APPLICATION FOR ASSET INSURANCE PROTECTION
(Please print this application, fill it out, then mail or fax it using the information above)

THIS INSURANCE COVERAGE PROVIDES PROTECTION FOR FINANCIAL INSTITUTIONS FOR
THEIR FORECLOSED PROPERTIES (REO, OREO) AND FORCED PLACE (NO SHOW, FORCED ORDER)
PROPERTIES - COMMERCIAL OR RESIDENTIAL

FINANCIAL INSTITUTION NAME__________________________________________

ADDRESS____________________________________________________________

CITY_______________________________________ST_____________ZIP________

MAILING ADDRESS____________________________________________________

PHONE (_______)_______________________ FAX (_______)__________________

OFFICER _____________________________CONTACT ______________________

TYPE OF FINANCIAL INSTITUTION _________________YRS IN BUSINESS______

HAS INSTITUTION EVER BEEN UNDER RECEIVERSHIP
OR CONSERVATORSHIP? ____

POLICY INFORMATION

EFFECTIVE DATE OF COVERAGE ________________________________________

1.) IS REO COVERAGE DESIRED?__________

     RESIDENTIAL__________COMMERCIAL_________

2.) REO LIABILITY COVERAGE DESIRED?___________

3.) IS FORCED PLACE COVERAGE DESIRED?__________

     RESIDENTIAL__________COMMERCIAL_________

DEDUCTIBLES REQUESTED:

COMMERCIAL _________________RESIDENTIAL________________

Coverage type requested:

Replacement Cost _____Actual Cash Value_______Loan Balance________

PLEASE ATTACH A SCHEDULE OF PROPERTIES TO BE INSURED TO
INCLUDE ADDRESS, CITY, STATE, ZIP CODE, IDENTIFIED AS REO,
FORCED PLACE, RESIDENTIAL, COMMERCIAL, VACANT LAND,
AND VACANT OR OCCUPIED.

PRIOR CARRIER INFORMATION

Has applicant had coverage?________ If yes, Previous Carrier__________________

Coverage dates_____________Annual Premium____________Deductible____________

Has applicant had any losses last 3 years?______________If yes, please list below:

Please attach loss runs from prior carrier.

Any policy or coverage been declined, cancelled or non-renewed in 3 years?_________

UNDERWRITING INFORMATION

Are regular inspections made of the foreclosed properties? ____________How often______

Are there written procedures for the inspection of properties?_________________*

*(PLEASE PROVIDE COPY OF PROCEDURES WITH APPLICATION)

Who makes the inspections?_____________________________________________

Is any outside firm contracted to make inspection? Realtor/Broker or
Management Firm or Other ______________________________________________

Exterior and Interior inspected_______Written report received?_______________

**Important** Are vacant properties properly secured?____________
Monthly interior and exterior inspections?___________
Are vacant properties winterized?____________

Applicant’s Signature:____________________________________Title__________

                                           Broker/Agent information

Agency Name:____________________________Agent Name:________________

Address:____________________________________________________________

City____________________________STATE_______________Zip_____________

Date signed:_____________Telephone_________________Fax________________

Agent’s Signature:___________________________________________________