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Coverage applies only to claims first made against the insured during the policy period (or any extended reporting period) and reported to the insurer as specified in the claims and events section, with defense costs eroding the limits. The application requires complete answers, attached audited financial statements and annual reports, and supplemental documents for selected coverage types, including representations and reporting obligations for material changes.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/axis-privatus-platinum-new-business-application-axis-101-0576-10-16/179508/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/axis-privatus-platinum-new-business-application-axis-101-0576-10-16/179508.png","ImageObject",442,249,{"name":88,"@type":89},"Xiajie","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-10-24","2026-09-02",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What basis of coverage does this application use?","Question",{"text":108,"@type":109},"Coverage is provided on a claims-made and reported basis, limited to claims first made during the policy period (or an extended reporting period) and reported as specified in the claims and events section.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Do defense costs affect the insurance limits?",{"text":113,"@type":109},"Yes. Defense costs are included in the limits of insurance and will erode—and may exhaust—the limits.",{"name":115,"@type":106,"acceptedAnswer":116},"What materials must be attached when submitting the application?",{"text":117,"@type":109},"The application requests the applicant’s most current audited financial statement and annual report, and full details for each question answered YES. It also references supplemental applications for the selected coverage types.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},179508,1788337262,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":125,"read_time":140},8814010472675,"https://avatar.qwps.com/avatar/WGlhamll","SOLELY AS RESPECTS CLAIMS-MADE LIABILITY COVERAGES UNDER THE POLICY FOR WHICH THIS APPLICATION IS BEING SUBMITTED:  THIS INSURANCE POLICY PROVIDES COVERAGE ON A CLAIMS-MADE AND REPORTED BASIS AND APPLIES ONLY TO CLAIMS FIRST MADE AGAINST THE INSURED DURING THE POLICY PERIOD OR ANY APPLICABLE EXTENDED REPORTING PERIOD AND REPORTED TO THE INSURER AS SET FORTH IN THE REPORTING OF CLAIMS AND EVENTS SECTION.  DEFENSE COSTS ARE INCLUDED IN THE LIMITS OF INSURANCE, AND PAYMENT THEREOF WILL ERODE, AND MAY EXHAUST, THE LIMITS OF INSURANCE.\nABOUT THIS APPLICATION\nThe term “Applicant,\" herein refers individually and collectively to all proposed insureds. All responses shall be deemed made on behalf of all proposed insureds.\nThis Application and all materials submitted herewith shall be held in confidence.\nThe submission of this Application does not obligate the Applicant to buy insurance nor is the Insurer obligated to sell insurance or to offer insurance upon any specific terms requested.\nIf the policy applied for is issued, this Application, which shall include all Supplemental Applications and material and information submitted in connection with this Application, will be deemed attached to and will form a part of the policy.\nINSTRUCTIONS\nRespond to all questions completely, leaving no blanks. Check responses when requested.\nIf space is insufficient, continue responses on your letterhead.\nThis Application must be completed, dated, and signed by an authorized officer of the entity identified in the section entitled \"Applicant Information\" below.\n\u000f\nPolicy Period: From: \u0013 FORMTEXT \u0014\u003Cclick to enter date>\u0015 To: \u0013 FORMTEXT \u0014\u003Cclick to enter date>\u0015.\nComplete the chart below and the respective Supplemental Application attached hereto for each Coverage requested.\nOther Coverage Requests: \u0013 FORMTEXT \u0014\u003Cclick to enter text>\u0015\nPlease attach the Applicant’s most current audited financial statement and annual report.\nPlease provide the following information for the Applicant:\nIs the Applicant currently in violation of a debt covenant?\tYES \u0013 FORMCHECKBOX \u0014\u0015  NO \u0013 FORMCHECKBOX \u0014\u0015\nIs the Applicant currently a going concern or has an auditor issued a going concern opinion for the Applicant in the past two years?\tYES \u0013 FORMCHECKBOX \u0014\u0015  NO \u0013 FORMCHECKBOX \u0014\u0015\nPlease attach full details for each question below answered YES.\nIn the last five years, has any claim, suit, proceeding, or investigation been made against the Applicant or any predecessor in business, or past or present subsidiary, affiliate, owner, partner, member, director, officer, trustee or employee of the Applicant arising out of or related to any activity described in this Application or for which coverage would be available under the insurance for which the Applicant is applying?\tYES \u0013 FORMCHECKBOX \u0014\u0015  NO \u0013 FORMCHECKBOX \u0014\u0015\nIs any leader of the Applicant’s legal, finance, human resources, security, or risk management organization or their functional equivalent, or any owner, partner, member, director , trustee or executive officer or their functional equivalent aware of any actual or alleged fact, circumstance, situation, act, error, or omission, that reasonably could give rise to a claim being made against any proposed insured?\tYES \u0013 FORMCHECKBOX \u0014\u0015  NO \u0013 FORMCHECKBOX \u0014\u0015\nIn the last five years, has the Applicant or any predecessor in business, or any past or present subsidiary, affiliate, owner, partner, member, director, officer, trustee or employee of the Applicant been investigated or cited by any governmental agency or body for any actual or alleged violations of law arising out of the Applicant’s business activities or in connection with any of the Applicant’s employees or employee welfare benefit or pension plans?\nYES \u0013 FORMCHECKBOX \u0014\u0015  NO \u0013 FORMCHECKBOX \u0014\u0015\nIn the last five years, has the Applicant or any predecessor in business, or any part or present subsidiary or affiliate of the Applicant experienced a workplace violence incident or threat?\tYES \u0013 FORMCHECKBOX \u0014\u0015  NO \u0013 FORMCHECKBOX \u0014\u0015\nI","cbCaiuF6dFTPB0gT","https://ap.wps.com/l/cbCaiuF6dFTPB0gT","docx",229751,27,"English","# About this application\n## Instructions and submission requirements\n## Policy period fields\n## Coverage questions and attachments\n## Supplemental application selections and representations","[{\"question\":\"What basis of coverage does this application use?\",\"answer\":\"Coverage is provided on a claims-made and reported basis, limited to claims first made during the policy period (or an extended reporting period) and reported as specified in the claims and events section.\"},{\"question\":\"Do defense costs affect the insurance limits?\",\"answer\":\"Yes. Defense costs are included in the limits of insurance and will erode—and may exhaust—the limits.\"},{\"question\":\"What materials must be attached when submitting the application?\",\"answer\":\"The application requests the applicant’s most current audited financial statement and annual report, and full details for each question answered YES. It also references supplemental applications for the selected coverage types.\"}]","Axis Privatus Platinum New Business Application - Axis 101-0576 (10-16) | DOCX",9]