Directors and Officers insurance quote for Non-Profit Company

Insured

Name of Applicant*

Email*

Contact Phone*

Mailing Address of Applicant*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Description of Applicant's operations*

How many years has the Applicant been in business?*

Coverage

Desired Effective Date*

Coverage required by Applicant*

D&O
EPL
Fiduciary

Corporate information

What is the Applicant's gross revenue for the last financial year?*

What are the Applicant's total assets?*

Does the Applicant’s latest financial report show a positive net worth?*

Yes
No

During the last 3 years, has the Applicant completed any merger or acquisition, divestiture, or name change?*

Yes
No

Please provide details*

Has any fiduciary been found guilty for a breach of trust or convicted of criminal conduct?*

Yes
No

Directors & Officers Liability Coverage

Does the Applicant currently have D&O Liability coverage in force*

Yes
No

Date Coverage First Purchased*

Does the Applicant have operations or stakeholders outside of the USA?*

Yes
No

Please provide in which country*

Have there been any claims or official investigations against the Applicant or past or present director or officer of the company which would be covered under this policy?*

Yes
No

Please provide details*

In the next 12 months, is the Applicant contemplating any significant corporate restructuring?*

Yes
No

Please provide details*

Directors and Officers insurance quote for Non-Profit Company

Non-for-Profit D&O Insurance Application

Insured

Coverage

Corporate information

Directors & Officers Liability Coverage

Employment Practices Coverage