Shreveport Forms

General Underwriting Email

Tracking - la-tracking@deep-south.com

• Send all new submissions
• Request current loss runs and certificates of insurance

Processing - la-processing@deep-south.com

• Send all signed forms
• Make endorsement requests
• Inquire about status of policy and endorsement issuance
• Request the addition or deletion of drivers

Renewal - la-renewal@deep-south.com

• Send all renewal applications and additional information

Underwriting Forms

The following Underwriting forms are available to download. These forms are created in Adobe Portable Document Format (PDF) . If you do not have Adobe Reader, click the link below to download a free version of the software.

Automobile/Garage General  Van Questionnaire Designated Professional Service Exclusion  Garage Drivers List Garage Dealer Supplemental Hired and Non-Owned Supplemental Driver Exclusion 12.10 Driver Exclusion-Texas Physicians Statement Towing Questionnaire  9.19.2011 General Liability Supplementals Artisan Supplement OCP Supplement  Pool Supplement Contractors Supplement QBE Specialty Insurance Company  Non-Specified Operators Endt Arkansas Rejection of Uninsured and Underinsured Motorists Coverage and Offer of Increased Limits Form 12.27.2011 Louisiana Uninsured/Underinsured Motorist Selection 1.03.2012 Mississippi UM Selection/Rejection 4.12.2011  Mississippi Non-Stacking Uninsured Motorist 4.12.2011 Texas UM/UIM Coverage Rejection/Selection Form 12.27.2011   Praetorian/Redland Insurance Company Non-Specified Operators Endorsement Arkansas Rejection of Uninsured and Underinsured Motorists Coverage and Offer of Increased Limits Form 12.27.2011 Louisiana Uninsured/Underinsured Motorist Selection 1.03.2012 Mississippi UM Selection/Rejection 4.12.2011  Mississippi Non-Stacking Uninsured Motorist 4.12.2011 Consent to Rate - Louisiana Texas UM/UIM Coverage Rejection/Selection Form 12.27.2011 Texas PIP Selection Rejection Other Underwriting Forms Mississippi Affidavit Terrorism Disclosure Vacant Land Supplemental Questionnaire 9.19.2011

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To learn more about Deep South, contact us at (800) 235-3891.

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333 Texas Street, Suite 725

Shreveport, Louisiana 71101

 

P.O. Box 202

Shreveport, Louisiana 71162

800-235-3891

800-686-6128 fax

318-227-3636

318-934-1874 fax