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Insurance Law Podcast

Update Listing

Applicant for Best’s Directory of Insurance Adjusters

This data is required to establish eligibility for your firm and create a permanent file.
Bold fields are required.

Firm Name:
Year Established:
Street Address 1:
Street Address 2:
City:
State/Province:
Country:
Zip/Postal Code:
Firm Telephone:Firm Email:
Firm Fax Number:Firm Website:

Mailing Address:
Address/P.O. Box: City: State: Zip:

Contact Person: Title:
Contact Telephone:
Contact Email:

Adjuster License Number(s) – if applicable
State: Number:
State: Number:

Check type of losses handled by your firm. If other than those listed, please advise in space provided
First Party Losses:
Automobile Physical Damage
Fire & Allied Lines
Inland Marine
Other:

Third Party Losses:
Automobile
General Liability
Bodily Injury
Property Damage
Personal Injury
Workers Comp.
Other:

List Adjuster Association Memberships:

List previous claim experience of primary partner or principal prior to organization of firm:
I.1. Name:
2. State Licenced:
3. Type of Claim Experience:
4. Employment History:
 CompanyPositionFromTo
1.
2.
3.

II.1. Name:
2. State Licenced:
3. Type of Claim Experience:
4. Employment History:
 CompanyPositionFromTo
1.
2.
3.

III.1. Name:
2. State Licenced:
3. Type of Claim Experience:
4. Employment History:
 CompanyPositionFromTo
1.
2.
3.

Important: Please list contact names and addresses of insurance company and non-insurance company clients below:

  • A minimum of two Clients is required in order to process.
  • Only include one contact for each Client.
  • Include name and complete address of individual branch office or department for Client where verification letter will be sent.
Client 1:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 2:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 3:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 4:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 5:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 6:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 7:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 8:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 9:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 10:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 11:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Client 12:
Client Firm Name: Contact Person: Title:
Street Address /P.O. Box: City: Country: State/Province:
Zip/Postal Code: Firm Telephone: Fax: Email: No. of Years Rep.:
Type of Losses Handled:

Submitter Name:
Submitter Email:
Submitter Phone:
 

 

Questions? Any questions about Best's Insurance Professionals Center can be sent to: directories.group@ambest.com.