AGENT/BROKER OF RECORD CHANGE - Applied …

agent/broker of record change date (mm/dd/yyyy) policy number(s) effective date expiration date named insured line of business (as it appears on policy) please be advised that we wish to name

  Change, Record, Agent, Broker, Agent broker of record change

PERSONAL INSURANCE APPLICATION DATE …

date (mm/dd/yyyy) applicant information section personal insurance application residential (89) indicate sections attached personal inland marine (81)

  Information, Section, Applicants, Applicant information section, Yyyy, Dd yyyy

AUTOMOBILE LOSS NOTICE - Applied Systems

page 2 of 4 witnesses or passengers name & address phone (a/c, no) ins veh oth veh other (specify) reported by reported to name & address phone (a/c, no) ped

  Notice, Loss, Automobile, Automobile loss notice

I CERTIFY THAT I AM NOT AWARE OF ANY LOSSES, …

acord 37 (2008/01) © 1996-2008 acord corporation. all rights reserved. witness date and time receipt $ amount received by: producer applicant's signature

  Acord

AGENCY CUSTOMER ID: COMMERCIAL GENERAL …

attach to acord 125 agency customer id: effective date carrier naic code policy number applicant / first named insured agency 4. retroactive date: 3. number of employees covered by employee benefits plans:

  General, Commercial, Commercial general, Acord

Applied University Schedule

Applied University Schedule Author: Teresa Cronin Keywords: Applied University Created Date: 2/19/2018 10:15:22 AM ...

  University, Schedule, Applied, Applied university schedule

IVANS Real-Time Configuration - Applied Systems

9 ACUITY Agents ACUITY has enabled Billing Inquiry, Policy Inquiry, Claims Inquiry, Loss Run Inquiry and Personal Lines Endorsement Bridge for all agents. They’ve also enabled Auto, Home and Package bridge for all personal lines agents in all states and Commercial Auto bridge and Work Comp bridge for all

  Configuration, Time, Real, Endorsement, Navis, Ivans real time configuration

COMMERCIAL INSURANCE APPLICATION DATE …

acord 125 (2007/10) page 2 of 3 6.any policy or coverage declined, cancelled or non-renewed during the prior three (3) years? (not applicable in mo)

WORKERS' COMPENSATION - Applied Systems

Page 3 of 5 Any person who, with purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as …

  Compensation, Worker

AGENCY CUSTOMER ID: COMMERCIAL GENERAL …

10. does any named insured sell to other named insureds? 9. vendors coverage required? 8. products under label of others? 7. products of …

  General, Customer, Commercial, Agency, Agency customer id, Commercial general

PROPERTY LOSS NOTICE DATE (MM/DD/YYYY)

Applicable in Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution, fines, or confinement in

  Date, Property, Notice, Loss, Yyyy, Mm dd yyyy, Property loss notice date

GENERAL LIABILITY NOTICE OF …

date (mm/dd/yyyy) agency phone date of occurrence and time date of claim previously (a/c, no, ext): reported effective date expiration date policy type retroactive date

  General, Date, Liability, Notice, Yyyy, General liability notice of

COMMERCIAL INSURANCE APPLICATION DATE …

EFFECTIVE DATE YEAR EXPIRATION DATE PREMIUM POLICY NUMBER CARRIER CATEGORY GENERAL LIABILITY AUTOMOBILE PROPERTY OTHER: PRIOR CARRIER INFORMATION REMARKS / PROCESSING INSTRUCTIONS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)

  Date, Applications, Property, Commercial, Insurance, Commercial insurance application date

INSURANCE BINDER DATE (MM/DD/YYYY) - Morstan

AGENCY CUSTOMER ID: This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company.

  Date, Yyyy

CERTIFICATE OF PROPERTY INSURANCE DATE …

insurer(s) affording coverage naic # insurer f : insurer e : insurer d : name: contact insurer c : insurer b : (a/c, no): fax e-mail address: customer id:

  Date, Property, Certificate, Insurance, Certificate of property insurance date

COMMERCIAL INSURANCE APPLICATION DATE …

amt ea accident claims made claims made claims made claims made claims occurrence occurrence occurrence occurrence made occurrence state supplement(s) (if applicable)

  Date, Applications, Commercial, Insurance, Commercial insurance application date