Insurance Policy Prebinding Checklist Form
Complete this checklist to confirm all underwriting requirements are met before binding an insurance policy.
Policy Reference Number
*
Applicant or Insured Name
*
Type of Insurance Policy
*
Please Select
Property
Liability
Auto
Workers' Compensation
Other
Brief Risk Description
*
All required underwriting documents received
*
Yes
No
Checklist: Confirm the following have been reviewed
*
Application reviewed
Loss history checked
Risk inspection completed
Premium calculation verified
Other (please specify)
Effective Date of Policy
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are all underwriting conditions satisfied?
*
Yes
No
Underwriter/Agent Name
*
Additional Comments (if any)
Submit Checklist
Should be Empty: