Run-off Member Application

Fill out the member application below and then submit.

Applicant Company

  • example: 555-555-5555

  • example: 555-555-5555


Proposed Delegate

  • example: 555-555-5555


Proposed Alternate

  • example: 555-555-5555


Qualification Criteria

  • The By-laws provide that to qualify as a Run-off Member all of the following criteria must be met.

    • The Run-off membership of the Association shall consist of firms as hereunder defined, elected to Run-off membership by the procedure hereafter set forth. The word "Firm" shall mean an insurance and/or reinsurance company, agency or brokerage that formerly placed or accepted insurance/reinsurance business but no longer places or accepts such business. Further, the business of the "Firm" must be the management of claims the majority of which arise out of insurance/reinsurance business formerly placed or accepted by the firm.
    • The Run-off Member shall designate a representative to the Association and may designate alternate representatives to the Association. The person designated as the representative of the Run-off Member as well as the person or persons designated as alternate representatives of Run-off Member must be full-time employees of that Run-off Member.
  • Complete the following for each company whose business the applicant company is running-off:

    Please Enter All Companies.

    • Company:
      Percentage of that company’s business applicant company is running-off:
      Percentage of applicant’s company business attributable to the Run-off:
      If the foregoing does not represent 100% of the applicant company’s business, please describe the applicant company’s other business:
    Add Company

Proposed Representative's Ability to Contribute Knowledge


First Sponsor

  • example: 555-555-5555

  • File types allowed: pdf


Second Sponsor

  • example: 555-555-5555

  • File types allowed: pdf

  • It is understood that the Board of Directors may not act on any application received by the Association prior to 90 days before their next regularly scheduled meeting. In order for an application to be considered complete, all sections must be filled in and the application fee must be paid.

    It is further understood that after acceptance continued membership shall be continued upon payment of annual dues (as set by the Association's Board of Directors) and compliance with the Association's By-laws including the required for regular attendance at annual meetings.

    Code of Conduct

    Members of the Association agree:

    • To maintain high degree of professionalism.
    • To exercise the utmost good faith in dealing with their trading partners, underwriters, assureds, intermediaries and all members of the Association.
    • To refrain from maintaining or using the status of their profession, or their affiliation with the Association, to attract business for personal financial gain in other lines of endeavor.
    • To refrain from maintaining or using their membership within the Association as a means of taking unfair advantage of competitors, or for any other purpose than those for which the association is intended.
    • To regard the businesses of insurance and reinsurance as an unusual opportunity to provide essential services to the public and to conduct themselves with dignity, courtesy and the highest degree of fairness in their relations with members of the industry and the public at large.
    • To be governed by a spirit of cooperation, helpfulness, and frankness in their relationships with fellow members to the end that each shall be better equipped, through such cooperative measures and exchange of ideas, to better perform and function and to foster the advancement and prestige of their profession.

    Upon submission of this application, you will be asked to pay the $100 non-refundable application fee online. If you are unable to submit the fee online and would prefer to mail in payment, please select "Check" on the next page and follow the instructions.


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