Get Master Policy Application - Ironshore

This guide provides a comprehensive overview of filling out the Master Policy Application for Ironshore online. Follow the steps below to successfully complete this important document, ensuring that you provide all necessary information clearly and accurately.

Follow the steps to effectively complete your application.

1. Click ‘Get Form’ button to obtain the Master Policy Application form and open it for editing.
2. Fill out the applicant section, including the legal name, telephone number, address, city, state, and ZIP code. Ensure the information is accurate and up to date.
3. Provide your MMSEA Section 111 RRE ID and the primary contact information, including a phone number and email address.
4. List all affiliates and subsidiaries related to the insurance application, providing a complete description of their operations and their relationship to the applicant.
5. In the historical MSA data section, input the total number of workers' compensation claims settled involving MSAs, the total settlement value, and the total number of MSAs funded from those settlements. Provide the necessary numerical data.
6. Indicate any claims pending against MSA vendors and whether there is an anticipated change in MSA settlement volumes this fiscal year. If applicable, include estimated figures.
7. In the coverage structure section, specify the total number of MSA settlements anticipated and the estimated total amount of MSAs. Fill out your requested coverage specifics and effective period.
8. If applicable, provide information regarding past coverage and explain any claim incidents from the past five years that could impact coverage.
9. Complete any additional information section required, particularly regarding material risks not previously addressed in the application.
10. Sign and date the application as the authorized representative of the applicant, ensuring that the person signing is the CEO, President, or CFO.
11. After completing all sections, save your changes, and then download, print, or share the form as necessary.

Complete your Master Policy Application online today for a secure and efficient process.