ERRORS & OMISSIONS INSURANCE APPLICATION fax CA License # 0G78192 MORTGAGE BROKERS AND MORTGAGE BANKERS

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1 ERRORS & OMISSIONS INSURANCE APPLICATION fax CA License # 0G78192 This application is for a CLAIMS MADE insurance policy. If a policy is issued, this application will attach to and become part of the policy. If additional space is required, please provide complete details on Applicant s letterhead. CONTACT INFORMATION Applicant name: Business address: City: Zip code: Contact person: Phone number: MORTGAGE BROKERS AND MORTGAGE BANKERS State: Website: Fax number: GENERAL INFORMATION Individual Partnership Corporation Limited Liability Company 1. Legal Structure: Other (explain) 2. Date established: 3. Address(es) of Branch Office(s) 4. Number of Staff Partners or Officers: Professional/Technical: Support: Total: 5. List memberships in professional societies and organizations. 6. Describe in detail the nature of Applicant s professional or business services. 7. Describe all professional or business services performed for others and indicate the percentage of gross revenues derived from each activity: Professional/Business Services Percent of Gross Revenue 8. Total gross annual payroll: 9. Estimated gross annual revenue for the coming year: ERRORS & OMISSIONS INSURANCE APPLICATION - PAGE 1 OF 7

2 10. Percentage gross annual revenue for the coming year Domestic: Foreign: 11. Annual gross revenues for the last three years Last twelve months (date from: to: ): $ First prior year (date from: to: ): $ Second prior year (date from: to: ): $ 12. Enter Applicant s revenue by state (attach a separate sheet if necessary). State of Revenue State of Revenue 13. Is the Applicant engaged in any business or profession other than as described in items 6 and 7 above? 14. Is the Applicant owned by, associated with or controlled by any other business? If yes, attach an explanation and indicate the services provided by such business and if Applicant provides professional or business services to such business. 15. During the last year, has the Applicant been involved in, or is the Applicant presently considering or contemplating any merger, consolidation, or acquisition? 16. During the last year, has the Applicant been involved in, or is the Applicant presently considering or contemplating any change in the nature of business operations? 17. During the last year, has the name of the Applicant been changed? 18. Were more than 50 of the Applicant s gross revenues for any of the last three years derived from any one contract? If yes, specify client, professional services, and duration of contract: 19. Does the Applicant utilize the services of independent contractors or subconsultants? If yes, indicated percentage of billings and whether a certificate of errors & omissions insurance is required of each: 20. Does the Applicant use industry standard forms and contracts? 21. Have the Applicant s contracts and procedures been reviewed by a law firm? ERRORS & OMISSIONS INSURANCE APPLICATION - PAGE 2 OF 7

3 POLICY / CLAIM INFORMATION Limit of liability requested: Effective date requested: Deductible requested: Retro date requested: Previous Errors & Omissions Insurance (if no previous coverage, state none ) Claims Made or Policy Period Insurer Occur. Policy? Limit of Liability Deductible Retroactive Date Premium 22. Does the Applicant carry general liability insurance? If yes, provide the following: Insurer: Policy limit: Policy period: Does coverage include products/completed operations hazard? 23. Has any insurer canceled, rescinded, nonrenewed or declined any similar insurance for the Applicant, its predecessors, subsidiaries, affiliates, employees and/or for any other person or entity proposed for this insurance in the last five years? If yes, attached a copy of such insurer s notice. [Missouri Applicants Need Not Respond] 24. Has the Applicant and/or any of its directors, officers, employees, and/or its predecessors, and/or any person or entity proposed for this insurance been involved in or have knowledge of any pending or completed regulatory, investigative, or administrative proceedings? If yes, attach a copy containing details, including outcome of such proceedings. 25. During the last five years, have there been any errors, omissions, or professional liability claims against the Applicant, its predecessors, subsidiaries, affiliates, employees and/or against any other person or entity proposed for this insurance? If yes, attach complete details, including description of allegations, status of claim, amounts demanded or paid, date of claim, and action taken to prevent the same type of claim in the future. 26. Is the Applicant aware of any alleged act, circumstance, situation, error or omission which may result in a claim being made against the Applicant which might fall under the proposed insurance? If yes, provide details. MORTGAGE BROKER / BANKER INFORMATION 27. Percentage of gross annual revenue as a Mortgage Broker: and/or Mortgage Banker: 28. What percentage of the Applicant s gross annual revenue comes from the following activities: Loan Originating FHA or VA Loans Loan Servicing Refinances Loan Sales Manufactured Housing Interest Income Other Total 100 ERRORS & OMISSIONS INSURANCE APPLICATION - PAGE 3 OF 7

4 29. Total loan value of mortgages closed during the last 12 months: $ 30. Number of mortgages closed during the last 12 months: 31. Average loan value of mortgages closed during the last 12 months: $ 32. List the five largest financial institutions Applicant originates loans for: Financial Institution of Total Does the Applicant have a repurchase agreement with the financial institutions it originates loans with? If yes, complete the following: Number of loans repurchased 34. Does the Applicant have any underwriting authority to make any loan? If yes, what is the limit? $ 35. Dollar amount of largest loan originated in: Current Year $ Prior Year $ 2 nd Prior Year $ 36. Dollar amount of largest loan serviced in: Current Year $ Prior Year $ 2 nd Prior Year $ 37. Provide the percentages in the last 12 months for each mortgage type (need not equal 100): i. Conventional Government ii. 1 st Mortgage 2 nd Mortgage iii. Owner Occupied Non-owner Occupied iv. Purchase Refinance v. Conforming Non-conforming vi. Existing New Construction 38. Provide the percentage for each mortgage type for each period indicated (need not equal 100): Reverse Mortgages Interest Only Prime (A paper) Sub-Prime (B paper) Sub-Prime (C paper) Sub-Prime (D paper) Residential Commercial Fixed Rate Adjustable Rate ERRORS & OMISSIONS INSURANCE APPLICATION - PAGE 4 OF 7

