Transcription of APPLICATION FOR MANUFACTURERS’ PRODUCT …
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APPLICATION FOR MANUFACTURERS’ PRODUCT …
SM 1626-02 12/03 Page 1 of 3 APPLICATION FOR manufacturers PRODUCT engineering OR design ERRORS & OMISSIONS INSURANCE (Claims Made Basis) APPLICANT S INSTRUCTIONS: 1. Answer all questions. If the answer requires detail, please attach a separate sheet. 2. APPLICATION must be signed and dated by owner, partner or officer. 3. PLEASE READ CAREFULLY THE STATEMENTS AT THE END OF THIS APPLICATION . (PLEASE TYPE OR PRINT IN INK) 1. APPLICANT INFORMATION a. Full name of individual or entity to be Named Insured: b. Principal business premise address: (Street) (County) (City) (State) (Zip) c. Phone: d. [ ] Corporation [ ] Partnership [ ] Proprietorship [ ] Other_____ Years in business under present name: e.
sm 1626-02 12/03 page 1 of 3 application for manufacturers’ product engineering or design errors & omissions insurance (claims made basis) applicant’s instructions:
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