Zurich Programs Business questionnaire

Please complete the following form in order to submit your program information to Zurich Programs Business for review. A Regional VP will contact you within two business days.

Program questionnaire

Step 1 - General information* Required field
Name:* Required
Title:* Required
Company name:* Required
Address:
City:
State:*                              
Zip:
e-mail:* Required
Phone:* Required
Where did you hear about us:* Website
Conference
Trade Magazine or Publication
Other

Step 2 - Program information
Name of program:
Program inception:
Premium for each of last three years:
Loss ratio for each of last three years:
Description of the program's target market (class of business, average per account range, number of accounts in the program, unique exposures or coverages, etc.):
States or regions for writing the program:
Coverage/limits/retention desired:
Current carrier:
Reason for looking to a new market:
Time frame for establishing a new market:
Summary of activities performed by program administrator:
Additional comments:
Please include any attachments relevant to your programs submission:
Please include any attachments relevant to your programs submission: