ACORD 80 (2013/01) - Morstan

CIVIL UNION (if applicable)MARITAL STATUS * /CIVIL UNION (if applicable) ACORD 80 ( 2013 /01)HOW LONG HAVE YOU KNOWN THE APPLICANTFORM NAMEITEM #BOAT #VEH #FORMS AND ENDORSEMENTS (Attach ACORD 829, Forms and Endorsements Schedule, if more space is required)LOC #FORM NUMBEREDITION DATECOPYRIGHT OWNER CODESUSTAINEDACTUAL LOSSOF USE**Not Applicable in North CarolinaNamed Storm Percentage Deductible in North CarolinaHO FORM #:$$$$$% MAXHURRICANE**HURRICANE*$$$$AMOUNTTYPE%% %%PERCENT$$$$DEDUCTIBLEAMOUNTLIMITINCLUD EDINCLUDEDINCLUDEDOPTIONREPL COST - CONTENTSREPL COST - DWELLINGREPL COST - FULL VALUECOVERAGE* Includes Dwelling, Other Structures, Personal Property, Loss of UseTYPE%%%ANNUALNAMEDTHEFTWIND / HAILBASEPREMIUM%DEDUCTIBLEPERCENTMEDICAL PAYMENTS EA PERPERSONAL LIABILITY EA OCCLOSSPERSONAL PROPERTYCOVERAGELIMITBLANKET *DWELLINGOTHER STRUCTURESPREMIUM$$$$$$$$$$$$$$COVERAGES / LIMITS OF LIABILITY LOC #: date AGENT LAST INSPECTED PROPERTYEFFECTIVE DATESTATUS OF TRANSACTIONRENEWNEWPOLICY CHANGEPOLICY CHANGETIMEAMPMC heck if same as Applicant* This field may not be utilized for policyholders applying for residential property insura

acord 80 (2013/01) % % sq. ft. sq. ft. y / n incl excl y / n $ start date comp date int ext addition add levelstruc changesmaterials unattachedocc during ren cost of project

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  Date, 2013, Acord, Acord 80, 2013 01

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