LIG Maritime Employers Liability Application

Named Insured *

Agent Email Address *

What is the anticipated effective date? * +

This program has a minimum premium of $10,000 if written monoline or $5,000 if written with other supporting marine lines. Please confirm this is acceptable *

Yes

No

We are sorry but as this risk falls below our minimum premium, we are unable to assist you.

Please do remember LIG for your future Marine or Longshore accounts.

Thanks

LIG Marine Managers

Save & Return Account (optional)

New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish. The account you establish is only for this form.

Agent/Broker

First Name *

Last Name *

Agency or Broker Name *

City *

State *

Phone Number *

Please note: many questions have help associated to them. To access this help, hit the blue "?" above the question

Save & Return Account (optional)

New Users / Returning Users CLICK HERE to setup or return to your account for this form. Creating an account enables you to return to this form and your submitted results. An account will also enable you to partially complete this form and return later to finish. The account you establish is only for this form.