Crime Application Email for non-humansApplicant(s)Applicant(s) Include all trade names and insured’sApplicants Repeater 1 Applicant * 1 Applicant * Add Applicant Address(es)Address(es) Include all locations, if there is more than oneAddress Repeater 1 Address * City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Address Line 2 1 Address * City * State * - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip * Address Line 2 Add Address Telephone *Email Address *Organization Description * Proprietorship Partnership Corporation LLCTitle Agency * Yes NoYear Operations Began *Year Operations BeganLaw Firm * Yes NoYear Operations Began *Year Operations BeganHave you operated as a title agent under any other name in the past 3 years? * Yes NoPlease provide the other name(s) under which you operated *Has there been an ownership or management change in the past 3 years? * Yes NoPlease give the details surrounding the change *Any losses known or reported in the past 3 years? * Yes NoPlease provide the explanation(s) for the losses *Are all locations secured by an alarm system? * Yes NoDo all locations contain a safe? * Yes NoWhat is the number of employees who handle, have custody of, maintain records or, or have access to money, securities, or other property owned by you or your clients? *#What is the number of outside messengers? *#Current CoverageCurrent CoverageCarrierFidelityLimit$Deductible$Expiration Date CarrierSuretyLimit$N/A Expiration Date Scope of Financial Statement Preparation Internal CPA Compilation CPA Review CPA Audit None Insuring Agreements CoveragesInsuring Agreements CoveragesCoverage limit table Choose overall limit $250,000 $500,000 $1,000,000 Coverage Coverage Employee Dishonesty Forgery or Alteration Computer Fraud Funds Transfer Fraud Fraudulently Induced Transfers Limit of Insurance - 0 Limit of Insurance $0.00 $0.00 $0.00 $0.00 $0.00 Limit of Insurance - 250k Limit of Insurance $250,000 $250,000 $250,000 $250,000 $250,000 Limit of Insurance - 500k Limit of Insurance $500,000 $500,000 $500,000 $500,000 $500,000 Limit of Insurance - 1mil Limit of Insurance $1,000,000 $1,000,000 $1,000,000 $500,000 $500,000 Do you deposit and disburse funds for Closing and Settlement? * Yes NoAre funds deposited in a trust account separate from operating accounts? * Yes NoWhat is the average daily escrow (trust) account balance? *$Does the file contain loan closing and documentation of compliance with instructions? * Yes NoAre all escrow or trust funds reconciled by an independent party on a monthly basis? * Yes NoList and explain any discrepancies *Are you periodically audited by the title companies you represent? * Yes NoIndicate if you perform any of the following during the hiring process Prior employment verification * Yes No Drug testing * Yes No Education verification * Yes No Credit history * Yes No Criminal history * Yes No Are all incoming checks stamped "For Deposit Only" immediately upon receipt? * Yes NoAre bank accounts reconciled and controlled by… * The Owner The EmployeesFor employee bank account reconciliation, is there segregation of duties for the following? Deposits * Yes No Please provide an explanation * Withdrawals * Yes No Please provide an explanation * Check signing for Trust accounts * Yes No Please provide an explanation * Check signing for Operating accounts * Yes No Please provide an explanation * Check initiation and Check disbursement * Yes No Please provide an explanation * Reconciliation * Yes No Please provide an explanation * Does any Employee(s) have authority to execute a wire transfer? * Yes NoIs the ability limited to specific employees? * Yes NoHave authority for wire transfers outside the United States? * Yes No N/ADo you have any procedures to verify the identity and authenticate new customers before entering into a transaction with them?* * Yes NoPlease explain your screening procedures *Do you accept wire transfer instructions from customers over the telephone, fax, email, or some other electronic communication method? * Yes NoPlease explain your procedure to authenticate the instructions *Do you verify the followingDo you verify the following Do you investigate new customers through a credit reporting agency? * Yes NoDo you verify and confirm the customer's bank account information (account numbers, routing numbers, bank name and address) by calling the bank directly? * Yes NoDo you verify requests to change the customer or funds recipients' bank account information or wire instructions by calling the customer or funds recipient at a telephone number previously provided by the customer or funds recipient? * Yes NoDo you verify the amount requested to be transferred equals the amount due to the customer or funds recipient?* * Yes NoDo you accept and verify wire transfer instructions from your employee, officers, and owners over the telephone, or by fax, email, or some other electronic communications method? * Yes NoPlease explain your procedure to authenticate the instructions *Is there a written policy regarding wire transfers? * Yes NoDo wire transfers to an account outside the United States require review and approval by a supervisor? * Yes NoIs the authority to execute wire transfers limited to specified employees? * Yes NoWhat is the average daily dollar amount of wire transfers? *$What is the single largest amount that can be transferred? *$What is the average monthly number of fund transfers? *#Do all your computers, servers, and portable devices contain the following: Firewall Protection * Yes No Anti-virus software * Yes No Malware Protection * Yes No Spoofing Protection * Yes No Software to encrypt personal information stored * Yes No Do you provide anti-fraud training, including social engineering, phishing, masquerading, and other fraud schemes, to all employees? * Yes NoDo you restrict customer information access to only a particular employee? * Yes NoDo you control access to customer information in your computer systems? * Yes NoDo you implement access controls and firewalls in your database of customer information? * Yes NoDo you restrict access to only particular employees of yours? * Yes NoDo you require the customer to authenticate his or her identity by using passwords, personal identification numbers, shared secrets, tokens, or biometrics before the customer may access his or her data? * Yes NoDo you control the dissemination of customer information? * Yes NoDo you have a company policy prohibiting the dissemination of personally identifiable information pertaining to the customer? * Yes NoDo you provide customer information only to a designated representative of the customer? * Yes NoDo you require the customer requesting customer data to authenticate his or her identity by using passwords, personal identification numbers, shared secrets, tokens, or biometrics before the customer may access his or her data? * Yes NoSubmit
