Loan Insurance Application
I have reviewed this application for accuracy before signing it and acknowledge all obligations and risks, including that I’ll be liable to the Insurer if I declare bankruptcy or violate the “bad boy” covenants in my loan documents. As a condition precedent to coverage, I hereby state that the information contained herein is true, accurate and complete and no material facts have been omitted, misrepresented or misstated. I understand that any willful misrepresentations or inaccuracies in this application will void coverage. I understand that this is an application for insurance only and that completion and submission of this application does not bind coverage with any insurer. I also represent that the applicant is a commercial insured and the surplus lines broker procuring this surplus lines insurance has disclosed in writing that there may insurance available from the admitted market that may provide greater protection with more regulatory oversight. The undersigned commercial insured has subsequently requested via this application in writing that the surplus line broker procure or place surplus insurance from a non-admitted carrier.
LGIS GroupLGIS Group
