Application For Policy-Issuing Agency Status
Applicant Information:
1. Name:
2. Social Security Number:
3. Home Address:
4. Firm Name:
Address
Address (cont.)
City:
State:
Zip Code:
5. E-mail Address:
Office Phone Office FAX
6. Date firm commenced business:
7. Date of applicant's admission to bar:
8. List of other state jurisdictions and dates admitted to bar:

Business / Customer Information
9. Percentage of practice devoted to real estate:%
10. How many years experience in real property/conveyancing law does applicant possess?
11. Are all searches/abstracts performed by an attorney in the firm? Yes  No
12. Please list all attorneys in form who perform searches/abstracts:

13. If searches/abstracts are not performed by an attorney in your firm, please list by whom they are performed and whether by an attorney

14. Please list all lenders for whom you supply title evidence, title insurance, or conduct closings:

15.

Are you presently a policy-writing agent or approved attorney for any other title insurance company:

Yes  No
If yes, please list

16.

Were you previously an agent or approved attorney for any underwriters not listed in question 14 above?  Yes  No
If yes, please list the company and explain the reason why the relationship was terminated.

17. Over the next 12 months, Agent anticipates:
Net remittances to all title insurance underwriters  $
Proposed net remittances to Old Republic National Title Insurance Company  $
During the past two calendar years, the following was the approximate annual net remittance to all underwriters:
20 $
20 $
17a. What conveyancing software packages do you presently use?
   (For example: ABC, Std. Conveyancer, ProDocs)
18. What volume of title orders anticipated to be submitted?
monthly    annually
19. Name of Bank and the title of the Real Estate Trust Account

Name of Bank

Real Estate Trust Account Title

Insurance Coverage:
20. Please provide the following information concerning insurance coverage. Supply copies of policies in effect. If no insurance in place, please so state.
Professional liability carrier:
Coverage Limit Each Claim:$   Aggregate: $
Deductible: $   Expiration Date:
Fidelity/Surety Insurance Carrier 
Coverage Limit Each Claim: $   Aggregate: $
Deductible: $   Expiration Date:
Loss History:
21.

Have you or any other firm members been, or are you now, the subject of any disciplinary proceedings by any bar organization?

Yes  No
If yes, please explain:

22. Please list all losses, if any, which you or any of your insurers have paid or incurred in the last three years for you or any member or employee of your firm (Please attach sheet explaining each specific matter):

 

23. If applicant performs closings, maintains escrow/trust accounts, or disburses construction funds, complete Presigning Escrow Audit Procedure/Questionnaire, Exhibit 1.
References:
Please list two attorneys, not in your firm, whom we may contact to obtain a personal reference of your and your firm:
Attorney's Name
Firm:
Address:
City:
State:
Zip Code:
Phone:
Attorney's Name
Firm:
Address:
City:
State:
Zip Code:
Phone:

It is agreed and understood that in consideration of the Applicant's application for appointment as an Approved Attorney, Old Republic Title may seek further information relative to Applicant's business and professional reputation in the community and Applicant's credit history.  This may include matters in the nature of an investigative consumer report as defined in the Federal Fair Credit Reporting Act.  This notice is given to you in compliance with said Act.  It is further understood and agreed that the information set forth herein may be verified and investigated by Old Republic Title, but is furnished on a confidential basis by the Applicant to aid Old Republic Title in its investigation and determination of the qualifications of the Applicant. 

The Applicant further agrees to promptly contact Old Republic Title in the future if circumstances change and the Applicant's answers to the questions above are no longer accurately reflected by this application.  Applicant further acknowledges that Old Republic Title has the right to request that Applicant periodically complete other applications in the future so that our files and records will accurately reflect the Applicant's actual status at that time. 

The Applicant further acknowledges that this application has been executed and sworn to under the pains and penalties of perjury.

Applicant:   Date:

 

Exhibit 1 To Application for Policy-Issuing Agency

Presigning Escrow Audit

Procedure/Questionnaire
1. Approximately how many closings have occurred over the last six months? 
2.

Is a separate bank account maintained for the escrow  business of title underwriter: 

Yes  No
3. List all escrow checking accounts:

4.  How often are the escrow bank accounts reconciled?
5. Who prepares the reconciliations?
6. Who reviews the reconciliations?
7. Are escrow assets balanced to escrow liabilities monthly? 
8.

For each account listed, please supply copies of the following for the most recent three months that are available:

a. Bank reconciliation.

b. Bank statement for the month following reconciliation.

c. Outstanding check list.

d. Listing of deposits in transit.
9.

Is there an escrow account trial balance of all open file balances (both debt an credit) prepared whenever bank accounts are reconciled? 

Yes  No
Is there management review?
10.

Are procedures in place to properly segregate cash receipts, cash disbursements and bank reconciliation functions, or as an alternative, are reviews in place to cross-check transactions where proper segregation of duties is not possible?  

Yes  No
11.

Are procedures in place to follow-up the recording of satisfactions of mortgages in escrow? 

Yes  No
Notes:
1. The escrow information obtained will be sent to Home Office to the internal Audit Department for review and evaluation before the Applicant can receive final approval.
2. Internal Audit will communicate its questions, concerns and any requests for additional information to the State Manager
3. If necessary, because of size or complexity, an internal auditor will visit the agency location for an on-site review.
4. Upon completion of the escrow review, Internal Audit will issue the results of its review and its opinion as to whether:

a. the escrows appear to be adequately funded, and

b. the escrow records maintained appear to be adequate.