Forms by State
Organization Forms


Form Document
V 1

Please complete this form, sign it and email the completed form to
PolicyApprovalRequest@stewart.com with a copy to your underwriting contact, if applicable.

To:      Stewart Title Guaranty Company                 Date:_____________________________________________________________


            [Name of person requesting approval]


            [Full name of title insurance agent/company/issuing office/division requesting approval]


            [Location/address of requesting office. Please also include city and state.]

Your Telephone: _________________________________

Your Email: _____________________________________

Your Fax: _______________________________________

Your Stewart Agent ID number, if applicable:____________________________________________________________________

Title/File/Order No.________________________________________________________________________________________

Subject Property Address:__________________________________________________________________________________

[If an address is not available, please include city or county, state and ZIP code]

Project Name/Project Reference/Project Designation (“Re:”), if applicable:


Anticipated closing date, if known:_________________________________________________________________________________________

  1.   Premium. Please specify: (MUST ONLY BE COMPLETED FOR TRANSACTIONS OVER $15,000,000.00)

________________ (a) Total premium charge to customer for title insurance policies (excluding endorsements);

________________ (b) Amount of premium for title insurance policies (excluding endorsements) that will be remitted to Stewart Title Guaranty Company;

________________ (c)  Total premium charge to customer for endorsements;

________________ (d) Amount of premium for endorsements that will be remitted to Stewart Title Guaranty Company;

________________ (e) Total Amount of premium for title insurance policies and endorsements that will be remitted to Stewart Title Guaranty Company;

________________ (f)  $ per thousand premium charge to customer for title insurance policies and endorsements;

________________ (g) $ per thousand remitted to Stewart Title Guaranty Company for title insurance policies and endorsements.

  2.   Title was searched and examined from______________ to_______________ .

        [Please do not include the period covered by any Starter.]

  3A.    Starter, if any. Please specify: (a) Prior Company:___________________________________________________________

(b) Prior Effective Date:_________________________________________________________________________________

(c) _ Owner’s Policy or _ Loan Policy (check one). Please attach a copy of the Starter.

  3B. If this property was the subject of a prior overlimits approval, please insert the prior approval number: ____________________ .



  4.   List the Policy Form(s), Type, Insured and Stewart’s Policy amount.

        If Policy Form not identified, the form will be the 2006 ALTA Policy. Attach a copy of Commitment(s) and any pro forma(s).

Policy Form
(e.g., 2006 ALTA)


Type (e.g., Loan)


Proposed Insured



















  5.   Description of Property (e.g., undeveloped, apartments, offices, etc.):

  6.   Describe: (a) transaction and (b) purpose of financing (briefly, but in detail):

  7.   Describe grantor/mortgagor (e.g., person, entity) and authority (e.g., power of attorney, corporate resolution,
approval by shareholders, partners or members, etc.):

  8A.    Describe any conflict of interest or potential conflict of interest. A blank will be deemed “NONE”:

  8B.    If the Issuing Office is an agent, please provide the names of all officers of the agent and all principals of the agent that own 10%
or more of the agent. A blank will be deemed “NONE”:

  9.   If endorsements are being requested, attach a list or click below:

ALTA Endorsement List Supplement

Louisiana Endorsement List Supplement

Pennsylvania Endorsement List Supplement

Texas Endorsement List Supplement

10.  Does this file involve the following? (If applicable, write “YES” and describe the circumstances.
Please note: a blank will be deemed “NO”):

______   A construction loan?

______   Broken-priority (e.g., early start) or no-priority? If so, please describe underwriting:_____________________________

NOTE:    If no broken-priority, please explain:

______   Recent construction performed or completed within the lien period? If so, please describe underwriting:


                If not, how do you know?_________________________________________________________________________



______   Request for Mechanic’s Lien Coverage? NOTE: If this transaction is a construction loan and if the total project cost (i.e., the loan amount plus other contributions) is equal to or greater than $25,000,000, please also complete STG High Liability (Over $25 Million) Mechanic’s Lien Coverage Approval Request;

