Step 1 of 7 14% InstructionsThis policy applies only to claims first made against the insured during the policy period or discovery period. The limit of liability available to pay judgements or settlements shall be reduced by payment of defense costs. Defense costs are subject to the applicable retention. Please read and review the policy carefully. Instructions: this self-rating application is for an individual appraiser who performs 100% real estate appraisals work. Please note that coverage will only apply to services rendered by the applicant. The term "Applicant" shall mean all natural persons proposed for coverage. Section A: General InformationFull Name of Applicant* Official Business Name* Official Business Address* City* State*Please SelectAKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYMAMDMEMIMNMOMSMTNCNDNENHNJNMNVOHOKORPARISCSDTNTXUTVAVTWAWIWVWYZip* County* Primary Email Address* Primary Phone*Current/ Desired Effective Date* Alternative Information about the Applicant*Please describe any alternative business names, mailing/billing addresses or administrative contact information related to business activities other than the official ones listed above. If none, please enter “none”. In lieu of mailing my Policy, please Email the Policy to the address above. I agree to accept an electronic copy of my Application with my Policy. In lieu of completing multiple applications, I agree for this application to be used to place coverage with an alternative insurance company offering better coverage or lower rates for a comparable product. Section B. Confirm Eligibility for the “Self-Rated” Program1. The applicant holds a valid state license or certification in each state in which he/she provides appraisal services. If you are a Trainee, you have passed the initial exam (if required) or any other state requirements.* True False 2. The applicant does not appraise any real estate in which he/she has an ownership interest.* True False 3. The applicant has not been disciplined or investigated by any state licensing, administrative or regulatory board as a result of appraisal activities within the past 5 years.* True False 4. There have been no claims reported and/or pending circumstances which could result in a claim made against the applicant within the past 5 years.* True False 5. The applicant is not currently, and has not during the last five (5) years, operated under any chapter of the United States bankruptcy code* True False 6. The applicant does not have similar insurance which is in the process of being cancelled or non-renewed* True False QualificationI'm sorry, but you no longer qualify for the Self Rating E&O Program. Please call the ALIA Service Team at 1-800-882-4410 Extension 1 so we can renew your coverage in the Standard E&O Program. Go to our Homepage Calculate Your Premium7. In the last fiscal year, 80% or more of my revenues have been derived from residential appraisals.* True False 8. Within the last fiscal year, I have not appraised any properties valued at greater than $3,000,000.* True False 9. The Applicant’s combined total gross revenues for the last three (3) years did not exceed $500,000.* True False Additional Coverage Options (for a charge) Real Estate Trainee Coverage is available for 50% of the premium chosen from the table above Appraisal Management Company Extension (return completed application to your agent for final premium) Select Your PremiumCalculating Your Rates Please select your limits*Please Select300,000 / 600,000500,000 / 1,000,0001,000,000 / 1,000,0001,000,000 / 2,000,000Premium* SummaryYour State: {state:83} Your Selected Limits: {Please select your limits:43}PremiumHiddenCalculate TraineeHiddenCalculate AMCAdditional CoveragesALIA Subscription ($10 a month billed annually)Total DueHiddenTotal amount Due with DownpaymentPlease Read This proposal is based on your enrollment in the ALIA Professional Education Subscription as itemized above. As a benefit to this subscription, your standard Deductible of $500 is reduced to $0 and additional coverage enhancements are provided. The premiums listed above are subject to change based on carrier fillings and should not considered final until written confirmation is obtained from the carrier.E-Signature*HiddenTime : Hours Minutes AM PM AM/PM HiddenDate YYYY dash MM dash DD EmailThis field is for validation purposes and should be left unchanged. Δ TweetShareShare0 Shares
