Get Liability Insurance Form

Filling out the Liability Insurance Form online can seem daunting, but this guide provides clear and straightforward instructions to ensure you complete it accurately. By following these steps, you will efficiently fill out each section of the form and submit it without issues.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the name of your support group in the designated field. This should reflect the organization you represent.
3. Input the name of the HSLDA discount group to which you belong for continued eligibility.
4. Provide your membership number in the appropriate section to ensure your record is properly linked.
5. Fill in the insurance contact name, along with their title, to designate the primary contact for insurance matters.
6. Complete the address fields: street address, city, state, and zip code. Ensure accuracy for policy correspondence.
7. Specify your email address in the required field to receive important updates and documents related to the insurance.
8. List the telephone number where you can be reached for any inquiries or follow-up regarding your application.
9. Indicate the effective dates for your policy by providing the starting and ending dates clearly.
10. Fill out the classification section, estimating the number of participants in each age group and category as specified.
11. Calculate the total accident medical premium by inputting the amounts corresponding to the number of participants in each classification.
12. Complete the general liability premium section, adhering to the rates provided based on your classified participants.
13. If applicable, indicate if you must name an additional insured organization and complete the required details.
14. Provide prior insurance information for the last three years, including year, company, type of claim, and claim amount.
15. Check the box to acknowledge participation in the trust for accident medical coverage and provide your signature.
16. Ensure the licensed agent completes their section with the necessary contact information and signature.
17. Review all entered information for accuracy, then save changes and download or print the filled form for submission.

Complete your Liability Insurance Form online today for peace of mind.