide (Page 0)

B2
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Remove a Driver:

B7
Name (Remove Driver)*
First & Last Name
Household Status*

Still Lives in Household (Must Exclude)No Longer in Household
Note: All persons living in the house must be added or excluded (cannot be simply be removed from Policy).

B10
Driver Exclusion Rules

B11
Driver Exclusion Process

B12
D-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

B14
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Update Existing Driver Information:

B18
Update Driver Info (Mark all that Apply)*

NameDate of BirthMarital StatusEmployment StatusDriver License #Add Group/Occupation Discount
Date of Birth*

MonthDayYear
Date
Enter the First & Last Name*
Enter as it appears on the Driver License
Driver License Number *
License State*
Marital Status*

SingleMarried/Registred Domestic Partner)WidowedDivorced
Is the Spouse/Registered Dom. Partner already listed as a driver on Policy.*

YesNo
Note: A Spouse/Registred Domestic Partner must be added or excluded regardless if they have their own insurance policy.

B26
Driver Exclusion Rules

B27
Driver Exclusion Process

B28
Verify Group Discount

B29
Employment Status*

EmployedStudentRetiredDisabledHomemaker
Occupation/ Job Title*
Self-Employed?*
Name of Employer*
Nature of work/business*
If Self-Employed, describe the exact type of Work/Business the client performs.
Work Location*

Works from HomeSeperate LocationNot Set-Mutiple Locations
Name of School/College*
Address of Business/Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address of School/College*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Good Student (Discount)*
Must have 3.0 or better GPA with 12 Units or More
Notes:
What group/occupation discount does the client qualifiy for: *

Engineering DegreeScience DegreeEducator's DegreeCa. Licensed PhysiciansRegistered NurseVeterinarianPharmacistDentistAccountantFirefighterParamedicPilotPolice OfficerBusiness OwnerCollege Alumni /Any 4 yr DegreeNone / Not Applicable
Verify Group Discount

B42
Upload Proof*

Upload File
Drag & Drop or Browse for File Cancelof
E-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

B47
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Do you want to make another driver change?*

YesNo
Driver Change (mark all that Apply)*

Add a DriverRemove DriverUpdate Info (Existing Driver)
Name (Additional Driver 2)*
First & Last Name as Listed on Driver License
Date of Birth*

MonthDayYear
Date
Relationship to First Named Insured:*

SelfSpouse/Registered Domestic PartnerSon/DaughterBrother/SisterParentFiance (engaged)Boyfriend/GirlfriendOther Relative
Driver License Number *
License State*
Employment Status*

EmployedStudentRetiredDisabledHomemaker
Group Discount*

Engineering DegreeScience DegreeEducator's DegreeCa. Licensed PhysiciansRegistered NurseVeterinarianPharmacistDentistAccountantFirefighterParamedicPilotPolice OfficerBusiness OwnerCollege Alumni /Any 4 yr DegreeNone / Not Applicable
Verify Group Discount

B61
Occupation/ Job Title*
Self-Employed?*
Work Location*

Works from HomeSeparate LocationNot Set-Multiple Locations
Name of Employer*
Nature of work/business*
If Self-Employed, describe the exact type of Work/Business the client performs.
Name of School/College*
Address of Business/Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address of School/College*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Good Student (Discount)*
Must have 3.0 or better GPA with 12 Units or More
F-Processing: *

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
License Status*
How to Run MVR (Page 15)

B74
Does Driver have a Suspension in last 3 years :*
Identify (Page 26)

B76
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B77
Does this Driver have a DUI in the last 10 years:*
Identify (Page 25-26)

B79
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B80
Full Driving Experience licensed from Age 16:*
Identify (Page 25-26)

B81
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B82
Driving Experience from Actual Date Licensed:*
Identify (Page 25-26)

B84
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B85
Number of Minor Violations (1 point for each):*
Identify (Page 22-25-26)

B87
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B88
Number of Major Violations (2 point for each):*
Identify (Page 25-26)

B90
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B91
# of Non-Fault Accidents (0 points for each):*
Idenitify (Page 22-26)

B93
# of At-Fault Acc. PD Only (1 point for each):*
Identify (Page 22-26)

B95
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B96
# of At-Fault Acc. with BI (2 point for each):*
Identify (Page 22-26)

B98
* Driver is not a Ca. Good Driver but
may still disqualify with Nationwide.

B99
Are we adding a Spouse/Registered Domestic Partner*
Note: Spouse or Registered Domestic Partner

can be added as a 2nd Named Insured.

C2
Amendment Guide (Page 0)

C3
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes
Remove a Driver:

C8
Name (Remove Driver)*
First & Last Name
Household Status*

Still Lives in HouseholdNo Longer in Household
Note: All persons living in the house must be added or excluded (cannot be simply be removed from Policy).

