Insurance Loss Run Request — shared by the community
Yusuf E. shared this 15-question build with 2 conditional rules already wired up. Test it below, then take a copy.
A ready-to-use insurance form for small teams who need a reliable intake process: 15 questions, 2 pages, 2 conditional rules.
- Shared by
- Yusuf E. · Recruitment partner
- Questions
- 15
- Replies
- 17
- Copies taken
- 110
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Live preview and test console
This is the real form. Answer it to test the 2 conditional rules — nothing is sent or stored.
Page 1 of 2 — Identify the Policies
Every question on this page is currently visible.
Works for you? Take Yusuf E.'s copy into your own workspace — questions, rules and settings included.
Who this template is for
Insurance Loss Run Request is built for small teams who need a reliable intake process who need to collect the same complete information from everyone.
- Small teams who need a reliable intake process working in insurance.
- Teams who need to collect the same complete information from everyone without writing code or paying for a custom build.
- Anyone replacing chasing missing details over email with one structured record per enquiry.
- Respondents are the people you send it to — the form asks them 15 questions across 2 screens.
- Mobile-heavy audiences, thanks to the one-question-per-screen card layout.
Why this form is useful
It removes the cost of chasing missing details over email and turns each submission into a record your team can act on immediately.
- 12 questions are required, so submissions arrive complete instead of needing a follow-up email.
- It collects a verified email address so replies and confirmations land.
- It accepts a document or photo upload as evidence.
- It pins the request to a specific date.
- Conditional logic hides 2 questions until they are relevant — shorter forms convert better than long ones.
- Splitting the form across 2 pages keeps each screen short and shows respondents how much is left.
- Every response is stored, searchable and exportable, so nothing depends on one person's inbox.
How to use this template
From copy to live form is a few minutes of work, and every step is reversible.
- 1Press “Use this template” — a fresh copy of Insurance Loss Run Request lands in your workspace, ready to edit.
- 2Rename or delete any question, and change what is required. Nothing here is fixed.
- 3Open Notifications and add the email addresses that should be alerted on each submission; add an auto-reply to the respondent if the form collects an email address.
- 4Check the upload limits on the file question so respondents can attach what you actually need.
- 5Publish it, then either share the link directly or paste the embed snippet into your site — the embedded form resizes to fit and loads no marketing or advertising trackers.
- 6Watch responses land in Submissions, where you can filter, label and export them to CSV or PDF.
Logic and conditions blueprint
Exactly how this form behaves as it is answered — 2 conditional rules ship with it.
- Features advanced show logic: if “Requester Relationship” is Authorized agent or broker, the form dynamically exposes “Authorization Document”. Otherwise that question never appears.
- Features advanced show logic: if “Report Valuation” is Specific valuation date, the form dynamically exposes “Requested Valuation Date”. Otherwise that question never appears.
- All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other.
What this form asks
Page 1 — Identify the Policies
- Named Insuredrequired
- Insurance Carrierrequired
- Policy Numbers and Termsrequired
- Line of Coveragerequired
- History Start Daterequired
- History End Daterequired
Page 2 — Authorization and Delivery
- Requester Namerequired
- Requester Emailrequired
- Requester Relationshiprequired
- Authorization Document
- Report Valuationrequired
- Requested Valuation Date
- Report Recipient Emailrequired
- Requested Delivery Date
- Authority to Request Recordsrequired
Conditional logic in this build
- When “Requester Relationship” is Authorized agent or broker, show “Authorization Document”.
- When “Report Valuation” is Specific valuation date, show “Requested Valuation Date”.
Questions about this shared form
Can I request a loss run if there were no claims?
Yes. Include those policy terms in the request and ask the carrier to confirm the no-loss history rather than leaving the period undocumented.
How many years should I request?
Use the period requested by the intended report recipient. If this supports a Business Insurance Quote, confirm the history period needed before contacting former carriers.
Does submitting this form authorize release automatically?
No. It captures the requester's confirmation and any attached authorization, but the carrier may still require a signed release, identity checks, or its own request process.
What if a policy number or valuation date is unavailable?
Flag the missing policy number alongside the known term dates rather than inventing one. Choose the latest available valuation unless a particular date is needed; confirm any date-specific request with the carrier.
Is the Insurance Loss Run Request template free to use?
Yes. You can preview and test Insurance Loss Run Request on this page without an account, and take a copy into your own HelloForms workspace on the free plan. There is nothing to install and no card required to publish it.
What does the Insurance Loss Run Request template ask for?
It asks 15 questions across 2 pages, 12 of which are required. Every question is listed in full further down this page, and each one can be renamed, reordered, made optional or deleted after you copy the template.
Can I edit the Insurance Loss Run Request form after copying it?
Yes — the copy is entirely yours. Change wording, add or remove questions, switch between the classic and card layouts, restyle it to match your brand, and set who gets notified on each submission.
How does the conditional logic in this insurance form work?
2 conditional rules ship with the template: Features advanced show logic: if “Requester Relationship” is Authorized agent or broker, the form dynamically exposes “Authorization Document”. Otherwise that question never appears. Features advanced show logic: if “Report Valuation” is Specific valuation date, the form dynamically exposes “Requested Valuation Date”. Otherwise that question never appears. All 2 rules are editable in the Logic tab, and the built-in checker warns about rules that contradict each other. All rules are editable in the Logic tab.
Where do responses to the Insurance Loss Run Request form go?
Submissions land in your workspace under Submissions, where you can search, filter, label and export them to CSV or PDF. You can also email a notification to your team on every submission and send the respondent an auto-reply.
Can I embed the Insurance Loss Run Request form on my own website?
Yes. Publish the form and paste the embed snippet into any page or share the direct link. The embedded form resizes to fit its container and loads no advertising or marketing trackers inside the iframe.
Can respondents upload files?
Yes. This template includes a file upload question, so respondents can attach documents or photos with their answers. You can adjust the accepted file types and size limits on that question.
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