Supplemental application
AI Liability Supplemental Application
The supplemental application tells our underwriters how your company builds, governs and monitors its AI systems, and it is how you apply for Mayflower's AI D&O, AI EPL, AI E&O and AI DIC excess coverage. You can complete it online, which is quicker for most companies, or download the PDF and return it by email.
- Policy form
- Claims made and reported
- Length
- 12 sections, 15 pages
- Filed with
- ACORD applications for D&O, EPL and E&O
- Signed by
- An authorized officer
Two ways to apply
Complete It Online or on the PDF
Both routes ask the same questions and reach the same underwriting team. We recommend the online application for most companies, because it saves your progress and removes the printing and scanning that the PDF needs.
Complete It Online
The online application takes you through the questions one section at a time and saves your progress as you go, so you can stop and come back later with nothing to print or scan.
- Saves your progress
- No printing or scanning
- Same questions as the PDF
Download the PDF
The PDF suits teams that prefer to gather answers on paper before an officer signs. You accept the Limited Use License Agreement, the 15-page application downloads straight away, and you email it back with the required documents.
- License acceptance required
- Returned by email with your documents
What it covers
Twelve Sections, From Your AI Systems to Your Claims History
Most questions are multiple choice, and a handful ask for short written answers about your AI systems, oversight structure and any incidents. It is a good idea to involve the people who own AI, data, security and legal before you begin, because the answers draw on all four.
Section I
Applicant Information
The named insured, locations, revenue, ownership, business type and the geographic scope of your AI operations.
Section II
AI Systems Overview
How many AI systems you run in production, how autonomous they are, how material their decisions are and which third-party models you rely on.
Section III
AI Governance
Your governance framework, oversight body, board reporting, policies, pre-deployment reviews and the people accountable for AI risk.
Section IV
Data Governance
Data lineage, quality controls, bias and fairness testing, sensitive data categories, privacy compliance and training data provenance.
Section V
System Operations and Monitoring
Criticality tiers, reliance on external AI infrastructure, fallbacks, drift monitoring, retraining and staged rollouts.
Section VI
AI Incident Response
Your AI-specific incident response plan, detection methods, tabletop exercises, complaint and appeal routes and incidents in the past 24 months.
Section VII
Regulatory Environment and Compliance
EU AI Act classification, the US AI rules that apply to you, sector regulation, external audits and ISO/IEC 42001 status.
Section VIII
Claims and Loss History
AI-related claims and any D&O, EPL or E&O claims from the past three years, known circumstances and any declined or non-renewed coverage.
Section IX
Prior and Current Insurance
Your current or expiring D&O, EPL and E&O coverage, with the proposed retroactive date and current expiration date.
Section X
Required Documentation
The five documents every application needs and eight more that are recommended and may improve terms.
Section XI
Applicant Representation and Warranty
The declaration that your answers are true, accurate and complete, signed by an authorized officer.
Section XII
Fraud Warnings
The insurance fraud warnings that apply under the laws of your state.
Before you start
Who Signs It and What to Send With It
It is best to line up the signing officer and the required documents before you begin, because underwriting reviews the application and its documents together.
Documents to Include
Section X of the application lists five documents that every application needs:
- Completed ACORD applications for the coverage lines you are applying for
- Three years of loss runs for D&O, EPL and E&O
- Your most recent annual financial statements or audited financials
- Your AI governance policy or responsible AI framework
- An AI system inventory covering systems, use cases and data types
Eight more are recommended, and the application notes that they may improve terms:
- An organizational chart showing AI oversight and reporting
- Board or committee minutes on AI risk oversight
- Model documentation, model cards or data sheets
- Bias audit or fairness testing results
- Your AI incident response plan
- An ISO 42001 certificate or audit report
- Third-party AI vendor contracts or due diligence summaries
- Privacy impact assessments for AI systems that process PII or PHI
Who Must Sign
The application must be signed by one of these officers of the applicant:
- Chairman of the Board
- Chief Executive Officer
- Chief Financial Officer
- President
- General Counsel
By signing, the officer confirms after diligent inquiry that the answers are true, accurate and complete, and the applicant agrees to report material changes before the policy is issued. Completing the application does not bind coverage.
Claims Made and Reported
The policy applied for covers only claims first made against an insured during the policy period or any applicable extended reporting period. Defense costs reduce, and may exhaust, the limit of liability and are subject to the retention, so it is worth reading the policy carefully.
Download the PDF
Accept the License, Then Download
The application and its questions are the proprietary and confidential property of Mayflower Specialty, Ltd., so everyone who downloads it accepts a Limited Use License first. The PDF downloads as soon as you agree.
Your details
Your name, work email, job title and company, so we know who accepted the license.
The license
Read the Limited Use License Agreement and confirm that you can accept it for the applicant.
Download and return
Complete and sign the PDF, then email it with the required documents to submission@mayflowerspecialty.com. Our underwriting team responds within 48 hours.
Download links expire 15 minutes after you accept the license. If you have a question about any part of the application, talk to us before you start.
- Your details, current step
- License
- Download