Personal Lines Underwriting Risk Assessment Worksheet

Evaluates property characteristics, prior claims, and rating factors for a personal auto or homeowners risk and documents underwriting acceptability.

Submission Notice

• Submission Type
• Line of Business
• Underwriter Name
• Submission Date
• I acknowledge that the information provided is accurate to the best of my knowledge and will be used only for underwriting review.

Applicant and Risk Identification

• Applicant / Named Insured
• Policy Number
• State of Risk
• Requested Effective Date
• Risk Address
  Enter the insured location or garaging address. Include only what is needed for underwriting review.

Risk Characteristics

• Occupancy Type
• Construction Type
• Roof Age (Years)
• Dwelling Protection / Fire Protection Class
• Number of Vehicles
• Primary Use
• Estimated Annual Mileage
• Number of Rated Drivers

Prior Claims and Loss History

• Number of Prior Claims in the Last 5 Years
• Largest Prior Loss Amount
• Loss Description / Pattern
  Summarize the nature of prior losses, including cause, frequency, and any relevant underwriting concerns.
• Any Claims Within the Last 3 Years?

Underwriting Decision and Referral

• Underwriting Decision
• Referral Reason
• Underwriting Rationale
  Document the key facts relied upon, any exceptions, and why the risk is acceptable, referable, or not acceptable.
• Additional Conditions or Requirements
  List any required inspections, photos, documentation, or policy conditions.