C11
Driver Exclusion Rules

C12
Driver Exclusion Process

C13
G-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

C16
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Update Existing Driver Information:

C21
Update Driver Info (Mark all that Apply)*

NameDate of BirthMarital StatusEmployment StatusDriver License #
Date of Birth*

MonthDayYear
Date
Enter the First & Last Name*
Enter as it appears on the Driver License
Driver License Number *
License State*
Marital Status*

SingleMarried/Registered Domestic Partner)WidowedDivorced
Is the Spouse/Registered Dom. Partner already listed as a driver on Policy.*

YesNo
Note: A Spouse/Registred Domestic Partner must be added or excluded regardless if they have their own insurance policy.

C29
Driver Exclusion Rules

C30
Driver Exclusion Process

C31
Employment Status*

EmployedStudentRetiredDisabledHomemaker
Verify Group Discount

C33
Occupation/ Job Title*
Self-Employed?*
Name of Employer*
Nature of work/business*
If Self-Employed, describe the exact type of Work/Business the client performs.
Work Location*

Works from HomeSeparate LocationNot Set-Multiple Locations
Name of School/College*
Address of Business/Employer*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Address of School/College*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Good Student (Discount)*
Must have 3.0 or better GPA with 12 Units or More
Notes:
H-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

C46
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Changes to Vehicles:

C51
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered from Download
Type of Vehicle Change 1*

Add a VehicleRemove VehicleChange Coverage on Existing VehicleAdd/Update Lienholder on Existing Vehicle
1- Add Vehicle-Enter VIN*
(Vehicle Identification Number - 17 digits)
VIN Verification

C55
VIN Verified Successfully?*

YesNo
Purchased Date*

MonthDayYear
Date
Year of Vehicle*
Vehicle Make*
Vehicle Model*
Who is Registered Owner*

Named Insured/SpouseDriver on PolicyOther
Driver Name*
Name of Driver who owns it.
Other Person/Company*
Name of other Driver/Company
Odometer:*
Current odometer on dashboard
Intended Use of Vehicle*

Pleasure OnlyCommute UseRide Share/TNC (Uber,Lyft,etc)Business / Commercial Use
Describe the Exact Nature of Business*
Title of Vehicle*

Clean TitleSalvage Title
Salvage Title

C68
Any Existing Damage *

YesNo
Describe the Damage in Full:*
Coverage for the Additional Vehicle:

C71
To quote Different Limits of Policy Coverage, then go to

the top and select "(Coverage Change - Policy Limits)"

C72
Liability (Bodily Injury)

C73
Liability Limits are per policy and not per vehicle. The current limit on the Policy will be given.

C74
Liability (Property Damage)

C75
Liability Limits are per policy and not per vehicle. The current limit on the Policy will be given.

C76
Uninsured Motorist (Bodily Injury)

C77
UM Limits are per policy and not per vehicle. The current limit on the Policy will be given.

C78
Medical Payments

C79
Medical Pay coverage is per policy and not per vehicle. The current limit on the Policy will Apply.

C80
Roadside Assistance

C81
Roadside assistance is per policy and not per vehicle. The current limit on the Policy will Apply.

C82
Physical Damage Coverage (Full Coverage)

C83
Quote Physical Damage (Full Coverage)*

YesNo
Comprehensive Coverage

C85
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded$1,500 ded$2,000 ded
Collision Coverage

C87
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded$1,500 ded$2,000 ded
Car Rental Coverage

(Not offered

without Collision)

C89
Quote Car Rental (for 30 days)*

Decline/Delete$30 Day$40 Day$50 Day$60 day
Gap Coverage

(Not offered

without Collision)

C91
Quote Gap*

YesNo/Delete
Add Additional Interest *

None (Owned)Loss Payee (Purchased/Making Payments)Loss Payee & Additional Insured (Leased)
Additional Interest Info*

Name of Company

Street/Po Box

CityState / Province

Postal / Zip Code
I-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval *

MoJackAlex
Acceptable/Unacceptable Vehicles

(Identify Above)

C98
Verified Eligibility*

Vehicle is AcceptableNot AcceptableExisting Pol Vehicle
Reason Not Acceptable
Registration/Ownership Acceptability

(Must be Named Insured or Spouse)

D2
Verified Eligibility*

Vehicle is AcceptableNot AcceptableExisting Pol Vehicle
Reason Not Acceptable
Intended Use of Vehicle Acceptability

D5
Verified Eligibility*

Vehicle is AcceptableNot AcceptableExisting Pol Vehicle
Reason Not Acceptable
Title Acceptability

(Salvage Title Verification)

D8
Title Verified*

Clean TitleSalvage Title-Acceptable (Liability Only)Salvage Title-Acceptable for Physical DamageSalvage Title-Not Acceptable at AllExisting Pol Vehicle (already Accepted)
Amendment Guide (Page 0)

D10
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Remove a Vehicle:

