REAL ESTATE SERVICES INSURANCE INTAKE FORM

REAL ESTATE SERVICES E&O INSURANCE APPLICATION INSTRUCTIONS

Follow the steps 1–3 below and then when you have completed steps 1–3 come back to this page and complete the final step "4".

IMPORTANT FORM NOTICE: This form is intended for Real Estate Services Professional Liability (Errors & Omissions) insurance covering real estate agents (individuals and firms), property managers and property management companies, title agencies and closing services, real estate appraisal services, residential and commercial mortgage brokers and firms, escrow services, and real estate sales and brokerage services. If your operation falls outside these categories, please contact us for the correct application.
1

COMPLETE, SAVE & UPLOAD THE APPLICATION USING THE "UPLOAD APPLICATION" INFO BELOW

First, complete the Real Estate Services Professional Liability Application. It will open in a new browser tab so you can return here after saving it.

After completing the application, save the completed file to your computer. Then return to this page and upload it in Step 4.

Supporting Documents: Depending on your services, also upload the partner/principal/director schedule if applicable, sample dual agent disclosure statement (real estate sales), standard property management contract (property management), standard property appraisal contract (appraisal), limited partnership schedule (asset management), sample investment advisory contract, and full claim details for any claims in the past five years.

CLICK HERE FIRST OPEN APPLICATION CLICK
RED BOXESRequired for all customers — applicant info, staffing, gross income breakdown, claims history, and prior insurance history (Sections I & IX).
GREEN BOXESRequired only if the applicable service applies to your firm — sales/brokerage, title/escrow, mortgage, property management, appraisal, asset management, or joint ventures (Sections II–VIII).
BLACK BOXAdditional remarks, clarification, or anything else you need us to know. Located in the Remarks Section on page 12 of the PDF.
2

NO LOSS STATEMENT

If your firm has never experienced any claims, or if this is for a new business, complete a No Loss Statement. You do not need to email it to us. Once submitted, it will automatically notify the Kelly Insurance Group team.

NO CLAIMS? COMPLETE NO LOSS STATEMENT CLICK
3

CURRENT LOSS RUNS

If you currently have E&O coverage, we will need copies of your current carrier loss runs. Click the button to view what loss runs are, how to request them, and copy a ready-made email to send to your current carrier or agent.

WHAT ARE LOSS RUNS?

Official reports from your current or prior carrier documenting all claims — open and closed — losses, and payments during your policy period. E&O carriers typically provide 5 years of history. Any new carrier will require these before quoting professional liability.

HOW TO REQUEST

  1. Contact your current agent, broker, or E&O carrier.
  2. Ask for "loss runs" covering the past 5 years, in PDF format.
  3. Request each policy type: Professional Liability/E&O, General Liability, Cyber, Fidelity Bond, Umbrella.
  4. Turnaround is usually 3–10 business days.
Subject: Loss Run Request — [Your Firm Name]

Hello,

I am requesting copies of the loss runs for my professional liability and related commercial policies for the past five years for an E&O quote review.

Please include all active or recently expired coverages:
- Professional Liability / Errors & Omissions
- General Liability
- Property (office contents)
- Cyber Liability (if applicable)
- Fidelity Bond (if applicable)
- Umbrella / Excess (if applicable)

Please send them in PDF format at your earliest convenience.

Thank you,
[Your Name]
[Your Firm Name]
[Your Contact Info]

Once you receive them, upload the loss runs along with your completed application PDF in Step 4 below.

4

UPLOAD YOUR COMPLETED APPLICATION

Upload your completed Real Estate Services Professional Liability application PDF, your No Loss Statement or current loss runs, and any supporting documentation (partner schedule, disclosure statements, standard contracts, limited partnership details, claim documentation) using the intake form below.

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Disclaimer: Coverage availability and eligibility may depend on underwriting review, carrier guidelines, policy terms, state requirements, business operations, risk characteristics, and other information provided during the application or quoting process. Kelly Insurance Group cannot guarantee that every individual, customer, organization, or business seeking coverage will qualify for, receive, or successfully place insurance coverage. All policy coverages, exclusions, conditions, limits, endorsements, and terms should be carefully reviewed by the consumer, insured, or applicant to confirm that the coverage requested is the coverage being quoted, offered, or provided. Insurance coverage, policy changes, endorsements, cancellations, and other policy terms are not bound, changed, confirmed, or altered unless and until written confirmation is provided by a licensed Kelly Insurance Group team member, the applicable insurance carrier, or an authorized underwriter. This page is provided for general informational purposes only and does not provide legal advice, legal opinions, insurance coverage opinions, or policy interpretations.