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Run: Facultative Reinsurance Placement Request Form

Facultative Reinsurance Placement Request Form template for documenting an individual risk submission, the terms sought, and the approvals needed to route an...

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Submission Notice

Purpose of Request

Submitter Name (required)

Submitter Email (required)

Submission Date (required)

Confidentiality and Minimum Necessary Acknowledgment (required)

Yes No N/A

Risk and Policy Details

Account / Insured Name (required)

Policy Number

Line of Business (required)

Primary Risk Location

Risk Description (required)

Summarize the exposure, operations, and any unusual characteristics that make facultative placement necessary.

Reason Facultative Coverage Is Sought (required)

Exposure and Underwriting Metrics

Total Insured Value

Enter the total insured value for the risk if applicable.

Requested Facultative Limit (required)

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? (required)

Requested Terms and Structure

Coverage Type Requested (required)

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 (required)

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

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