Application Loading
beach_access account_circle work

Application Loading

Accept

Accept
Confirm action

Do you want to continue?

Accept
Cancel
Processing

{{Insurance.Description}}

  • {{s}}
{{currentWizard.Name}}

{{item.Title}}

Coverage Type Limit of Liability Retention Premium
Directors and Officers {{Variables.limit | currency:"$"}} {{Variables.selectedretention| currency:"$"}} {{Variables.DOPremium | currency:"$"}}
Employment Practices {{Variables.limit | currency:"$"}} {{Variables.selectedretention| currency:"$"}} {{Variables.EPLIPremium | currency:"$"}}
Fiduciary {{Variables.limit | currency:"$"}} {{Variables.selectedretention | currency:"$"}} {{Variables.FLIPremium | currency:"$"}}
{{discount.OnlineDescription}} {{discount.OnlineDiscount}}% {{ Variables.Discounts | currency:"$ "}}
Premium Subtotal {{ Variables.SubTotal | currency:"$ "}}
Taxes {{Variables.StateTaxDescription}} {{Variables.StateTaxRate*100 | number :2}}% {{Variables.SubTotal*Variables.StateTaxRate | number :2 | currency:"$"}}
Taxes {{Variables.CityTaxDescription}} {{Variables.CityTaxRate*100 | number :2}}% {{Variables.SubTotal*Variables.CityTaxRate | currency:"$"}}
Total {{ Variables.Total | currency:"$"}}
VISA Accepted Mastercard Accepted Discover Accepted
Shopping is always safe and secure
Security Transaction

{{Lang == "es" ? 'Información de Pago' : 'Payment Information'}}

Named Insured: {{Variables.orgName}}
{{Purchase.Valids.CardType.message}}
{{Purchase.Valids.NumberCard.message}}
{{Purchase.Valids.CardName.message}}
{{Purchase.Valids.Month.message}}
{{Purchase.Valids.Year.message}}
{{Purchase.Valids.SecurityCode.message}}

{{Lang == "es" ? 'Dirección de Facturación' : 'Billing Address'}}

{{Lang == "es" ? 'Dirección' : 'Address'}} {{Lang == "es" ? 'Ciudad' : 'City'}} {{Lang == "es" ? 'Código Postal' : 'Zipcode'}} {{Lang == "es" ? 'Código Postal' : 'Postal Code'}} {{Lang == "es" ? 'Estado' : 'State'}} {{Lang == "es" ? 'Provincia' : 'Province'}}
{{Variables.address}} {{Variables.address2}} {{Variables.city}} {{Variables.zipcode}} {{Variables.state}} {{Variables.Province}}
{{Lang == "es" ? 'Dirección' : 'Address'}} {{Lang == "es" ? 'Ciudad' : 'City'}} {{Lang == "es" ? 'Código Postal' : 'Zipcode'}} {{Lang == "es" ? 'Código Postal' : 'Postal Code'}} {{Lang == "es" ? 'Estado' : 'State'}} {{Lang == "es" ? 'Provincia' : 'Province'}}
{{Purchase.Valids.Address1.message}} {{Purchase.Valids.City.message}} {{Purchase.Valids.Zip.message}} {{Purchase.Valids.State.message}}

Total: $ {{Variables.Total | number:2}} $ {{Variables.TotalPaid | number:2}} $ {{Variables.TotalPr | number:2}}

{{c.Title}} Total

{{c.Value | currency}}

{{SpecialPurchaseSummary.Total | currency}}

{{SpecialPurchaseSummary.Message}}

Total: $ {{SpecialPurchaseSummary.Total | number:2}}

{{Lang == "es" ? 'Importante' : 'Important'}}

{{Lang == "es" ? 'IMPORTANTE SABER' : 'IMPORTANT TO KNOW'}}:

{{Lang == "es" ? 'Enviar' : 'Submit'}}
Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}

{{Lang == "es" ? 'Información de Pago' : 'Payment Information'}}

Named Insured: {{Variables.orgName}}
VISA Accepted Mastercard Accepted Discover Accepted

{{Purchase.Valids.CardType.message}}
{{Purchase.Valids.NumberCard.message}}
{{Purchase.Valids.Month.message}}
{{Purchase.Valids.Year.message}}
{{Purchase.Valids.SecurityCode.message}}
{{Purchase.Valids.CardName.message}}

{{Lang == "es" ? 'Dirección de Facturación' : 'Billing Address'}}

Your credit card was not able to be processed, please confirm your address below.

