High-Liability/Hazardous Risk Submission Letter

This form may be used by agents to obtain approval to insure title in excess of the agent’s authority level, or for extra-hazardous risks.

Branch Office/Agency
Request for Policy Approval

  Chicago Title        Ticor Title

Date:
Your E-Mail Address:
Agent/Your Information:
  
Title: (Mr. Ms. etc):
First Name:
Last Name:
From (Branch Office/Agency):
Branch Office Address:
Phone:
Attn (Reader, Councel, etc):
The above-named Branch Office/Agent hereby requests the Company's approval for the issuance of the policy or policies described below:

Policy 1
Title No:
Proposed Insured:
Amount of Insurance $
Type of Policy:
 Fee Mortgage Fee & Mortgage
Leasehold

Policy 2
Title No:
Proposed Insured:
Amount of Insurance $
Type of Policy:
 Fee Mortgage Fee & Mortgage
Leasehold

Policy 3
Title No:
Proposed Insured:
Amount of Insurance $
Type of Policy:
 Fee Mortgage Fee & Mortgage
Leasehold
Construction Mortgage?
 Yes No
Property Location:
(Municipality, County)
Co-Insurance?
 Yes No
If Yes, names of other companies involved and liability to be assumed by each:
Name of Company
 Amount
Reinsurance?
 Yes No
Requests to cede reinsurance to other companies, or customer requirements which differ from the above, should be noted below:
Name of Company
 Amount

Title Evidence
Complete Search by:
Continuation from prior policy issued in:
By:
Other:
Requests for Special Affirmative Coverage or endorsements:
Unusual or Extra-Hazadous Title Risks:
Is the "Creditors' Rights" Exception applicable to this transaction?
 Yes No Not Sure
Have tidelands maps been checked?
 Yes No
What Result?
Other relevant information:

 
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