______   Access based solely upon an easement (i.e., Is there no direct access to a dedicated public street)? If so, was title to the access easement examined and insured?___________________________________________________________ ;

______   Lien priority based upon subordination of a lien or mortgage; if so, please explain:

______   Tidelands, filled land, submerged land, navigable waters or riparian issues;

______   Insuring title to railroad property;

______   Title based upon judicial proceedings (e.g., tax foreclosure, condemnation, bankruptcy);

______   Title based upon foreclosure or deed in lieu of foreclosure;

______   Mineral coverage on commercial property in area of mineral development;

______   Title derived from foreclosure or deed in lieu of foreclosure regarding a construction loan deed of trust, within the last three years;

______   Easement independent of real property (i.e., an easement in gross);

______   Insured option;

______   Native American (Indian) lands;

______   Water rights;

______   Sheriff’s Sale in last 10 years (other than mortgage foreclosure);

______   Assignment or partial assignment or mortgage of a lease, easement, or other interest (if so, describe consents/approvals
to be obtained):________________________________________________________________________________ ;

______   Reliance upon an indemnity; if so, describe purpose and provide a copy;

______   Insuring around a recorded lien or encumbrance (e.g., by omitting, deleting or providing affirmative insurance);

______   Survey concerns (e.g., does the survey show any significant conflict or encroachment?);

______   Current owner out of possession of the property;

______   Commercial purchasers of fruits, vegetables, livestock, or poultry, or wholesalers or retailers of meat products.
See Stewart Bulletin SLS2014001 (UNDERWRITING – The Perishable Agricultural Commodities Act (PACA) and
The Packers and Stockyards Act (PSA));

______   A hospital, medical facility, health research facility, teaching facility for health related fields, facility for individuals with intellectual disabilities, medical or nursing school. If so, please see VU Underwriting Manual Section 8.12.;

______   Any purchase contract(s) or option(s) outstanding, other than the purchase contract in favor of the proposed insured;

______   Other extra hazardous risks, such as those shown in VU Underwriting Manual Section 5.36;

______   Current, recent or impending litigation that might affect the subject property;

______   A transaction that, to your knowledge, has been turned down by another underwriter; or

______   If a loan in the amount of $10 Million or more, will it be disbursed in multiple disbursements?

If “YES” to any of the above, please describe in the next section or by supplement.

11.  Other unusual risks, issues and/or affirmative coverages, if any:

12.  If this transaction involves co-insurance, list the co-insurers and their liability amounts/percentages:

13.  This policy will be issued by (must be completed):

______   (a) an issuing agent authorized in the state, in compliance with state law; or

______   (b) direct issue/home office, in compliance with state law.

14.  From our examination of the Title and the foregoing, we are of the opinion that the requested Policy
complies with Company Guidelines, including, but not limited to, those on Virtual Underwriter®, and can be safely issued.

The requested coverages and endorsements are allowed to be issued in the state, and the rates to be charged will comply with state requirements, and the amount remitted to the Company complies with our underwriting agreements.



                    Title Examiner/Chief Title Officer/Closer


Print Name:______________________________________                       Title: ____________________________________________



This approval is NOT an approval for Reinsurance. If the Policy amount is $100,000,000.00 or larger, contact our Reinsurance Department, even if Reinsurance is not required, so that the transaction may be properly reported to management.

This approval form must be signed by your State, District or Division Counsel, or other Underwriter before forwarding to a Senior Underwriter.

APPROVAL Re: Title/File/Order No._________________________________________

Based upon the information given above, approval is hereby granted to issue the Policy as requested, subject to the following:

Issuance of policies and endorsements is subject to compliance with Underwriting Guidelines.

__________________________________         __________                 __________________________________         __________

Local/Regional/Associate Senior Underwriter     Date                               Senior Underwriter                                                      Date

__________________________________         __________                 __________________________________         __________

Senior Underwriter                                                    Date                               Senior Underwriter                                                      Date




Revised 03-26-2015. VU-1513-01-23







Please use this area if you need additional space.

















































No guidelines are available for this form at this time.