5 39. What percentage of loans originated are reviewed by separate quality control personnel? 40. What percentage of loans originated are for clients who applied over the internet? 41. Yield Spread Premiums a) Does the Applicant receive compensation from Yield Spread Premiums? If yes, complete b) and c) b) Enter the percentage of revenue derived from Yield Spread Premiums: Next Year (Projected) of Revenue from YSPs c) Describe the procedure in place for disclosing the yield spread premium to the borrower: 42. Does the Applicant have a warehouse line of credit? If yes, what is the amount? $ 43. Does the Applicant, or any organization controlled by, owned by, or commonly owned, affiliated or associated with the Applicant: a) currently provide loan funding, including partial funding or short term funding, or have an in-house line of credit? b) in the last five years provided loan funding, including partial funding or short term funding, or had an in-house line of credit? 44. Are loans closed without advanced commitment to purchase the loan? If yes, please respond to the following: a) Average length of time the Applicant is in possession of the loan: b) Maximum length of time the Applicant is in possession of the loan: 45. What is the default rate of loans made in the: Default Rate: 46. Please list the federally sponsored agencies the Applicant has relationships with: 47. Are any mortgage banking activities provided to any affiliated entities including any Title Escrow or Real Estate Development Company? If yes, approximately what percentage of gross annual revenue is from this activity? 48. Does the Applicant hold the appropriate licenses in the states which require Mortgage/Correspondents to be licensed? 49. In which states is the Applicant licensed? ERRORS & OMISSIONS INSURANCE APPLICATION - PAGE 5 OF 7

6 50. In which states does the Applicant operate where they are not licensed? 51. Has any of the Applicant s license(s) ever been suspended, placed on probation, revoked or restricted in any way? 52. Has the Applicant ever been reprimanded, disciplined or fined by any government agency, regulatory entity, investor group, warehouse wholesaler/banker, or the Department of Housing and Urban Development (HUD)? 53. Is the Applicant aware of any violations of laws in the following areas: a) Real Estate Settlement Procedures Act? b) Truth in Lending? c) Equal Credit Opportunity? 54. Has the Applicant ever been denied a written correspondent or loan broker agreement with a lender? 55. Has any mortgage lender ever cancelled or withdrawn a written correspondent or loan broker agreement? 56. Does the Applicant hold funds in escrow? If yes, does the Applicant hold these funds in a fiduciary account? 57. Enter limit of Applicant s fidelity or surety bond: $ or No Bond 58. Does the Applicant or any organization controlled by, owned by, or commonly owned, affiliated or associated with the Applicant perform property appraisals? 59. Does the Applicant sub-contract property appraisals? If yes, is sub-contractor required to carry E&O insurance? 60. Are in-house reviews of appraisals provided? 61. What procedures are followed to ensure that proper hazard/flood insurance is in place at closing? ERRORS & OMISSIONS INSURANCE APPLICATION - PAGE 6 OF 7

7 62. Does the Applicant receive referrals from a parent company or any organization controlled by, owned by, or commonly owned, affiliated or associated with the Applicant? 63. Has the Applicant ever closed a loan with a lender that is currently in bankruptcy or no longer in business? If yes, list the defunct mortgage lending company(ies) and the number of loans placed: Company Name Number of Loans Attach the following documents List of owners, partners, and officers and percentage of ownership in Applicant. List of all branch offices including a breakdown of staff at each location. Resumes, including professional qualifications, of each of the owners, partners, officers, and key employees of Applicant. Current brochure or similar item describing activities or services. Most recent financial statement or annual report. A copy of Applicant s formalized standard client contract. A copy of the outline from the Applicant s Quality Assurance / Quality Control manual. FRAUD WARNING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or submits a claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. Completion of this application does not bind coverage nor does it obligate any insurance company to issue a policy or insure any services. CB Malaga Insurance Services LLC may not be able to obtain quotation from any insurance company on behalf of Applicant. The limit of liability in the policy, if issued, may be reduced or completely exhausted by claim costs and/or legal defense, and, in such event, the insurance company shall not be liable for the costs of legal defense or for the amount of any judgment or settlement to the extent that such exceeds the limit of liability. The undersigned Applicant further declares that he or she has read and understands the entire application including the applicable fraud warning and that the statements set forth in this application are true and complete and that if the information supplied on this application or attachments changes between the date of this application and the inception date of the policy, the Applicant will immediately notify CB Malaga Insurance Services LLC of such changes. Applicant s Name Signature Title Date Application must be signed by an owner, officer, partner or principal of Applicant. Please complete and sign this application and return to us: By (scan of application) at info cbspecialty.com or by fax at (310) ERRORS & OMISSIONS INSURANCE APPLICATION - PAGE 7 OF 7

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