When this form may help
Use this form when a risk needs a structured loss and claims summary beyond the loss-run documents themselves. Complete it with facts from the insured and current records, then include supporting loss runs when available.
Authority boundary: This Hedge form is a submission-preparation resource. It is not a quote, binder, coverage commitment, market-access statement, or instruction to release a risk to a carrier.
Topics covered
- loss history
- open claims
- claim status
- supporting loss runs
Before you send it
Complete the form with current facts from the insured. Confirm the named insured, operations, locations, requested coverage, effective date, and loss information. Include the primary application, loss runs, schedules, and other documents that apply to the account. Hedge will identify any additional market-specific requirements after review.
Download the fillable PDF
This file is published by Hedge and can be completed in a PDF editor. Review every answer before attaching it to a submission.
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