Transcription of Directors and Officers Liability Application
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Directors and Officers Liability Application
Directors and Officers Liability Application I. PRODUCER INFORMATION. Agency _____ Name _____. Address _____ Phone _____ Fax _____. City _____ St _____ Zip _____ Email _____. II. GENERAL INFORMATION. Effective Date:_____ Exp Date_____. 1) Name of Applicant:_____. (The term "Applicant", as used in this Application , means the Parent Corporation and all Subsidiaries, if applicable.). 2. Address of Parent Corporation:_____. City: _____ State: _____ Zip Code: _____ Telephone:_____. 3. Executive officer authorized to receive notices and information regarding the proposed policy: Name: _____ Title: _____ Telephone:_____.
Directors and Officers Liability Application Page 2 of 3 III. DIRECTORS AND OFFICERS LIABILITY COVERAGE 1. (a) Number of Units or Lots:_____
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