Single Family and 2-4 Unit Residential Dwelling Application

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Insurance agents already registered with Private Market Flood: enter your Unique Agency ID or your Agency Name

Insurance agents not already registered: Click Here to Register

Consumers choosing to do business directly with Private Market Flood enter: 101976000
Coverage limits
Enter requested coverage amount in $100 increments
minimum: $0 / maximum: $500,000
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Enter requested coverage amount in $100 increments
minimum: $0 / maximum: $250,000

Enter $0 if contents is not desired
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You can quote your own policy using the Calculate Your Own Premium page AL, AZ, CA, CO, CT, DE, FL (Coverage NOT available in Monroe county), GA, HI, IA, IL, IN, KS, LA, MA, MD, ME, MI, MO, MS, NC, NE, NH, NJ, NM, OH, OK, OR, PA, RI, SC, TX, VA, VT, WA, WI, WV. Because underwriting approval is only good for 60 days, applications should only be completed when you are ready to purchase coverage.
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Deductible *
Applies separately to building and contents What is a deductible? A deductible is a predetermined amount of money that the insured must pay before a claim is paid. The deductible is applied separately to building coverage and contents coverage.
TFIA’s Private Market Flood program offers FOUR solutions to ever-increasing annual flood insurance premiums: Rate-Lock allows you to pay the same rate for two years with one year rate lock or three years with two year Rate-Lock (Premium is paid annually). Additionally, Pre-Pay in full for a two year policy guaranteeing no increase for the second year of the policy or Pre-Pay three years premium guaranteeing no increase for three years.
Purchase Requirement *
Purchase Requirement Date *
Purchase Requirement Date
Please enter your loan closing date or the date of your expired or expiring flood insurance policy. If you have selected “Other – 14 Day Waiting Period,” please enter 00/00/0000. Your purchase requirement date cannot be more than 75 days after the date of application (today). The required waiting period is 14 days unless the date of a loan closing is sooner, you have an active FEMA policy, or a FEMA policy unpaid renewal within the 30 day grace period (in which case a no known loss statement will be required, click here).

NO COVERAGE IS BOUND UNTIL THE APPLICATION IS APPROVED BY UNDERWRITER AND THE FULL ANNUAL PREMIUM IS RECEIVED.
Each structure requires a separate application other than a detached residential garage used only as a garage.
Phone *
Phone
Property Owner Phone Numbers (not insurance agent’s phone number)
Cell Phone
Cell Phone
Underwriting information
Current cost to build new, not including land value How do I determine my replacement cost? The replacement cost of your home can be found on your homeowner's policy or an appraisal.
If contents coverage is not desired use $0
Primary Residence *
Is this residential building lived in by the owner for at least 250 days per year? This information effects both coverage at the time of a loss and the premium, so be sure to answer this question carefully. How does this effect my coverage? Only primary residence single family homes covered to at least 80% of the replacement cost at the time of the loss are paid Replacement Cost Value on building coverage (up to the coverage amount listed on the policy).
Contents coverage is always paid Actual Cash Value.
A non primary residence is always paid Actual Cash Value for building coverage.
Actual Cash Value (ACV)-The cost to replace an insured item of property at the time of loss, less the value of physical depreciation.
Replacement Cost Value (RCV)-The cost to replace property with the same kind of material and construction without deduction for depreciation.


This information can be found on: your present FEMA policy, a flood zone determination from your lender, an appraisal, or an elevation certificate. Your city or county building department may be able to provide you with this information as well. If flood insurance is required by a lender 99% of the time the flood zone will be an “A”. If the structure is within one mile of the Atlantic or Pacific Ocean or the Gulf of Mexico it is possible the flood zone will be a “V”. Our underwriters will verify the flood zone you enter when we receive your application and inform you if it is different than what you entered.
Date of Construction *
Date of Construction
Number of Floors *
Occupancy *
Check all that apply
Please indicate which diagram number best describes your foundation by choosing from the dropdown list below the illustrations.



If applicable
If applicable
Acknowledgement of Potential loss of fema subsidy
In 2014, Congress enacted the Homeowner Flood Insurance Affordability Act, which authorizes the National Flood Insurance Program (NFIP) to make a lower cost flood insurance rating option (known as grandfathering) available to property owners who have participated in the NFIP by maintaining continuous, uninterrupted coverage through NFIP. If you intentionally allow your NFIP policy to lapse and later choose to repurchase a NFIP policy, it is possible that FEMA may apply the full risk rate -- and not the grandfathered lower cost rate -- for flood insurance for this property. Applicant hereby understands and acknowledges that if continuous coverage is not maintained with NFIP, then the subject property might no longer be eligible for a grandfathering discount, and the full risk rate may apply, if at some later date insurance applicant seeks to obtain coverage from the NFIP. *
acknowledgement of availability of coverage
Applicant attests that they are aware that personal property coverage of up to $250,000 is available and excess flood insurance over $250,000 is available and requires a separate application. *
Applicant attests that they are aware that flood insurance building coverage is available up to $500,000 and excess flood insurance over $500,000 is available and requires a separate application. *
loss record
please answer yes if the following statements are TRUE and no if the following statements are FALSE.
Applicant attests that they are NOT aware of more than one flood loss within the past five years, unrepaired damage from a flood, a flood loss to the structure of $250,000 or greater, or that the property has been designated by FEMA as a Severe Repetitive Loss property. *
I understand that quoted premiums for properties with more than one flood loss within the past five years, properties with unrepaired damage from a flood, properties that incurred a flood loss to the structure of $250,000 or greater and any property that has been designated by FEMA as a Severe Repetitive Loss property are double those premiums quoted for properties without such losses and the policy, if issued, contains provisions for reduction and reformation of coverage if prior flood damage is discovered that has not been disclosed *
Ineligible properties
please answer yes if the following statement is TRUE and no if the following statement is FALSE.
Applicant attests that the building for which coverage is requested is NOT a Mobile Home, Condominium Unit, or Commercial Building. The building does NOT reside in an NFIP community under NFIP probation. The building is NOT located in a Coastal Barrier Resources System (CBRA zone) or an Otherwise Protected Area (OPA). NOR has the property been designated by a duly constituted State or local authority to be in violation of State or local floodplain management regulates (Section 1316). *
Payor of INITIAL policy term *
Who will be paying for this year's policy?

An underwriter will review your application the same or the next business day and, if approved, will email you an approved application for you to sign along with instructions on how to remit payment. This Application will be attached to and form a part of any Certificate and/or Policy that may be issued with certain UNDERWRITERS AT LLOYD’S OF LONDON or LEXINGTON INSURANCE COMPANY. TFIA will determine whether to offer you a Lloyd's policy or a Lexington policy based on various underwriting criteria. If you have a strong preference which company you prefer, you may indicate so in the "comments" field above, however we may not be able to accommodate your request.