Non-Profit Insurance Application

General Liability Supplemental Application
  • Applicant Information
  • General Information
  • Special Events/Fundraisers
  • Foster Homes
  • Premises
  • Animals
  • Other
    • Signature

    General Information

    Check here if none available
    Check here if none available
    Billing Address
    Address Line 1
    Apartment/suite #

    General Information

    Does Applicant currently have any General Liability coverage in force?
    If yes, please submit currently valued loss runs for the past three years and complete the following:
    Is the Applicant a tax-exempt nonprofit organization under the U.S. Internal Revenue Code 501(c)(3), or in the process of obtaining this tax-exempt status?

    Maximum file size: 25MB

    If no, stop. We can only write insurance for tax-exempt 501(c)(3) organizations.

    Complete the following:

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