D15
Vehicle Year*
Enter Year
Make*
Last 4 of VIN*
Title Verified*

Sold/Traded InMilitaryRepossessedWreckedSpin-Off/TransferOther
J-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

D23
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Change Coverage on Existing Vehicle:

D28
Vehicle Yr/Make*
Last 4 of Vin*
Comprehensive Coverage

D31
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded
Collision Coverage

D33
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded
Car Rental Coverage

(Not offered

without Collision)

D35
Quote Car Rental (for 30 days)*

Declined/Delete$30 Day$40 Day$50 Day$60 day
Gap Coverage

(Not offered

without Collision)

D37
Quote Gap*

YesNo/Delete
K-Processing*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

D42
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By *

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
A-Add/Update Lienholder on Existing Vehicle:

D47
Vehicle Yr/Make*
Last 4 of Vin*
Add Additional Interest*

Loss Payee (Purchased/Making Payments)Loss Payee & Additional Insured (Leased)
Additional Interest Info*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Note: If a vehicle is not paid off, then the client is making payments to buy it and that means the finance company that he is making payments to requires that they be listed as a lienholder on the policy so they can make sure he is always insurance the car for comprensive and collision coverage.

For car are not purchased but rather leased, then the company he makes payments to wants to be listed as a lienholder and additional insured since they are still the legal owner want to be protected by the policy and also want the vehicle coverage for any damages.

D52
L-Processing*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
How to add an additional interest

D55
Note: When you add the additonal interest then the carrier will automatically

send the copy of the policy. However if we cannot wait and need to do one

right away then we can complete a Binder (How to complete a Binder)

D56
Amendment Guide (Page 0)

D57
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Another Vehicle Change?*

YesNo
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered from Download
Type of Vehicle Change 2*

Add a VehicleRemove VehicleChange Coverage on Existing VehicleAdd/Update Lienholder on Existing Vehicle
2- Add Vehicle-Enter VIN*
(Vehicle Identification Number - 17 digits)
VIN Verification

D64
VIN Verified Successfully?*

YesNo
Purchased Date*

MonthDayYear
Date
Year of Vehicle*
Vehicle Make*
Vehicle Model*
Who is Registered Owner*

Named Insured/SpouseDriver on PolicyOther
Driver Name*
Name of Driver who owns it.
Other Person/Company*
Name of other Driver/Company
Odometer:*
Current odometer on dashboard
Intended Use of Vehicle*

Pleasure OnlyCommute UseRide Share/TNC (Uber,Lyft,etc)Business / Commercial Use
Describe the Exact Nature of Business*
Title of Vehicle*

Clean TitleSalvage Title
Salvage Title

D77
Any Existing Damage*

YesNo
Describe the Damage in Full:*
Coverage for the Additional Vehicle:

D80
To quote Different Limits of Policy Coverage, then go to

the top and select "(Coverage Change - Policy Limits)"

D81
Liability (Bodily Injury)

D82
Liability Limits are per policy and not per vehicle. The current limit on the Policy will be given.

D83
Liability (Property Damage)

D84
Liability Limits are per policy and not per vehicle. The current limit on the Policy will be given.

D85
Uninsured Motorist (Bodily Injury)

D86
UM Limits are per policy and not per vehicle. The current limit on the Policy will be given.

D87
Medical Payments

D88
Medical Pay coverage is per policy and not per vehicle. The current limit on the Policy will Apply.

D89
Roadside Assistance

D90
Roadside assistance is per policy and not per vehicle. The current limit on the Policy will Apply.

D91
Physical Damage Coverage (Full Coverage)

D92
Quote Physical Damage (Full Coverage)*

YesNo
Comprehensive Coverage

D94
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded
Collision Coverage

D96
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded
Car Rental Coverage

(Not offered

without Collision)

D98
Quote Car Rental (for 30 days) *

Declined/Delete$30 Day$40 Day$50 Day$60 day
Gap Coverage

(Not offered

without Collision)

E1
Quote Gap*

YesNo/Delete
Add Additional Interest*

None (Owned)Does not have Now/Will Add LaterLoss Payee (Purchased/Making Payments)Loss Payee & Additional Insured (Leased)
Additional Interest Info*

Name of Company

Street/Po Box

CityState / Province

Postal / Zip Code
M-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Acceptable/Unacceptable Vehicles

(Identify Above)

E8
Verified Eligibility*

Vehicle is AcceptableNot AcceptableExisting Pol Vehicle
Reason Not Acceptable*
Registration/Ownership Acceptability

(Must be Named Insured or Spouse)

E11
Verified Eligibility*

Vehicle is AcceptableNot AcceptableExisting Pol Vehicle
Reason Not Acceptable*
Intended Use of Vehicle Acceptability

E14
Verified Eligibility*

AcceptableNot AcceptableExisting Pol Vehicle
Reason Not Acceptable*
Title Acceptability

