Get Renewal Application For: E-md Claims Made Basis. Underwritten ...

Filling out the RENEWAL APPLICATION for E-MD Claims Made Basis requires careful attention to detail to ensure all information is accurate and complete. This guide provides a straightforward process to assist users in completing the application effectively and submitting it online.

Follow the steps to complete your renewal application successfully.

1. Click ‘Get Form’ button to obtain the form and open it for editing.
2. Begin with Section I, where you will provide general information. Enter the name of the applicant and include names of any subsidiary or affiliated companies to be insured. Fill in the headquarters and mailing addresses, along with contact information such as telephone and email.
3. Indicate if there have been any changes in the firm's name, or any mergers or consolidations in the past twelve months. If yes, provide necessary details.
4. State whether there has been any change in the nature of professional services offered in the past twelve months.
5. Report total revenues in the designated field.
6. Estimate the total number of customer and employee records stored, specifying both electronic and physical locations.
7. Indicate whether personal information is stored on portable devices and confirm if such data is encrypted to adhere to industry standards.
8. Answer provided questions regarding any claims or incidents related to security or privacy that may have occurred in the last twelve months. Be prepared to report any claims to NAS if applicable.
9. Proceed to Section II, where acknowledgements and representations must be made. Ensure that all statements are accurate and complete, as these are crucial for the insurance contract.
10. Once all sections are completed, review the application for accuracy. The form must be signed by an authorized director or officer and dated appropriately.
11. Save changes, and consider downloading or printing the completed form for your records. Share the application with relevant parties as needed.

Complete your documents online today for a streamlined process.