Univista - People's Trust Insurance Company

Request for Binding Authority – Univista

Agency Information

*Agency Name:

*PTI Agency Code:

*Agency Principal Name:

*Agency Principal Email

*Agency Address:

*Agency Principal Phone:

bindingrequire_SBP0316133

Questionnaire

*How many homeowners policies does your Agency sell per month with ALL carriers?

*How many homeowners policies do you estimate your agency will be able to sell per month through Peoples Trust?

*Which counties are you primarily writing new business in currently?

*How many CSRs/Producers does your agency have?

*How many locations do you have?

Any Additional Comments:

Contact Information – for PTI use ONLY

Once you are writing new business our Underwriting and Inspections Departments might need to be in contact your agency regarding policies you have written. In recent times we have been experiencing much longer hold times to get through to some agencies. Please provide DIRECT telephone and email contact information to assist us as fast as possible.

Underwriting Questions

*Contact Name

*Contact Email

*Contact Phone

Inspections Questions

*Contact Name

*Contact Email

*Contact Phone

TRI County Agency Commitment

ANY agency writing business with People’s Trust in Tri-County is REQUIRED to acknowledge that you understand that you MUST write a minimum of 1 policy in Rest OF State for EVERY 1 Policy in Tri-County. There can be no exceptions to this rule. Please also acknowledge that you understand that if your agency is not in compliance with the 1:1 rule by the end of each week your agency will be subject to immediate suspension from binding ANY policies in Tri-County until the 1:1 ratio is restored. Any Tri-County quotes already in our systems will not be honored after suspension.

I acknowledge that my agency is being allowed to write new business with peoples Trust Insurance solely on the condition that the above paragraph is strictly adhered to.

*Name

*Title

*Date