Select a Personal Umbrella Application & Rate Sheet: 

CURRENT APPLICATION as of June 1, 2018 (Use for ALL Business to be Effective JUNE 1, 2018 and after)

Insured Payment Authorization Form

UM-UIM Purchase or Rejection Form (PUP 261-0111)

Auto Endorsement Form

Secure Submission Portal

Upload the insured's completed application and payment authorization form using the submission portal on this page.

Direct Access to Complete, Sign & Pay on the RLI Website

Member Agents may access the RLI website directly.  “PUP ACCESS” gives you the ability to submit/quote applications, send it to the insured for Review, eSignature and Payment...plus gain access to Policy Status, Billing Info, Policy Documents.  To obtain PUP ACCESS or learn more, contact Angelina Coelho at 508-634-7360.

Mail Submissions

Forward completed RLI applications with a FULL premium check (payable to RLI):

RLI c/o Number One Insurance Agency
91 Cedar Street

Milford, MA 01757

• Personal Umbrella Agency Offer/Rejection Form

• Excess UM/UIM FAQ's

Not a Fit with RLI? Try an alternative market Endorsed by IIABA: Anderson & Murison (A&M). 

• Anderson & Murison (A&M) is the national administrator for National Casualty Insurance's personal umbrella and excess personal umbrella policies.

Laura Long, Underwriter

800/234-6977 ext. 264  |  f: (323) 255-0957

lauralong@amqts.com  |  andersonmurison.com

Office Hours: 9 am - 8 pm EST  

Mail Renewal Bill Payment Stub:  

RLI Insurance 
Box 4726 
Carol Stream, IL 60197

WARNING: MAILED PAYMENTS TAKE 10 DAYS TO PROCESS

Mail Overnight:

JP Morgan Chase

Attn: RLI Ins Co

Box 4726

131 S. Dearborn, 6th Floor

Chicago, IL 60603

Pay Online for the Insured:

A User Name & Password is provided on the Insured’s Renewal Bill.
The insured should log on to www.myrli.com and enter the user name and password provided (case sensitive) then follow the prompts. These credentials expire after renewal date.

Pay by Phone for the Insured:

Call (866) 302-7925 to make a Credit Card/ACH Payment

• A future date requested.
• The date the insured signs and dates a request (within 30 days). If the requested date is further back than 30 days, RLI will use 30 days back.
• The date RLI or administrator receives the signed request from the insured, (if the request is not dated).
• Returned premium, if applicable, will be subject to a short rate factor of 10%.

Member Agents may access the RLI website directly.  

“PUP ACCESS” gives you the ability to submit/quote an application then send it to the insured for Review, eSignature and Payment. Additionally, agents gain direct access to the Policy Status, Billing Info and Policy Documents.  

To obtain PUP ACCESS or learn more, contact Angelina Coelho at 508-634-7360.

Email to new.claim@rlicorp.com or fax to (309) 683-1629.