(Salvage Title Verification)

E17
Title Verified *

Clean TitleSalvage Title-Acceptable (Liability Only)Salvage Title-Acceptable for Physical DamageSalvage Title-Not Acceptable at AllExisting Pol Vehicle (already Accepted)
Amendment Guide (Page 0)

E19
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Remove a Vehicle:

E24
Vehicle Year*
Enter Year
Make*
Last 4 of VIN*
Title Verified*

Sold/Traded InMilitaryRepossessedWreckedSpin-Off/TransferOther
N-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

E32
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Change Coverage on Existing Vehicle:

E37
Vehicle Yr/Make*
Last 4 of Vin*
Comprehensive Coverage

E40
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded
Collision Coverage

E42
Quote Deductible*

Decline/Delete$250 ded$500 ded$1000 ded
Car Rental Coverage

(Not offered

without Collision)

E44
Quote Car Rental (for 30 days) *

Declined/Delete$30 Day$40 Day$50 Day$60 day
Gap Coverage

(Not offered

without Collision)

E46
Quote Gap*

YesNo/Delete
O-Processing: *

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

E51
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
B-Add/Update Lienholder on Existing Vehicle:

E56
Vehicle Yr/Make*
Last 4 of Vin*
Add Additional Interest*

Loss Payee (Purchased/Making Payments)Loss Payee & Additional Insured (Leased)
Additional Interest Info*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Note: If a vehicle is not paid off, then the client is making payments to buy it and that means the finance company that he is making payments to requires that they be listed as a lienholder on the policy so they can make sure he is always insurance the car for comprensive and collision coverage.

For car are not purchased but rather leased, then the company he makes payments to wants to be listed as a lienholder and additional insured since they are still the legal owner want to be protected by the policy and also want the vehicle coverage for any damages.

E61
P-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
How to add an additional interest

E64
Note: When you add the additonal interest then the carrier will automatically

send the copy of the policy. However if we cannot wait and need to do one

right away then we can complete a Binder (How to complete a Binder)

E65
Amendment Guide (Page 0)

E66
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Changes to Policy Coverage

(Policy Limits Only)

E68
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered from Download
Nationwide offered the following policy limits per policy and not per vehicle.

E70
Liability (Bodily Injury)

E71
Quote BI Limits*

No Change/Leave As Is$25,000 per person / $50,000 per per accident$50,000 per person / $100,000 per per accident$100,000 per person / $300,000 per per accident$250,000 per person / $500,000 per per accident (Min for Umbrella)$500,000 per person / $500,000 per per accident
Liability

(Property Damage)

E73
Quote PD Limits*

No Change/Leave As Is$25,000 per person$50,000 per person$100,000 per person$250,000 per person$500,000 per person
Uninsured Motorist

(Bodily Injury)

E75
Quote UMBI Limits*

No Change/Leave As Is$25,000 per person / $50,000 per per accident$50,000 per person / $100,000 per per accident$100,000 per person / $300,000 per per accident$250,000 per person / $500,000 per per accident (Min for Umbrella)$500,000 per person / $500,000 per per accident
Uninsured Motorist

Property Damage

E77
Quote UMPD Limits*

No Change/Leave As Is$3500 or CDW (Full Value of Car with Collision Coverage)
Medical Payments

E79
Quote Medical*

No Change/Leave As Is$1,000$2000$5,000$10,000$25,000 per accident$50,000 per accident$100,000 per accident$250,000 per accident
Roadside Assistance

E81
Quote Roadside*

No Change/Leave As IsWith RoadsideWithout Roadside
Q-Processing:*

Taking RequestProcess Now
Does amendment/pst require the client to see quote:*

Yes-client must see/approve quote firstNo-ok to process now
Quote Release Approval*

MoJackAlex
Amendment Guide (Page 0)

E86
Is the Amendment/PST ready for Approval*

YesNot Yet
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
AMV

(Annual Mileage)

E91
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered RT Cntr/Download
AMV Status as of Today*

Preemptive (Avoidance)Coming Renewal (Increase Scheduled)Already Renewed & Increased
Note: Its important to understand what options we have with nationwide when it comes to annual mileage calculations.

Option 1-No smart ride at all. We are required to get 2 points of data such photos of odometer reading, service record, Smog Check docs, etc to either prevent or avoid any increase otherwise all vehicles will be increased to 12,000 miles at renewal. We have to do this every year & client is not excluded from QPC.

Option 2-Smart Ride Self Reporting. We are required to get 2 points of data such photos of odometer reading, service record, Smog Check docs, etc to either prevent or avoid any increase otherwise all vehicles will be increased to 12,000 miles at renewal. The policy does get 5% discount but we have to do this every year & client is excluded from QPC.