Total: $ {{Variables.Total | number:2}} $ {{Variables.TotalPaid | number:2}} $ {{Variables.TotalPr | number:2}}

{{Lang == "es" ? 'Términos y Condiciones' : 'Terms and Conditions'}}

{{Lang == "es" ? 'IMPORTANTE SABER' : 'IMPORTANT TO KNOW'}}:

Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}
Named Insured: {{Client.ClientName}}

{{Lang == "es" ? 'Información de Pago' : 'Payment Information'}}

VISA Accepted Mastercard Accepted Discover Accepted

{{Purchase.Valids.CardType.message}}
{{Purchase.Valids.NumberCard.message}}
{{Purchase.Valids.CardName.message}}
{{Purchase.Valids.Month.message}}
{{Purchase.Valids.Year.message}}
{{Purchase.Valids.SecurityCode.message}}

{{Lang == "es" ? 'Dirección de Facturación' : 'Billing Address'}}

Premium Summary

Annual Policy Premium {{wfDefault.Invoice.Subtotal | currency}}
Taxes 2022-1 FIGA Assessment Surcharge {{wfDefault.Invoice.Taxes | currency}}
Administrative Fee {{wfDefault.Invoice.Fees | currency}}
{{c.Name}} {{c.Prorate | currency}}

Total: $ {{wfDefault.Invoice.Total | number:2}}

Total: $ {{wfDefault.Invoice.TotalProrated | number:2}}

{{Lang == "es" ? 'Términos y Condiciones' : 'Terms and Conditions'}}

{{Lang == "es" ? 'Enviar' : 'Submit'}}
Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}
Premium 1 Premium 2 Premium 3
{{Variables.Premium01 | currency:"$"}} {{Variables.Premium02 | currency:"$"}} {{Variables.Premium03 | currency:"$"}}
Premium Subtotal {{ Variables.SubTotal | currency:"$ "}}
Taxes {{Variables.StateTaxDescription}} {{Variables.StateTaxRate*100 | number :2}}% {{Variables.StateTaxTotal | number :2 | currency:"$"}}
Taxes {{Variables.CityTaxDescription}} {{Variables.CityTaxRate*100 | number :2}}% {{Variables.CityTaxTotal | currency:"$"}}
Total {{ Variables.Total | currency:"$"}}

Check Payment Info

Uncheck the "Apply Payment in Nexsure box" if this is a partial payment or a split of two payment methods (credit card and check or 2 checks). For all PHLY Special event manual payments (American Express and Wires) uncheck the Apply Payment in Nexsure box).

TOTAL $ Payment Amount Apply Payment in Nexsure

$ {{Variables.Total}}

$ {{Variables.TotalPr}}


Client Info

Policy Effective Date E-mail Policy Documents to Client Client E-mail
{{Variables.EffDate | date}}
{{Variables.Email}}
{{Purchase.Valids.CheckAmount.message}}

Premium Summary

Professional Liability Premium {{OperationCoverages.PL.Premium | currency}}
Additional Insured Premium {{OperationCoverages.AdditionalInsured.Premium | currency}}
Additional Occupation Premium {{OperationCoverages.AdditionalOccupation.Premium | currency}}
General Liability Premium {{OperationCoverages.GL.Premium|currency}}
Premium Subtotal {{wfDefault.Invoice.Subtotal | currency}}
Taxes 2022-1 FIGA Assessment Surcharge {{wfDefault.Invoice.Taxes | currency}}
Administrative Fee {{wfDefault.Invoice.Fees | currency}}

Total:
$ {{wfDefault.Invoice.Total | number:2}}

{{Lang == "es" ? 'Información de Pago con Cheque' : 'Check Payment Information'}}

Uncheck the "Apply Payment in Nexsure box" if this is a partial payment or a split of two payment methods (credit card and check or 2 checks). For all PHLY Special event manual payments (American Express and Wires) uncheck the Apply Payment in Nexsure box).

