Transcription of Religious Pac Supplemental Application - btisinc.com
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Religious Pac Supplemental Application - btisinc.com
CX-1078 (Revised 02-06) Page 1 of 5 Religious Pac Supplemental Application Named Insured: Agent Name and Phone: Effective Date: Risk Control Contact Name: Phone: Account 1. Does the business have a website? Yes No Unknown Please provide URL: 2. What background steps are taken to verify the qualifications of employees/volunteers? (Check all that apply) Criminal background check Credit check Reference check Prior employment verification Verification of certifications, degrees and licenses Other Please describe: Unknown 3. Are any buses or 15 passenger vans operated? Yes No Unknown 4. Do members use their own vehicles on church business or to transport others to and from activities?
files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and shall also be
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