Option 3-Smart Ride Device. Device will record mileage for 90 days and then the annual mileage will be calculated and used for rating purposes. We only have to do this once since its for the life of the car. The policy does get 5% discount but we have to do this every year & client is excluded from QPC.

E94
Indicate below what methed we are pursuing to address the AMV.

E95
What Method are we presenting/client agreed to:*

Standard (No Smart)Already on Smart Ride-Self ReportSigning up for Smart Ride-Self ReportAlready on Smart Ride-DeviceSigning up for Ride-Device(No Smart-Device)
Calculate the impact to mileage and premium for vehicle 1:*

YesNo
A-Year of Vehicle*
Enter the Year of the Vehicle
Make/Model*
Enter the make and model of vehicle
Date of the First Odometer Reading*

MonthDayYear
Date
First Odometer Reading*
Enter the Mileage
Date of the 2nd Odometer Reading*

MonthDayYear
Date
Amendment Guide (Page 0)

F3
2nd Odometer Reading*
Enter the Mileage
Difference In Days*
Difference in Odometer*
Average Miles (per day)

F7
Calculation*
Annual Miles Calculated

F9
Current Annual Miles

Listed on the Policy

F11
Optional
Difference in Miles

F13
First Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
2nd Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
B-AMV on Another Vehicle*

YesNo
What Method are we presenting/client agreed to:*

Standard (No Smart)Already on Smart Ride-Self ReportSigning up for Smart Ride-Self ReportAlready on Smart Ride-DeviceSigning up for Ride-Device(No Smart-Device)
Calculate the impact to mileage and premium for vehicle 1:*

YesNo
Year of Vehicle*
Enter the Year of the Vehicle
Make/Model*
Enter the make and model of vehicle
Date of the First Odometer Reading*

MonthDayYear
Date
First Odometer Reading*
Enter the Mileage
Date of the 2nd Odometer Reading*

MonthDayYear
Date
2nd Odometer Reading*
Enter the Mileage
Difference In Days*
Difference in Odometer*
Average Miles (per day)

F29
Annual Miles Calculated

F31
Current Annual Miles

Listed on the Policy

F33
Optional
Difference in Miles

F35
First Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
2nd Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
C-AMV on Another Vehicle*

YesNo
What Method are we presenting/client agreed to:*

Standard (No Smart)Already on Smart Ride-Self ReportSigning up for Smart Ride-Self ReportAlready on Smart Ride-DeviceSigning up for Ride-Device(No Smart-Device)
Calculate the impact to mileage and premium for vehicle 1:*

YesNo
Year of Vehicle*
Enter the Year of the Vehicle
Make/Model*
Enter the make and model of vehicle
Date of the First Odometer Reading*

MonthDayYear
Date
First Odometer Reading*
Enter the Mileage
Date of the 2nd Odometer Reading*

MonthDayYear
Date
2nd Odometer Reading*
Enter the Mileage
Difference In Days*
Difference in Odometer*
Average Miles (per day)

F50
Annual Miles Calculated

F52
Current Annual Miles

Listed on the Policy

F54
Optional
Difference in Miles

F56
First Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
2nd Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
D-AMV on Another Vehicle*

YesNo
What Method are we presenting/client agreed to:*

Standard (No Smart)Already on Smart Ride-Self ReportSigning up for Smart Ride-Self ReportAlready on Smart Ride-DeviceSigning up for Ride-Device(No Smart-Device)
Calculate the impact to mileage and premium for vehicle 1:*

YesNo
Year of Vehicle*
Enter the Year of the Vehicle
Make/Model*
Enter the make and model of vehicle
Date of the First Odometer Reading*

MonthDayYear
Date
First Odometer Reading*
Enter the Mileage
Date of the 2nd Odometer Reading*

MonthDayYear
Date
2nd Odometer Reading*
Enter the Mileage
Difference In Days*
Difference in Odometer*
Average Miles (per day)

F71
Annual Miles Calculated

E73
Current Annual Miles

Listed on the Policy

F75
Optional
Difference in Miles

F77
First Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
2nd Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
E-AMV on Another Vehicle*

YesNo
What Method are we presenting/client agreed to:*

Standard (No Smart)Already on Smart Ride-Self ReportSigning up for Smart Ride-Self ReportAlready on Smart Ride-DeviceSigning up for Ride-Device(No Smart-Device)
Calculate the impact to mileage and premium for vehicle 1:*

YesNo
Year of Vehicle*
Enter the Year of the Vehicle
Make/Model*
Enter the make and model of vehicle
Date of the First Odometer Reading*

MonthDayYear
Date
First Odometer Reading*
Enter the Mileage
Date of the 2nd Odometer Reading*

MonthDayYear
Date
2nd Odometer Reading*
Enter the Mileage
Difference In Days*
Difference in Odometer*
Average Miles (per day)

F92
Annual Miles Calculated

F94
Current Annual Miles

Listed on the Policy

F96
Optional
Difference in Miles

F98
First Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
2nd Odometer Record:*

