Life Insurance Agents E&O Application

Thank you for applying for life insurance agent professional liability coverage, sponsored by I-Genius by Levinson & Associates, Inc. and underwritten by the National Casualty Company. The Financial Services Professional Liability Purchasing Group is managed by ProSurance Group, Inc. ProSurance Group, Inc. acts as the program administrator for this program. This is a claims made and reported policy that provides: $1,000,000 or $2,000,000 per wrongful act limit $1,000,000 annual agent aggregate limit (with options up to $3,000,000) $10,000,000 annual policy aggregate for all insureds $500 retention (deductible) for claims solely arising from fixed insurance products $2,500 retention for claims involving fixed and indexed annuities Certain exclusions apply to the coverage. Click Policy Info for more information about the coverage and a sample policy .
* required field
Applicant Information
First Name *
Last Name *
Street Address *
Suite, Apt #
City *
State *
Zip *	· zip format (i.e. 11767) or zip+4 (i.e. 11767-2345)
Day Phone *	. phone format (444-333-2222)
Alternative Phone *	. phone format (444-333-2222)
Revenue, as a life insurance agent *	$ . revenue format only numbers (i.e. 50800)
Email *