Transcription of COMMERCIAL POLICY CHANGE REQUEST DATE …
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The ACORD name and logo are registered marks of ACORDSHORT DESCRIPTION OF CHANGES / REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)POLICYTYPEPROPERTYGENERAL LIABILITYINLAND MARINEAUTOUMBRELLAWORKERS COMPTRUCKERSBUSINESS OWNERSMOTOR CARRIERSTHIS IS AN ACKNOWLEDGEMENT OF YOUR REQUEST . UPON APPROVAL, THE COMPANY'SRECORDS WILL BE ADJUSTED ACCORDINGLY, AND IF A PREMIUM ADJUSTMENT ISREQUIRED, IT WILL BE DONE AT PREMIUM AUDIT OR BY NUMBERCARRIERNAIC CODEACCOUNT NUMBERPOLICY EXPIRATION DATEPOLICY INCEPTION DATEEFFECTIVE date OF CHANGEATTENTIONINSURED'S NAME AND MAILING ADDRESS, IF CHANGED (INC ZIP+4)NAMED INSUREDFAX(A/C, No):AGENCYNAME:CONTACT(A/C, No, Ext):PHONESUBCODE:CODE:AGENCY CUSTOMER ID:ADDRESS:E-MAIL 1991-2012 ACORD CORPORATION.
acord 175 (2012/04) additional interest add change delete item description item class: item: boat: building: vehicle: mortgagee certificate as …
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