Facultative Reinsurance Placement Request Form

Documents an individual risk submission and the terms sought when placing facultative reinsurance for an oversized or unusual exposure.

Submission Notice

• Purpose of Request
• Submitter Name
• Submitter Email
• Submission Date
• Confidentiality and Minimum Necessary Acknowledgment

Risk and Policy Details

• Account / Insured Name
• Policy Number
• Line of Business
• Primary Risk Location
• Risk Description
  Summarize the exposure, operations, and any unusual characteristics that make facultative placement necessary.
• Reason Facultative Coverage Is Sought

Exposure and Underwriting Metrics

• Total Insured Value
  Enter the total insured value for the risk if applicable.
• Requested Facultative Limit
  Enter the limit requested from the facultative reinsurer.
• Attachment Point / Retention
• Expected Premium
• Loss History Summary
  Provide a brief summary of relevant loss experience. Avoid unnecessary personal data.
• Catastrophe Exposure Present?

Requested Terms and Structure

• Coverage Type Requested
• Requested Attachment / Layer
  Describe the layer or attachment in underwriting terms if a numeric value is not sufficient.
• Requested Policy Term
• Requested Conditions / Endorsements
• Broker / Intermediary

Supporting Documentation

• Submission Package
  Upload the underwriting submission, statement of values, loss runs, and any relevant schedules.
• Additional Supporting Documents
• Submission Notes
  Add any context that will help the reviewer understand the placement request.

Approval and Routing

• Underwriting Manager Approval
• Ceded Reinsurance Review
• Approval Status