Transcription of AmRisc Application General Insured Information
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AmRisc Application General Insured Information
AmRisc ApplicationGeneral Insured InformationSTARRED (*) ITEMS ARE MANDATORY AND REFLECT EXCLUSIONS OR WARRANTS IN THE POLICY UNLESS Information IS PROVIDEDOTHERWISE HEREIN.*First Named Insured :*Expiration Date of Existing Coverage:Describe any gut rehabs including location number, year and extent of any Locations less than 200 ft. apart?Has any applicant been convicted of arson in the past 10 years?Are there any bankruptcies or tax credit leans against applicant in prior 5 years?Property losses min 3 years, prefer 5 years. Warranted Summary (Material misstatements may void policy back to inception)DOLC auseIncurred($)Status (Open/Closed)*Number of years provided:*Does the applicant have any reason that they would not be aware of all losses for the prior 5 years?
AmRisc Application General Insured Information STARRED (*) ITEMS ARE MANDATORY AND REFLECT EXCLUSIONS OR WARRANTS IN THE POLICY UNLESS INFORMATION IS PROVIDED OTHERWISE HEREIN.
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