When this form may help
Use this form to organize ownership, governance, financial, employment, prior-acts, and claims information for management liability review. The requested coverage parts should be identified separately.
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
- directors and officers
- employment practices
- ownership
- financial condition
- claims
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.
Download Hedge Management Liability D&O and EPL Supplemental