Applicant Information - National Risk Management

Low Hazard Special Events
Insurance Program

Applicant Information

(Step 1 of 5)

View Program Highlights

There were errors with this submission. Please correct the errors below and resubmit.

Fields marked with an asterisk (*) are required.

Legal or Business Name *

Policyholder Name

Please enter a name above.

Type of Operation *

Corporation

Individual / Sole Proprietor

Partnership / Joint Venture

Limited Liability Company (LLC)

Other

DBA Name *

Other Type *

Contact *

Contact Email *

Confirm Email *

Phone *

This contact information will be used by insurance company personnel should there be a claim. It is the responsibility of the policyholder/insurance contact to retain all documentation, video or other evidence and respond immediately to all requests or inquiries from insurance company personnel.

* Is the above contact the insurance claim contact?

Yes No

Mailing Address *

For Questions: National Risk Management
(407) 767-2950
robert.ray@nrmafla.com