J. B. Lloyd & Associates, LLC 



Force Place Hazard/Force Place Flood/Foreclosed Property

  Enrollment Form


Note:  Policies will be issued in the name(s) of all of the lender’s name(s) listed.. Please list all addresses of lender’s name(s).  All questions and answers apply to all lender(s) listed.  It is acceptable to complete an enrollment form for each lender desiring coverage.  Please answer all questions.

 1.   Lender’s Name:   

      Street Address:    

      City:                            State:         Zip:           

      Contact Person:            Telephone:     



      A.  Number of Offices  (attach address listing)                     

      B.  Loan Originations:  Please indicate the number and average of loan originations per year.

            Residential:            No.         Value                 

      Mobile Home:           No.         Value                  

      Commercial:               No.         Value              

How many loans are sold or sub-serviced annually?


            1. Current Loan Portfolio (approximate)


Number of Escrowed Loans

Number of Non-Escrowed Loans

Avg. Loan Balance

Avg. Term

Residential 1st Mtg.




Home Equity

            2. Are there any unusual exposures?    YES   NO 

      If “YES,” please describe: 


      3. What percentage of portfolio is B & C paper?                     

      D.  Types of Property to be Insured:  Residential     Commercial     REO 

 a. Will there be properties under construction? YES   NO    If yes, report completed value when

                construction is finished at the time property is added.  Also report if property is under construction.

E.  Geographic Information:   Please indicate all States in which your organization issues

      mortgages. Attach a zip code aggregate report that indicates total values and number

      of  locations, by zip code, if available: 



      F.  Please provide a current schedule of properties, if any, to be insured:

           Attached here:

      G.  Is Liability coverage desired for foreclosed properties? YES    NO

      H.  Is force placed and/or foreclosure coverage presently in effect?  YES   NO

            If so, indicate present carrier name, effective/expiration dates and policy number:


            Present Rates:

    Residential      Mobile Home         Commercial        Liability (REO)  

      Present Deductible:     

   Residential      Mobile Home         Commercial        Liability (REO)  

      Loss Experience:  Please indicate all losses and insurance recoveries for the past three years.


      Has any similar coverage been canceled or non-renewed during the last three years?  YES   NO   

      If so, please give details (name of carrier, policy dates, reason):


      I.  1. Do you currently monitor your loans for hazard insurance?  YES   NO

          2.  If you monitor your loans, how are the loans monitored?  In-house Outsource

J.  1.  Please list names, email addresses and fax numbers of all Preparers of FP Properties:      


    2.  List names, email addresses and fax numbers of all Preparers of FC Properties:


K.  Do you have an in-house Insurance Agency?  YES     NO

            If so, please attach license

The Lender agrees to maintain accurate books and records for the purpose of establishing the effective date of coverage for any property to be   covered under this policy and to permit access to such records by any representative of the Company/Insurance Carrier(s).

 Printed Name:                      



 Resident Surplus Lines Broker Name:                     

 Street Address:                     

  City:               State:    Zip:    Telephone

 Producing Agent Name:                     

 Street Address:                     

  City:               State:    Zip:    Telephone: