Southern Cross Underwriters
Jackson, MS Office
6311 Ridgewood Road, Suite E-401
Jackson, MS 39211

Toll Free: 800-682-5263
Phone: 601-957-3344
Fax: 800-370-6790



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DISCLAIMER: Please remember that a completed ACORD application must accompany any supplemental application. You may either print the application and fax it in to your Underwriter, or fill it out directly online and hit the “Submit by Email” button to immediately send the filled out application. You can replace the general office email address with your Underwriter’s specific email address if you prefer.

Brokerage Lines          Commercial Lines         Personal Lines 
Garage Applications          Transportation Applications

Brokerage Lines:

Commercial Umbrella Liability | D&O - Corporate | D&O - Non Profit | E&O
Employment Practices Liability | Environmental | Professional Liability | Public Entity

4Commercial Umbrella Liability

• Apartment & Condo Questionnaire
• Auto Dealers Questionnaire
• Church Supplemental Application
• Contractor Questionnaire
• Contractors Supplemental Application
• Contractors Supplemental Application - Colony
• Convenience Store Supplemental Application
• Equipment Dealer Questionnaire
• Excess Auto Liability Questionnaire
• Farm & Ranch Questionnaire
• Farm & Grain Questionnaire
• Financial Institution Questionnaire
• Hotel & Motel Questionnaire
• Hunt Club Questionnaire
• Mobile Home Park Questionnaire
• Oil & Gas Consultants Application
• Oil & Gas Contractors Application
• Oil & Gas Drilling Contractors Application
• Oil & Gas Lease Operator & Non-Operator Application
• Oil Jobbers Questionnaire
• Refuse Questionnaire
• Restaurant Questionnaire
• Roofer Questionnaire
• Security Guard Questionnaire
• Trucking Supplement Application

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4D&O - Corporate

• AIG Private Collection - D&O & EPLI Application
• Chubb Excess D&O Application
• Chubb Forefront Portfolio D&O Application
• Chubb Health Care Portfolio Application - Up to 250 Employees
• Great American Private Company D&O Application
• Philadelphia Private Plus Application
• Tudor D&O Application
• USLI Corporate D&O Application

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4D&O - Non Profit

• AIG Non Profit D&O Protector Application
• Chubb Forefront NFP D&O Application
• Chubb Health Care Portfolio Application
• Chubb Personal Director Liability Application
• CNA Community Association D&O Application
• Great American Non Profit D&O Application
• Philadelphia Flexi-Plus Five Application
• Tudor Community Association Supplemental Application
• Tudor Non Profit D&O Application
• USLI Community Association Application
• USLI Community Association Package Supplemental Application
• USLI Non Profit D&O Application
• USLI Non Profit New Business D&O Supplemental Application
• USLI Non Profit Subsidiary Addendum

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4E&O

• Media/Professional Tech Net Solutions

4Employment Practices Liability

• Chubb EPL Application
• Great American EPL Third Party Questionnaire
• Great American EPL Application
• Philadelphia EPL Application
• PIA EPL Application - Houston Casualty
• Shand Morahan EPL Application
• USLI EPL Application

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4Environmental

• AIG Contractors E&O, Pollution & Prof Application
• AIG Contractors Professional & Pollution Liability Application
• AIG Environmental Auto Liability Supplemental Application
• AIG General Contractors Pollution Liability Questionnaire
• NECC Environmental contractors & Consultants Application
• NECC Environmental Contractors Application
• NECC Landfill Supplemental Application
• NECC Mold Consultants Application
• NECC Mold Coverage for Non Environmental Contractors Application
• NECC Motor Vehicle Pollution Liability Application
• NECC Motor Vehicle Pollution Supplement - to add to CGL or CPL
• NECC Pollution Application for Non Environmental Contractors
• NECC Restoration & Mold Contractors Application
• NECC Site Specific Pollution Application
• NECC Storage Tank Application

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4Professional Liability

• Admiral Ambulance Services Application
• Admiral Architects & Engineers Application
• Admiral Claims Appraisers & Adjusters Supplemental Application
• Admiral Clinical Research Application
• Admiral Consultants  E&O Application
• Admiral Health Care Organization & Provider Application
• Admiral Insurance Agents & Brokers E&O Application
• Admiral Land Surveyors Application
• Admiral Medical Cosmetic & Non Medical Outpatient Application
• Admiral Medical EMT & Paramedic Application
• Admiral Medical Lab & Imaging Application
• Admiral Medical Miscellaneous Medical Professional Liability Application
• Admiral Medical Testing Lab Application
• Admiral Miscellaneous Professional Liability Application
• Admiral Technology E&O Application
• Admiral Title Abstratrors & Title Agents Application
• AIG Bankers Professional Liability Application
• Chubb Investment Advisors E&O Application
• Chubb Miscellaneous Professional Liability Application
• Colony Allied Medical General Application
• Colony Ambulance & Non Emergency Transport Supplemental Application
• Colony Assisted Living Facility Supplemental Application
• Colony Counselors & Counseling Centers Supplemental Application
• Houston Casualty Consultants Supplemental Application
• Houston Casualty Miscellaneous E&O Application
• JH Ferg Collection Agency Application
• JH Ferg Funeral Home E&O Application
• JH Ferg Paralegal E&O Application
• JH Ferg Temporary Employment Agency Application
• JH Ferg Title Abstractor Application
• Lexington Architects & Engineers Application
• Lexington Home Inspectors Application
• Media Prof Advertiser Liability Application
• Media Prof Advertising Agency Application
• Media Prof Book Publisher Application
• Media Prof Broadcaster Liability Application
• Media Prof Magazine Publisher Application
• Media Prof Multi-Media Liability Application
• Media Prof Radio, TV, & Film Producers Application
• National Casualty Company Architects & Engineers Application
• Philadelphia Advertising Agency Media Consultant Supplemental Application
• Philadelphia Claims Adjuster Supplemental Application
• Philadelphia Computer Consultants Supplemental Application
• Philadelphia Employment Agency Supplemental Application
• Philadelphia Fundraising Consultant Supplemental Application
• Philadelphia Genealogical Investigator Supplemental Application
• Philadelphia Interior Designer & Decorator Supplemental Application
• Philadelphia Management Consultants Supplemental Application
• Philadelphia Marketing Consultants Supplemental Application
• Philadelphia Mortgage Bankers & Brokers Supplemental Application
• Philadelphia Printers Supplemental Application
• Philadelphia Property Manager Supplemental Application
• Philadelphia Publishers Supplemental Application
• Philadelphia Safety, Loss Control Consultant Supplemental Application
• Philadelphia Specified Professions E&O Application
• Philadelphia Technology Consultant Supplemental Application
• Philadelphia Telecommunications Consultant Supplemental Application
• Philadelphia Third Party Administrators Supplemental Application
• Philadelphia Travel Agent Supplemental Application
• Shand Building Inspection Supplemental Application
• Shand Clinics Application
• Shand Dentist Medical Malpractice Application
• Shand General Liability Supplemental Application
• Shand Home Health Supplemental Application
• Shand Medical Imaging Application
• Shand Medical Spa Supplemental Application
• Shand Pharmacy Application
• Shand Specified Medical Professions Application
• Shand Specified Professional Application
• Shand Technology Professional Application
• Shand Tenant Discrimination Application
• Shand Title Escrow Supplemental Application
• Tudor Appraisers Supplemental Application
• Tudor Architects & Engineers Application
• Tudor Auctioneers Supplemental Application
• Tudor Collection Agents Supplemental Application
• Tudor Consultants Supplemental Application
• Tudor Employment Agents Supplemental Application
• Tudor Home Inspectors Supplemental Application
• Tudor Information Technology Application - EDP APPLN 02
• Tudor Insurance Claims Adjuster Supplemental Application
• Tudor Miscellaneous E&O Application
• Tudor Mortgage Brokers Supplemental Application
• Tudor Tax Prep & Bookkeeping Supplemental Application
• Tudor Title Application
• USLI Appraisers Supplemental Application
• USLI Claim Warranty Letter
• USLI Claims Adjuster Supplemental Application
• USLI Consultants & Specified Professional Package Supplemental Application
• USLI Employment Agencies Supplemental Application
• USLI Insurance Agents Application - Personal Lines Only
• USLI Management Human Resources Marketing Supplemental Application
• USLI Mortgage Brokers Supplemental Application
• USLI Paralegals Supplemental Application
• USLI Printers Supplemental Application
• USLI Private Investigator & Background Check Supplemental Application
• USLI Property Managers Application
• USLI Property Managers Package Supplemental Application
• USLI Public Relations Supplemental Application
• USLI Recruiters Professional Liability Package Application
• USLI Specified Professions Application
• USLI Tax Preparer Bookkeeper Supplemental Application
• USLI Technology Application
• USLI Travel Agents Supplemental Application