Payment Amount Apply Payment in Nexsure
{{Purchase.Valids.CheckAmount.message}}

{{Lang == "es" ? 'Importante' : 'Important'}}

If you prefer, you can include additional attachments to this invoice

{{GetOtherInsuranceFiles()}}
Policy Effective Date Change Effective Date Send Email Has binding conditions?
{{Variables.EffDate | date}} {{Variables.EndorsementEffectiveDate | date:'MM/dd/yyyy'}}


Policy Effective Date E-mail pending reason to client
{{Variables.EffDate | date}}

Rates Table

Showing 6 of 10 levels. Click here for show all levels.

Coverage / Level 1 2 3 4 5 6 7 8 9 10
{{level.NewColumn}} ${{level.Level1}} ${{level.Level2}} ${{level.Level3}} ${{level.Level4}} ${{level.Level5}} ${{level.Level6}} ${{level.Level7}} ${{level.Level8}} ${{level.Level9}} ${{level.Level10}}
Please select your desired coverage level by clicking one of the following radio buttons.

Renewing Customers

Do you have a current Professional Liability Insurance Policy for Life Coaches with Philadelphia Insurance Company?

Yes No

Please enter your policy number or email address

Searching...

Your entry does match a record in our system:

  • Policy Number: {{userFound.PolicyNumber}}
  • Email address: {{userFound.Email}}
  • Current Retroactive date: {{userFound.RetroactiveDate}}
  • Current Effective date: {{userFound.EffectiveDate}}
Please proceed to complete remaining information in order to renew your policy.

We’re sorry, but your entry does not match a record in our system.
Please contact us at 800-875-1911 to retrieve your policy information.

Searching...

We’re sorry, but your entry does not match a record in our system.
Please contact us at 800-875-1911 to retrieve your policy information.

Payment Information

*Card Type: {{Purchase.Valids.CardType.message}}
*Card Number: {{Purchase.Valids.NumberCard.message}}
Security Code Shopping is always safe and secure
*Expires On:
{{Purchase.Valids.Year.message}} {{Purchase.Valids.Year.message}}
*Security Code: What is this? Security Code {{Purchase.Valids.SecurityCode.message}}
*Name on Card: {{Purchase.Valids.CardName.message}}
Gross Payment
Net Payment
Total: {{(!Variables.IsGrossPayment ? 0.80*Variables.TotalPremium + Variables.TotalTax + (Variables.Fee ? Variables.Fee : 0) : Variables.Total) | currency}}

Billing Address

Same as Insured:

{{Variables.orgName}}
{{Variables.address + ","}} {{Variables.address2}}
{{Variables.city + ","}} {{Variables.state}} {{Variables.zipcode}}

*Street Address 1: {{Purchase.Valids.Address1.message}} Street Address 2:
*City: {{Purchase.Valids.City.message}} *State: {{Purchase.Valids.State.message}}
*Zip Code: {{Purchase.Valids.Zip.message}}

Message:{{Purchase.Result.Message}}
Message:{{Purchase.Result.Message}}
Policy Effective Date E-mail Policy Documents To Client
{{Variables.EffDate | date}}
Policy Effective Date E-mail decline reason to client
{{Variables.EffDate | date}}

In order to Bind Coverage you must generate a proposal
and accept the terms and conditions of the policy.

Effective Date Send Email
{{Variables.EffDate | date}}

{{question.ErrorMessage}}

{{question.ErrorMessage}}
{{row.MultiAnswerLabel}} Review errors Remove

{{question.ErrorMessage}}


{{SubmitConfirmation.Header}}

Quote Number: {{LogWF.QuoteNumber}}

Policy Number: {{LogWF.PolicyNumber}}

Policy Number: {{LogWF.PolicyNumberWithVersion}}

Thank you for choosing us.

Register for access to the customer portal