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LOSS CONTROL SUPPLEMENTAL APPLICATION (INSURANCE COMPANIES) Surety One Email: Underwriting Urethane.org Facsimile: 9198347039 Mail: P.O. Box 37284, Raleigh, NC 27627 NAME OF INSURED: ADDRESS: DATE:

How to fill out loss control supplemental application

How to fill out a loss control supplemental application:

1. Start by carefully reading and understanding the instructions provided with the application form. This will give you a clear idea of the information and documentation required.
2. Begin by providing your personal information, including your name, address, contact details, and the name of your business (if applicable).
3. Next, fill in the section that asks for details about your insurance policy, such as the name of the insurance company, policy number, and effective dates.
4. In the "Loss Control Information" section, provide details about any previous claims or losses your business has experienced. This may include the date, description, and amount paid for each claim.
5. Answer all the questions in the questionnaire section honestly and thoroughly. These questions are designed to assess the risk associated with your business and help the insurer evaluate your eligibility for coverage.
6. If required, attach any additional documentation or reports requested in the application form. This may include safety audits, inspection reports, or other relevant documents.
7. Review all the information provided to ensure its accuracy and completeness. Double-check for any missing or incomplete sections and make necessary corrections.
8. Sign and date the application form, confirming that all the information provided is accurate to the best of your knowledge.
9. Keep a copy of the completed application form and any supporting documents for your records.

Who needs a loss control supplemental application?

1. Businesses in high-risk industries: Industries that involve significant hazards, such as manufacturing, construction, or transportation, often require a loss control supplemental application. This allows insurers to assess the risk level associated with the business and tailor coverage accordingly.
2. Companies with previous claims or losses: If a business has a history of claims or losses, insurers may request a loss control supplemental application to evaluate the risk profile and adjust the coverage terms accordingly.
3. Start-ups or new ventures: New businesses without a claims history or established risk profile may still require a loss control supplemental application to assess the potential risks associated with their operations.
4. Businesses with unique or specialized risks: Certain industries or operations, such as chemical manufacturing or aviation, may have specific risk factors that require additional evaluation through a loss control supplemental application.
5. Businesses seeking to mitigate risk: Even if not explicitly required, some proactive businesses may choose to complete a loss control supplemental application to demonstrate their commitment to risk management and potentially negotiate better insurance terms.

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