Contact Information
  • (Include any owners who are active in the business)
  • (Years that you have represented Stewart Title an an independent agent)
  • Is the Applicant controlled, owned, affiliated or associated with any other organization?
  • Does any Person/Entity with ownership interest in the Applicant also own, control or manage another entity?
    If so
    • Are services provided to the Organization?
  • Has the name or ownership of the Applicant ever changed or has any other entity been acquired, merged or consolidated with the applicant?
  • Are owners active in daily operations of the business?
  • Are background checks performed on new hires?
Title Underwriters Represented

List top three title insurers with whom business is or has been placed in the last three years. All information must be complete. Include any bar-related title insurer or fund.

Title Underwriter 1
  • (Current Annual Premium Remittance)
Title Underwriter 2
  • (Current Annual Premium Remittance)
Title Underwriter 3
  • (Current Annual Premium Remittance)
Total gross revenue from all services (Annualized)
Check applicable revenue source(s) and indicate the revenue breakdown from each service.
  • (Title Insurance Commissions)
Provide percentage of annual gross revenue by category.
Title Transaction Information
  • Are applicant’s title searches, closings or other services performed by independent contractors?
  • Are 1031 tax-deferred exchange services provided?
  • Does applicant have an Escrow Security Bond™ in force?
  • Currently using AgencySecure® or Stewart Financial Services?
  • Minimum of one week vacation required for staff?
  • Is there segregation of duties so that no single transaction can be fully controlled from initiation to recording by one person?
  • Are voice or facsimile-initiated wire transfers performed?
  • If yes, are independent-call-back procedures in place?
  • Are dual signatures required for checks written from the operating account or is an owner/manager required to sign checks?
  • Are bank accounts, including escrow and trust accounts, reconciled by someone not authorized to deposit or withdrawal?
  • Is a three-way reconciliation of bank account to the control account and to the trial balance prepared monthly and any unusual reconciliation issue investigated properly?
  • Have there been any employee dishonesty losses in the past five years, or are you aware of any situations that may result in a loss due to employee dishonesty?
  • Have any claims/suits been made in the past five years against the applicant, any officers or employees, or its predecessor firm?
  • Is the applicant, its predecessor firm or any of the officers or employees of the firm aware of any circumstance, act, error or omission which may result in a claim against them?
Current E&O Coverage
Personal Information

The undersigned represents and warrants on behalf of the Named Insured and all persons/entities for whom this insurance is being purchased, that to the best of your knowledge and belief, the statements set forth herein and attached hereto are true and accurate and that there has been no attempt at suppression or misstatement of any material facts known or that should be known. We will rely upon this application and all such attachments in issuing the policy.