Photo of Odometer (From Vehicle Dashboard)Service Records (Smog, Oil Change, Etc. (Showing Odometer)Sales Contract/Title (Pink Slip) (Showing Odometer)
Upload*

Upload
Drag and Drop Files or Browse Files Cancelof
R-Processing:*

Taking RequestProcess Now
AMV workflow.*

Verified that we have odometer on policy vehiclesVerified that each photo is labelled for identificationUploaded to Doc VaultSent Email to underwriter Danielle Maloyal. (T20)
Doc Vault Access

G7
Enrolled In Smart Ride Self Reporting*

YesNo
How to Enroll in Smart Ride

G9
Got Confirmation from Underwriter (Mileage will not be Increased)*

YesNo
Upload Email From Underwriter*

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
BPI

(Billing/Payments)

G13
Source (Origination):*

Call from ClientEmail from ClientText from ClientCall from OtherEmail from Other
BPI Type:*

Took a PaymentSetup/Change EFT (Bank Acc.)Removed from EFT (Bank Acc)Change Due Date/Deduction Date
How to Take a Mercury payment

G16
Payment Type*

Paid in Full (for whole term)Paid in Full (Total balance on term)Installment paymentOther partial payment
Form of Payment*

Debit/Credit CardChecking/Savings
Payment Amount *
Payment Card*

VisaMastercardAmexDiscover
Name on Card*

Named InsuredOther
Name on Credit/Debit Card:*
Address Associated with Card:*

Same as Policy AddressDifferent Address
Address Associated on Credit/Debit Card*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Credit/Debit Card #:*
Expiration:*
Month/Year
CCV Number*
Code (Back of Card)
Bank Name:*
Bank Account #:*
Bank Routing #:*
Record of Transaction:*

Got Proof of Payment from Carrier SiteSent Proof of Payment to Client/Originator
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
How to Setup EFT (Bank Acc)

G33
How to Change/Update EFT (Bank Acc)

G34
1: IF a payment is already past due or coming to be due then it must be first paid via one-time eft payment and then setup for eft payment for next time. You cannot setup EFT and expect a payment to come in the next 3-4 days because it takes 5 business day for the setup to be completed between the banks. If you do not make the payment first then the policy will setup for cancellation.

2: EFT payment refers to automatic monthly payment deducted from a bank checking account. For RCC, automatic payments charged to a credit or debit card must be steup by the client directly by signing uo for online policy management.

G35
Bank Name:*
Bank Account #:*
Bank Routing #:*
Record of Transaction:*

Got Proof of EFT Setup/Change from carrier site.Got the Signed EFT Authorization. (Sent thru Ezlynx/Agency Forms)
Upload Proof of Transaction:

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
How to remove from EFT (Bank Acc)

G42
Upload Proof of Transaction:

Upload File
Drag & Drop or Browse for File Cancelof
Reason for Removal of EFT
Change due date / Deduction date

G45
Upload Proof of Transaction:

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
(Cancellation Request)

G48
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered RT Cntr/Download
Reason for Cancellation:*
Note:

1 - Policies cannot be cancelled with the clients signature. So we send the client the cancellation request letter thru agency forms in ezlynx and send it via ezlynx e-signature option if the client has an email address. If they call nationwide directly then they will be given the accord Cancellation/LPR form to sign. This is basically the same thing but we create our own agency cancellation request form since its cleaner/less confusing for the client. If the client already wrote a letter and signed it then it will be sufficient.

2 - The client can request a cancellation in the past or in the future. Nationwide will cancel the policy gaoing back up to 30 days without any other documentation. However if the cancellation date will be more then 30 days old then we will need a copy of duplicate coverage (copy of new policy) for it to be honored. Exception, if the client is requesting a cancellation of the policy more then 30 days old and he/she did not buy another insurance policy (duplicate coverage) then client must provide proof of sale documents from DMV for consideration.

G50
S-Processing:*

Taking RequestProcess Now
Record of Transaction*

Uploaded to Doc VaultSend to plpc@nationwide.com for processing
Approved By*

MoJackAlexDeanne
Upload Signed Cancellation Form

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
(Cancellation due

to Underwriting Reasons)

G56
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierDiscovered RT Cntr/Download
Upload Actual Und. Canc. Notice:*

Upload File
Drag & Drop or Browse for File Cancelof
Reason for Cancellation:*

Information needed for possible household drivers.No signed driver Exclusion form was received.Unacceptable Commercial/Business UseUnacceptable Driving RecordUnacceptable VehicleClient no longer lives in CaliforniaOther Reason
Information needed for possible household drivers:

This must be treate as a PHD, therefore go to the top of the form and choose PHD under policy transaction type.

G60
Unacceptable Commercial/Business Use:

You must give this issue to an account manger who will decide what can be done to save the policy or if it has to be remarketed to another company for the proper coverage.

