Employment Practices Liability Application

Download the WBPI Employment Practices Liability Application Form or fill in the form below.

Fields marked with an * are required

Section 1. General Information

Section 2. Location & Employee Information

Section 3. Loss History (Both questions 1 and 2 must be answered)

Provide specific claim details for each employment practice claim, lawsuit, or incident

Section 4. Requested Limit Options

Section 5. Human Resources Procedures

Have you formally adopted and implemented the following:

8. Does your organization anticipate any of the following in the next 12 months?

Section 6. Third Party Discrimination and Sexual Harassment Coverage

Employment Practices Liability Insurance

Location and Employee Information Schedule