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Applications & Forms
The forms below are supplied for the sole use of our appointed retail agency force. You may email the completed forms to the appropriate W.E. Love employee.
American Southern1 ASIC Cargo ApplicationGreat Reasons to Pick ASICI American Southern Cargo Application CanalAlabama (092009)Arkansas (092009)C H Robinson Letter from CanalCanal Renewal Anniversary 112009 Canal WEL Quote BenefitsFlorida (09_2009)Florida Public Auto (09-2009)Florida Public Auto Renewal FormFlorida Renewal FormGeorgia (092009)Illinois (09-2009)Indiana (09_2009)Iowa (09-2009)Kansas (092009)Kentucky (092009)Minnesota (09-2009)MTC Coverage From PreferredNebraska (092009)News Flash Attention Florida AgentsNews Flash Attention Iowa AgentsNews Flash Attention Minnesota AgentsNorth Carolina 10-2010Ohio (09_2009)Oklahoma (092009)Pennsylvania (09-2009)Tennessee (092009)Texas (09_2009)Virginia (09-2009)West Virginia (09-2009)Wisconsin (09-2009) ChartisChartis Application CNA Intermodal1 CNA Application 1 to 10 units 0710 NEW1 CNA Application 11 Units and moreAlabama UM 89827 0708Alaska 16194 0708Arizona UM 43592 1008Arkansas PIP 144196 1102Arkansas UM 43593 1008California UM 43937 0209Colorado Med-Pay 300711 Colorado UM 43768 0707Connecticut UM 20474 0510Delaware UM 89816 0502District of Columbia PIP 144197 1102District of Columbia UM 89817 1203Florida PIP 44545 0704Florida UM 43319 1203Florida UMB 129970 0498Georgia UM 44127 0109Georgia UM NOTICE 300711Hawaii UM TAF3001 0907Idaho UM 43764 0109IL UM 43949 0307Indiana UM 89807 0709Iowa UM 142639 1203Kansas PIP 144198 1102Kansas UM 89812 1203Kentucky Anti Theft Kentucky PIP 142647 0310Kentucky UM 44130 1010Louisana UM 39386 0109Maine UM 89825 1203Maryland PIP 144237 1102Maryland UM 44220 1102Massachusetts UM 16892 0404Michigan PIP 144199 0509Minnesota PIP 144201 1102Minnesota UM 43773 1102Mississippi UM 44400 0106Mississippi UM Non Stacked 142642 0106Missouri UM 17882 1203Montana UM 142637 1203Nebraska UM 115122 1203Nevada UM 16225 1010New Hampshire UM Excess 20893 0494New Jersey PIP 44203 1102New Jersey UM 44133 0104New Mexico UM 43940 1205New York G89818 072010New York PIP 144204 0707North Carolina UM 89010 0109North Dakota PIP 144202 1102North Dakota UM 43767 1203Oklahoma UM 16372 0205Oregon PIP 144205 0904Oregon UM 43765 1010Pennsylvania PIP 144206 1102Pennsylvania UM 144207 1293Rhode Island Med-Pay 300835 Rhode Island UM 89828 0104South Carolina UM 43950 1006South Dakota PIP 144208 0303South Dakota UM 43958 0104Tennessee UM 142641 1203Texas PIP 144209 0706Texas UM 43952 0408Utah PIP 144213 1102Utah UM 89822 1203Vermont UM 43948 1203Virginia PIP 144210 1102Virginia UM 43946 1203Washington PIP 144211 1010Washington UM 43954 0104West Virginia UM FormA 20414 0500West Virginia UM FormB 20415 1002Wisconsin UM 118168 0510Wyoming UM 142638 1203 Great American1 Great American Cargo ApplicationGAIC Sample MTC Policy Important WorkFlow Email AddressesLoss Notice TemplateWorkFlow Email Addresses Star Insurance Company1 Star Application 1 - 10 Units NEW 71020101 Star Application 11 or more units2 AL and PD sample MCCF2 CR & GL Sample Policy2 New PD Additional CoveragesA List of Reasons For StarA Reason or 2 For StarAccord Loss FormAlabama 137 042004 fillableArkansas 137 200405 fillableArkansas 61 201004 fillableDeleware 137 200607 fillableDeleware 62 200410 fillableFlorida 137 200908 fillableFlorida 61 200806 fillableFlorida 62 200806 fillableFlorida 64 200806Georgia 137 200902 fillableIllinois 137 200901 fillableIllinois 61 200301 fillableIndiana 137 200909 fillableIowa 137 200701 fillableIowa 61 200202 fillableIowa 62 199802 fillableKansas 137 200701 fillableKentucky 137 200604 fillableMaryland 137 200912 fillableMaryland 62 011998 fillableMichigan 137 092000 fillableMichigan 62 032010 fillableMinnesota 137 200608 nonfillableMississippi 137 200409 nonfillableMississippi 61 200601 fillableMissouri 137Nebraska 137 201001 fillableNew Mexico 137 200504 fillableNew Mexico 61 200504 fillableNorth Carolina 137 201002 fillableOhio 137 200211 fillableOklahoma 137Oklahoma 60 200911 fillableOklahoma 61 199403 fillablePennsylvania 137 200907 fillablePennsylvania 60 200802 fillablePennsylvania 61 200708 fillablePennsylvania 62 200801 fillableSouth Carolina 137South Carolina 61 200708 fillableSouth Dakota 137Star WEL BenefitsTennessee 137 200201 fillableVirginia 137 201006 fillableWest Virginia 60 199312 fillableWest Virginia 61 200010 fillableWest Virginia 62 200010 fillableWisconsin 137 200910 fillable Stratford1 Stratford Maryland Application1 Stratford North Carolina Application1 Stratford Ohio Application1 Stratford South Carolina Application1 Stratford Texas Application2 Stratford Example AL, PD and Cargo PolicyMaryland Supplement 69North Carolina UM UIM South Carolina UM UIM Stratford General Liability Flyer Submissions To WEL122008 Submission InstructionsA List of Reasons For StarEarly Submission Rejection NoticeMTC Coverage From StandardWEL Fleet Appliction 11 or More units 102011 NEW Workers Comp SolutionsWorkers Comp WEL Questionaire