G61
Unacceptable Driving Record:

You must give this issue to an account manger who will determine what the clients wants to do.

Option 1 - We can exclude the unacceptable driver and save the policy from cancellation.

Option 2 - We can remarket to another carrier that will accept the driving activity.

G62
Unacceptable Vehicle:

You must give this issue to an account manger who will determine what we can do.

Option 1 - We can exclude that vehicle and save the policy from cancellation.

Option 2 - We can remarket to another carrier that will accept the vehicle.

G63
Client no longer lives in California:

You must give this issue to an account manger who will determine what we can do.

Option 1 - If the client vehicle is registered in california then we can write the policy, even if the driver license was issued in another state. The main issue is the registration. If the vehicle is registered in state other then California then the client must buy a policy in that state since our agency is only licensed to do business in California.

G64
This Cancellation of Policy requires you consult with Mo to determine proper course of Action:

G65
Describe the Specific Reasons for cancellation:*
What course of Action was decided*

Save policy/Provide carrier with what is neededWill not Save/Instead RemarketDo nothing, let customer go
T-Processing:*

Taking RequestProcess Now
MA Approval Required*

Yes
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
(Claims Handling)

G72
Source (Origination):*

Call from ClientEmail from ClientText from ClientFax from ClientCall from CarrierEmail from CarrierFax from CarrierMail from CarrierOther
Note: All claims are handled by Mo in the office. If any client, carrier or 3rd party wishes to discuss an potential claim and or an existing claim then it must be given to Mo for handling.

G74
U-Processing:*

Taking RequestProcess Now
Clients needs to be Advised:*

YesNo
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
(Ezlynx Policy Entry)

G79
Note: Since all clients are entered by account manager during the new business selling process, then all policies are entered right after the sale is made. But those policies are entered manually that are not available for download from the carrier.

So this ezlynx entry on this PST form is to be used in case the account manager/salesman somehow missed to enter the policy when originially sold.

G80
How to enter a policy manually

G81
(FPR-Full Policy Review)

G82
What triggered the full policy review:*

Call from Client inquiring how to lower the Policy RateRate Renewal was increasedClient made changes to policy that caused an IncreaseOther
Note: the following are all the ways a policy can be lowered in premium. Review carefully and see if the client is getting all the discounts/options that he/she can qualify for.

G84
1: Multi-Policy Discount (Client can get a muti-policy discount if they combine the auto with an HO4,HO6, OR HO3 Policy.

The client can also get a muti-policy discount if another member of the household has the other qualifing policy. Example if the father has home insurance with nationwide then when the son also purchase an auto policy then it will get mpd since they are in the same household. Note - MPD is not given if 2 people have only auto policy. It must be a package so auto + HO4-HO3-HO6.

G85
2: Married Discount (Client can get a discount for being married or being a registered domestic partner).

G86
3: Group-Occupation Discount (Client can get a discount for his/her occupation, having a degree or being a busines owner)

G87
4: Good Student Discount (Client can get a discount for his/her occupation, having a degree or being a busines owner)

G88
5: Driver Assignment (Driver assignment can make a huge difference esecially when it comes to your drivers, get help from mo when verifying this)

G89
What Discounts does the policy currently have:

MPD Multi-PolicyMarriedGroup/OccupationGood Student
Note: After reviewing all the discounts,

then it must be discussed with Mo to

determine if this client must be

remarketed or left with nationwide).

G91
V-Processing:*

Taking RequestProcess Now
What was decided:*

Leave with NationwideRemarket
Upload

Upload File
Drag & Drop or Browse for File Cancelof
What discounts did we add.*

NoneMPD Muti-PolicyMarriedGroup/OccupationGood Student
Notes:
(PHD)

Possible Household Drivers)

G97
What triggered the PHD:*

Call from CarrierEmail from CarrierFax from CarrierMail from CarrierOther
Upload the Und. Memo (if any)

Upload File
Drag & Drop or Browse for File Cancelof
Driver Exclusion (Carriers required that everyone of driving age is to be disclosed. Therefore anyone with a driver license living in the household must be added as a driver or excluded from the policy.

When carriers find out that there are additional drivers in the household or peoples that have regular access to the clients vehicles then we will get notified by the carrier and expected to add or exclude that person from the policy.

H1
Note: This can be a sensative issue for the clients, so it must be handled carefully by a qualified account manager. This must be discussed with Mo first. If we decide to exclude and client agrees then you must sent the exclusion form for signing, sent via ezlynx agency form for e-signature with client that have email.

H2
W-Processing:*

Taking RequestProcess Now
How did we decide to move forward.*

Added the driver to the policy (select DRV)Excluded the driver from the policyGave to Account Manager for Remarket
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
(Rmail)

(Return Mail)

H7
Source (Origination):*

Call from CarrierEmail from CarrierFax from CarrierMail from Carrier
Upload R-Mail Notice:

Upload File
Drag & Drop or Browse for File Cancelof
Note: When we get return mail , then there are several reasons why this could happen.

