Select a State
District of Columbia
Email Address *
Daytime Phone # *
Member # / Agency Customer ID (if applicable)
Please note that this is a claims-made policy
Amount of Coverage *
Per Claim/$150,000 Aggregate
Per Claim/$250,000 Aggregate
Effective Date (mm/dd/yyyy) *
State(s) and Expiration Date(s) of Current Notary
Number of Years
Experience as a Signing Agent
Number of Signings
Have you taken training and/or been certified to
handle signing documents for mortgage lenders, title or
escrow companies? *
Date Training Completed (mm/dd/yyyy)
If you carry Notary Errors and Omissions
Insurance, what is the limit? $
Any claims filed against any Notary or Signing Agents
Errors and Omissions Insurance or have you been sued for
activity in regards to a loan signing? *
No If yes, please explain.
Criminal background check done? *
If yes, when?
Notary or Signing Agents organization memberships or
Do you keep a journal of Notarial acts? *
Do you handle closing funds at signings? *
Notice to Applicant – Please read carefully
warrants that the information contained herein is true
as the date this application is executed and understands
that it shall be the basis of the policy of insurance
and deemed incorporated herein if the Insurer accepts
this application by issuance of a policy.
Yes, applicant so warrants.
No, provide complete details to Company.
By visiting our Web site, you accept the terms and conditions described in our
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Before submitting your request, be sure to check our list of Frequently Asked Questions. You can also contact us by calling 1-800-331-6053 or faxing us at 1-605-335-0357.