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4Public Entity

• AIG National Union Fire School Board Legal Application
• AIG National Union Public Officials Application
• National Casualty Application Information Application
• National Casualty Commercial Auto Section Application
• National Casualty Day Care Questionnaire
• National Casualty Electric Utility Questionnaire
• National Casualty Emergency Dispatchers Application
• National Casualty Employment Practices Application
• National Casualty Firefighters Professional Application
• National Casualty Gas Utility Questionnaire
• National Casualty General Liability Section Application
• National Casualty Landfill, Dump, Refuse Site, & Incinerator Application
• National Casualty Property & Allied Lines Application
• National Casualty Recreational Activities Supplemental Application
• National Casualty Special Events Questionnaire
• National Casualty Streets, Roads, highways, & Bridges Questionnaire
• National Casualty Water & Sewer Utility Questionnaire
• PGUI Police Professional Application - Darwin
• PGUI Public Officials Liability Application - Darwin
• PGUI School Board Liability Application - Darwin
• Tudor Educational E&O Application
• Tudor Public Officials Application

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Commercial Lines:

General Liability | Liquor Liability | Special Events Applications

4General Liability

• Alarm, Fire Extinguisher Installation Application
• Apartment Supplemental Application
• Artisan Contractor Supplemental Application
• Bars, Restaurants, & Taverns Supplemental Application
• Beauty & Barber Shop Application
• Catering Supplemental Application
• Condo & Homeowner Association Application
• Contractors / Developers Application
• Convenience Store Supplemental Application
• Crane & Rigging Supplemental Application
• Day Nurseries & Preschools Supplemental Application
• Demolition - Wrecking of Building
• Detective and Investigative Agencies Application
• Dwellings - Rental Supplemental Application
• Excavation & Grading Supplemental Application
• Exercise & Health Studio Supplemental Application
• Exterminators General Liability Application
• Flea Market, Bazaars, & Swap Meets Application
• Go Kart Tracks Supplemental Application
• Halfway House Application
• Hunt Club Application
• Indoor & Outdoor Playground Equipment Supplemental Application
• Janitorial Supplemental Application
• Landscaping Application
• Landowner's Program Supplemental Application
• Machine Shop Supplemental Application
• Mechanical Bull Supplemental Application
• Mobile Home Park & Campground Supplemental Application
• Motel Supplemental
• Outfitters & Guides Supplemental Application
• Paintball Field-Course Supplemental Application
• Product Liability Supplemental Application
• Race Track or Racing Exposures Supplemental Application
• Restaurant Tavern Supplemental
• Roofing Contractors Supplemental Application
• Rural Water Company Supplemental Application
• Sanitary Landfill Supplemental Application
• Security Guards Application
• Swim Club Application
• Swimming Pool Contractors - Dealers Supplemental Application
• Swimming Pool Maintenance - Management Supplemental Application
• Tanning Salon Supplemental Application
• Trailer Manufacturer Application
• Tree Trimmers Supplemental Application
• Trucker/Warehouse Supplemental Application
• Truckers Program Supplemental Application
• Vacant Building Supplemental Application
• Vacant Land - Land Leased to Others Supplemental Application
• Warehouse Program Supplemental Application
• Welding, Brazing, & Cutting Supplemental Application

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4Liquor Liability

• Hall Rental - Caterers Supplemental Application
• Liquor Liability Application
• Multi Location Supplemental Application
• Special Event Application

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4Special Events Applications

• Liquor Liability Special Event
• Livestock Related Exposures Supplemental Application
• Special Event Application

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Personal Lines:

RLI | Scottsdale | USLI |Lexington

4RLI

• RLI New Business Application - Effective October 1st
• RLI Renewal Application

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4Scottsdale

• Contents in Storage
• Dwelling Fire Application - Builder's Risk
• Dwelling Fire Application - Owner Occupied
• Dwelling Fire Application - Renters' Contents
• Dwelling Fire Application - Seasonal Occupancy
• Dwelling Fire Application - Tenant Occupied
• Dwelling Fire Application - Renovation
• Dwelling Liability Application
• Farm & Ranch Application
• Homeowner Application
• Medical Statement
• Personal Articles Floater - Stand Alone Application
• Personal Umbrella - New Business
• Personal Umbrella - Renewal Questionnaire
• Protection Class 9 & 10 Questionnaire

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4USLI

• Comprehensive Personal Liability
• Excess Personal Auto
• Personal Umbrella Application


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4Lexington

• Homeowners Dwelling Program Application

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Garage:

• Burlington Garage Application
• Burlington Heavy Truck Supplemental
• Burlington Mobile Home Dealer Supplemental
• Colony Exclustion of Certified Acts
• Colony Garage Application
• Colony Heavy Vehicle Equipment Application
• Colony RV Questionaire
• Colony Salvage Yard Questionaire
• Colony Terrorism Form
• Colony Terrorism Limited Acts Exclusion
• Colony Tow Truck Supplemental
• Colony Valet Parking Questionaire
• Essex DOL & GKLL Application
• Essex Equipment Dealers Application
• Lloyds GKLL & DOL Application
• NF&M Dealer Non-Dealer Renewal Application
• NF&M LA Auto Service Application
• NF&M LA Motorcycyle RV Dealer Application
• NF&M LA Trailer Dealer Application
• NF&M MS Motorcycle and RV Dealer Application
• NF&M MS Service Operations Application
• NF&M MS Trailer Dealer Application
• NF&M MS Used Auto and Motor Home Dealer Application
• NF&M Non Owned Garage Coverage Supplemental
• Salvage Yards Rebuilding Checklist
• Scottsdale Garage Dealers Application
• Scottsdale Garage Market Segment Application
• Spray In Bedliners Checklist
• Towing Operations Checklist
• Uninsured Motorist LA Form November 2006 M4443e
• Uninsured Motorist Form M2808
• Uninsured Motorist Form MS
• Western Heritage Antique Classic Auto Restoration Application
• Western Heritage Garage Application
• Western Heritage Renewal Application
• Western Heritage RV Dealer Questionnaire
• Western Heritage Valet Parking
• Western Heritage Terrorism

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Transportation:

• Canal Combination Application LA
• Canal Combo Applicationi MS
• Essex Auto Physical Damage Application
• Essex Cargo Application
• Essex High Value Physical Damage Application
• Heath XS Auto Supplemental Application
• Lloyd's Cargo Application
• Lloyd's Physical Damage Application
• Mile High Markets Daily Auto Rental Application
• NF&M MS Contingent Liability Application
• NF&M Automobile Inspection Report
• NF&M Cargo Application
• NF&M Cargo Renewal Application
• NF&M Hired Non Owned Auto Supplemental Application
• NF&M LA Public
• NF&M LA Special Types Application
• NF&M LA Truck Application
• NF&M MS Public Auto Application
• NF&M MS Public Physical Damage Only
• NF&M MS Rental Autos & Trucks Short Term
• NF&M MS Short Term Rental Application
• NF&M MS Special Types Application
• NF&M MS Truck Application
• NF&M MS Truck Physical Damage Only
• NF&M Renewal Application
• NF&M Tow Truck Supplemental Application
• Scottsdale Hired Non Owned Supplemental
• Scottsdale Auto Renewal Application
• Scottsdale Drive-A-Way Toter Supplemental Application
• Scottsdale Public Auto Supplemental Charter Sightseeing Intercity Bus App
• Scottsdale Public Auto Supplemental Limousine Airport Shuttle
• Scottsdale Public Auto Social Service & Ambulance Application
• Scottsdale Tow Tucks Wrecker Supplemental Application
• Scottsdale Truck Application
• Towing Operations Checklist
• Uninsured Motorists LA Form November 2006 M4443e
• Uninsured Motorist MS

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