1 - The client could simply have moved to another house.

2 - The client was using seperate mailing address such as his business or po box office that he is no longer using.

3 - The client could claim he is living at this address but in really he is not and therefore the post office is returning it because teh occupants of the property told the mail man he does not live there.

H10
Note: Return mail can be tricky and requires some experience in order to determine best course of action. You must check with Mo to determine how to proceed in handling this issue.

We need to take into consideration the following when determing what is best way to handle it.

1 - See if client has a homeowner policy with us and compare the mailing address on the home and auto policy.

2 - We need to see what other policies the client has with us and check the mailing addresses on those policies.

3 - We need to look up data tree to determine if he the owner of the home or renting. Perhaps he lost the home due to foreclosure or simply sold the home.

H11
X-Processing:*

Taking RequestProcess Now
How did we decide to move forward.*

Found a Mailing address from Other Policy (will process amendment)Got a new mailing address from client (will process amendment)No Action Mailing Address is correct.No Action (exhausted all ways to find correct mailing address)
(TLV)

(Total Loss Vehicle)

H14
Source (Origination):*

Call from CarrierEmail from CarrierFax from CarrierMail from Carrier
Upload R-Mail Notice:

Upload File
Drag & Drop or Browse for File Cancelof
Note: We usually get notified by a carrier that a vehicle on the policy was considered to be a Total Loss. This means the client got into an accident recently and due to the amount of damage to the car, the insurance carrier has decided not to repair the car and consider it a total loss. Insurance carriers usually considered totalled when the value of the damge is close to 75% of the value of the vehicle. The client is given the full market value of the vehicle and the insurance company now takes possession of the car.

The carrier is letting know about the vehicle being totalled because as agent we have to communicate with our clients and remove the vehicle from the policy. In many cases the clients take the money they receive and purchase another vehicle. So we need to determine if we should simply delete the car from the policy or do a transfer of vehicle (delete 1 and add the replacement).

H17
Note: You must consult with MO to determine the best course of action.

H18
Y-Processing:*

Taking RequestProcess Now
How did we decide to move forward.*

We decided to simply remove the vehicle from the policyWe decided to do a transfer (delete 1, add another)Do nothing at this time, until client get a new vehicle.
MA Approval Required*

Yes
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
(Request for Documents)

H25
Source (Origination):*

Call from ClientText from ClientEmail from ClientOther
Explain:Type a question*
Note: Keep in that if we make any policy change of any kind then the client will get an updated declarations in the mail (unless its on paperless policy). The client does automatically get new ID cards unless its at renewal or unless you order the id cards be mailed to him.

H28
Note: Mark All the type of documents the client is requesting or documents you want the client to have.

H29
Type of document to Send*

Send ID Cards (from ezlynx only)Send ID Cards (carrier issued ID cards)Send Declarations Page Only (policy summary from ezlynx)Send Declarations Page Only (carrier issued declarations)Send complete policy packet (declarations + policy specimen)
How to send ID Cards from Ezlynx

How to locate ID Cards from carrier

How to locate Declarations Page (policy summary)

How to locate Declarations from carrier

How to order/located complete policy packet
Notes*
Z-Processing:*

Taking RequestProcess Now
Sent ID Cards (from ezlynx only)
How to create ID Cards in Ezlynx

H34
Sent ID Cards (carrier issued ID cards)
How to order/send ID Cards (carrier issued)

H36
Sent Declarations Page Only (policy summary from ezlynx)
How to send/order Delcarations Page

(Policy summary from ezlynx)

H38
Sent Declarations Page Only (carrier issued declarations)
How to send/order Delcarations Page

(carrier issued declarations)

H40
Sent complete policy packet (declarations + policy specimen)
How to send/order Complete Policy

(declarations + policy specimen)

H42
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
(All Other)

H45
Explain the Issue:*
Z1-Processing:*

Taking RequestProcess Now
Quote Release Approval*

MoJackAlex
MA Approval Required*

Yes
Approved By*

MoJackAlexDeanne
Upload

Upload File
Drag & Drop or Browse for File Cancelof
Notes:
Notes:
Upload (if any)

Upload File
Drag & Drop or Browse for File Cancelof
Was there any documentation needed for this Transaction*

YesNoNot at this time
Did we get the required information or documentation that we needed and sent it to the carrier.*

YesNo
Was there any change/amendment that will generate a download to this policy.*

YesNo
Did the download/confirmation arrive in client file (policy history tab)*

YesNo
Note: Do not remove this PST Transaction from your gmail inbox. This is PST Form must only be placed in the client file when we have all the required information or docuemntation and we have the download confirmation.
Should be Empty: