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Run: Personal Lines Underwriting Risk Assessment Worksheet

Use this Personal Lines Underwriting Risk Assessment Worksheet to document property, vehicle, and loss-history factors before an accept, refer, or decline de...

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Submission Notice

Submission Type (required)

Line of Business (required)

Underwriter Name (required)

Submission Date (required)

I acknowledge that the information provided is accurate to the best of my knowledge and will be used only for underwriting review. (required)

Yes No N/A

Applicant and Risk Identification

Applicant / Named Insured (required)

Policy Number

State of Risk (required)

Requested Effective Date (required)

Risk Address (required)

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 (required)

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? (required)

Underwriting Decision and Referral

Underwriting Decision (required)

Referral Reason

Underwriting Rationale (required)

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.

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