The highlighted questions contain errors. Please review and amend.

This site allows you to quickly request servicing on your client’s policy or submit a general inquiry. Most requests will be responded to within 1 business day.

If you have any questions or need to speak with us regarding your request, please contact us at 1-866-739-0727, Mon – Fri from 7 am to 10 pm ET.

Your Information

First Name*

Last Name*

Hiscox Partner/Wholesaler Affiliation

Name

Agent ID

Email Address

Phone Number

Policy Servicing Requests

Agent & Partner Servicing Requests

Your Hiscox partner/wholesaler affiliation

Email address

Phone number

Please provide any special wording required on the certificate.

Policy Servicing Requests

Named insured (Business name)

Hiscox policy number

Please select one or more of the following options

Issue an Additional Insured an ACORD certificate

Send an ACORD certificate (Certificate holder request) as described here

ACORD certificate (Certificate holder request)

The one-page ACORD certificate of insurance summarizes essential information about your insurance policy, such as coverage types, policy numbers, insurance limits, and effective and expiration dates. If your client or landlord requires additional insured status under written contact with you we will issue the Acord certificate holder with additional insured status.

Add Authorized Person

Address Change

Business Name Change

Policy Document Request

Add a Waiver of Subrogation endorsement as described here

Modified Waiver of Transfer of Rights of Recovery Against Others to Us (Waiver of Subrogation)

General Liability: Some client contracts or landlord lease agreements require your Commercial General Liability insurance to include a waiver of subrogation. If your contract or lease agreement requires this coverage modification, you can include it on your policy for an additional fee.
This endorsement allows you to waive your rights against another party so long as you do so in writing prior to:
An offense arising out of your business that caused a “personal and advertising injury” or an "occurrence" that caused "bodily injury" or "property damage".

Professional Liability: Some client contracts require your Professional Liability insurance to include a waiver of subrogation. If your contract requires this coverage modification, you can include it on your policy for an additional fee. This endorsement allows you to waive your rights of recovery, provided that Your waiver of Your rights is in writing and predates the first such Wrongful Act giving rise to the Claim resulting in payment of Damages or Claim Expenses by Us.

Other

Submit Documents

Questions/Comments (Please be as detailed as possible)

Please indicate which of your client’s policies you would like to update:

Professional Liability (also known as Errors & Omissions)

General Liability

Business Owners Policy

Please provide the name and address of the entity requesting the waiver of subrogation.

What is your client’s relationship with this party?

Client

Landlord

Other, please explain

Please describe the professional service your client will provide to this party (Limit 1000 Characters)

Provide a brief description of your client’s professional services (please provide more detail than “Consulting”, a brief description will expedite handling).

If you are an Architect, Engineer or Design professional we will require a copy of your contract with the waiver of subrogation insurance requirement and the detailed statement of work. Please email this to contact@hiscox.com.

For the waiver of subrogation endorsement, a 10% premium charge will be applied to the policy. Please confirm:

Please Confirm:

I give Hiscox Insurance Company, Inc. my consent to automatically charge any additional premium using the credit card on my client’s policy.

Additional Insured Information

Landlord

Loss payee

Note: Please type the additional insured’s name exactly as you want it to appear on the documentation. Only one client name is allowed per Additional Insured endorsement. Multiple client names or client entities will be listed on separate endorsements.

Note: Please type the additional insured’s name exactly as you want it to appear on the documentation. Multiple landlord entity names for the same address may be listed on the same endorsement.

Name of Additional Insured (entity will be listed as a certificate holder on the ACORD)

Street

Secondary street (optional)

City

State:

ZIP code

Description of operations:

Please click here if your client or landlord requires specific language on the ACORD certificate. You understand and agree any language entered in the description of operations wording field does not alter or change any of the policy's terms and conditions.

Description of operations wording - some clients ask for specific language to be added to the ACORD certificate to meet their requirements. If your client has requested this, please enter it here. If not, please leave this section blank.

Please provide a description of the services you will perform for this client:

Please include a description of leased property and estimated value.

Please describe your relationship with the third party and why an Additional Insured status is being requested.

Acord Request

Certificate holder (the name of the business requesting a certificate of insurance)

Street

Secondary street (optional)

City

State:

ZIP code

Description of operations:

Add Authorized Person

Authorized Person Name

Authorized Person Last Name

Role

Phone Number

Email Address

Address Change

Street

Secondary street (optional)

City

State:

ZIP code

Square feet occupied at this address

Total number of business locations

Any change in business services, if yes please describe.

Business Name Change

Reason for change

Typographical Error

Other, please explain

Reason for change explanation

Has your business experienced any of the following?

Adverse financial event

YesNo

Unreported claim or loss

YesNo

Change in services

YesNo

Change in control

YesNo

Merger, acquisition, or other change in ownership

YesNo

Business Name

Policy Document Request

Reason for Request

Resend Policy purchase documents

Other

Please advise what document/documents are requested

Agent & Partner Servicing Requests

Please select one or more of the following options

Partner

Agent ID

Request a Loss Run

Missing Credit for Policy Sale or Commission

Request Broker or Agent of Record Change

Submit Documents

Request a Loss Run

Named Insured (Business Name)

Hiscox Policy Number

Where should we send the Loss Run Report (Email Address)?

Missing Credit for Policy Sale or Commission

Named Insured (Business Name)

Hiscox Policy Number

Date of Sale

Any other additional comments

Request Broker or Agent of Record Change

Broker of Record Change Form

Effective Date

Please upload your completed request form. We will contact you if we need further information.

Any other additional comments (optional)

Uploaded documents

You will receive a set of your most recent Hiscox policy documents via email within one business day.

Hiscox Agent

If applicable, please enter the name of the Hiscox Agent who requested these documents.

Please describe briefly what you would like us to do with these submitted documents.

If this is in response to a request from us, please provide a brief description regarding the reason we asked for these documents (as this request will be processed by a different individual than the one you spoke to or heard from earlier.)

Please limit your response to 1000 characters

You can find the policy number on the upper right hand corner of the policy documents or emails we’ve sent you. The policy number will begin with a UDC or P100.

Please click "Browse" and "Upload" to submit up to 5 files with a total size of 25 MB.
Acceptable files: PDFs, Outlook email files (.msg), HTML files, Word docs, Excel docs and jpgs.

Thanks for choosing Hiscox to protect your client’s business.