Apply for Self-Defense Coverage

If you currently have an active Self-Defense policy with us, please do not complete this new business application. Please email us at nrainsurance@locktonaffinity.com or call us toll free at 1-877-672-3006, Option 3 to discuss renewal payment options with one of our Client Solutions Representatives.

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Self-Defense coverage is available only in conjunction with Personal Firearms Liability coverage. Total annual premium amount shown is for both coverages.
TERMS AND CONDITIONS

Fraud Warning

For your protection various state laws require the following notice:

GENERAL FRAUD STATEMENT (Not applicable in CA, CO, HI, NE, OH, OK, OR, UT, and VT.)

Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and [NY: substantial] civil penalties." In the District of Columbia, Louisiana, Maine, Tennessee and Virginia, insurance benefits may also be denied.

STATE SPECIFIC FRAUD STATEMENTS

COLORADO law requires the following notice: It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purposes of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

HAWAII law requires you be informed that presenting a fraudulent claim for payment of a loss or benefit is a crime punishable by fines or imprisonment or both.

OHIO law requires you be informed that any person with intent to defraud or knowing that he / she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

OKLAHOMA law requires the following notice: Any person who knowingly and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy, containing any false, incomplete or misleading information is guilty of a felony.
Surplus Lines Warning
This policy is not subject to the protection of any guaranty association in the event of liquidation or receivership of the insurer.
Agent Disclosure
Coverage is written through carrier rated "A, Excellent" by A.M. Best

Certain Underwriters at Lloyd’s London is rated "A Excellent" by A.M. Best indicating the company's strength and ability to meet its ongoing insurance policy and contract obligations. More detailed information about A.M. Best Company and their rating methodology can be found at www.ambest.com

Certain Underwriters at Lloyd’s London is an approved, non-admitted carrier. Approved, non-admitted insurance carriers are neither licensed by nor under the supervision of the state department of insurance. If an approved, non-admitted carrier is found insolvent, the State Insurance Guaranty Fund will not respond. Also, all premiums are taxable. Lockton Affinity, LLC has not performed an independent financial analysis, and, as such, cannot guarantee or make any representations in regard to the financial condition of Certain Underwriters at Lloyd’s London or any other insurance companies with which we place business.
Do you agree to the above terms and conditions?
 
If you currently have an active Self-Defense policy with us, please do not complete this new business application. Please email us at nrainsurance@locktonaffinity.com or call us toll free at 1-877-672-3006, Option 3 to discuss renewal payment options with one of our Client Solutions Representatives.
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