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Applications and Forms

Please complete and return the appropriate form.

You can email to your Highland Risk contact or, if this is your first time, you can email to This email address is being protected from spambots. You need JavaScript enabled to view it.. Our general fax number is (847) 574-7611.


Nursing Home Application
ALF Application
Broker Agreement
Surplus Line Certificate
TRIA Terrorist Form

Submission requirements:

To receive a quote, please provide the following data:

  • Current financials
  • 5 year loss-runs
  • Completed application

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