Date of Application:

Applicants name:

Applicants Lawyer or Law Firm: Customer File No:

Project Name:

Present Owner's Name:

Property Identification of Premises to be Insured:

Lot:     Block:     Municipality:     State: 

• Was title previously insured?

• Is a copy of the prior policy presented with this title application? 

• Prior Policy issued by:

• Is a copy of the present owner's deed attached?

• Is a Deed Book and Page reference provided?

What is the proposed date of closing?

When is the Commitment to Insure needed by?

SPECIAL INSTRUCTIONS

Specifics of Policy(ies) requested:

• ALTA Owner's Policy 

• Form Specified: 1992 ALTA Policy Form 
• 1970 (rev.10/17/84)
  ALTA Policy Form 

[yes ]

• "Standard Coverage" or "Extended Coverage"

• Amount of coverage requested: $

• Name of Proposed insured(s):

• ALTA Loan Policy

• Amount of Coverage requested: $

• Name of Proposed Insured Lender(s):

What Special Endorsements or Multiple forms of Coverage are requested? (please attach details)

Are there any Special Reinsurance/Co-insurance Requirements? (please attach details)

This Concludes the Initial order process
Please proceed to the bottom of the form to submit.

• Are there multiple lenders to this transaction?

• Will Participation Agreements be recorded?

• If there are multiple lenders how is the transaction structured? (please explain detail on separate page)
  

• Is this a refinance of an existing loan?

• Is this a modification of an existing mortgage or policy?

• Is this a Construction Loan?

Does this transaction include new construction?

• Is special coverage requested against mechanic's liens?

• Has a Stipulation Against Liens been filed?

• Have lien waivers been obtained?

• Is the project covered by Payment and Performance Bonds or otherwise bonded over?

• Is there concern of Loss of Loan Priority?

• What is the cause of the concern?

• Are "Date Down endorsements" requested upon each draw? 

• Is Indemnification Offered?

• Who will sign indemnities?

• Will the proposed insured agree to answer more detailed questions submitted on a Mechanic's Lien Risk Form?

• Type of Improvements to be erected:

Does the proposed new construction include a Restrictive Covenant Risk?

• Is it presently existing or contemplated?

• What is the nature of the violation?

• Is there a known enforcement, reverter or re-entry provision?

• Is there specific coverage requested?

• Is Indemnification offered?

• Who will sign indemnities?

What General Exceptions are to be deleted?

1. Taxes and Assessments;

2. Matters of Survey;

3. Parties in Possession;

4. Easements and Claims of Easements;

5. Mechanics' Liens

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