Insurance Dashcam Policy

INSURANCE DASHCAM POLICY

Policy Identification

Insurer Name:

Policy Number:    Issued By (Agent/Office):

Insured / Applicant Information

Date of Birth: Month Day Year

Vehicle & Dashcam Details

Date of Installation (approx.): Month Day Year

Coverage Options (select applicable coverages)

Physical Damage to Dashcam (repair or replacement)
Coverage Limit:    Deductible:

Data Recovery / Corrupted Footage
Coverage Limit:

Tamper / Vandalism
Deductible:

Cloud Storage Reimbursement (monthly)
Monthly Limit:

Third-Party Liability Reduction Credit (policy benefit for validated footage)

Policy Period & Premium

Policy Period Commences: Month Day Year

Policy Period Expires: Month Day Year

Exclusions (standard and material)

The following are excluded from coverage unless expressly endorsed: intentional damage, loss or corruption due to willful tampering by the insured, pre‑existing damage documented prior to the policy effective date, loss attributable to use of devices in violation of applicable law, recording conducted in restricted jurisdictions where consent is required but not obtained, commercial use not disclosed at inception (including unreported rideshare or commercial fleet operations), and failures caused by aftermarket modifications not approved by the manufacturer.

Insured acknowledges responsibility to follow manufacturer's installation and maintenance instructions. Failure to maintain or properly install the dashcam voids coverage for related loss unless insurer's prior written waiver is obtained.

Acknowledgement of Exclusions: I have read and understand the exclusions set forth above.

Beneficiary Designation (for any direct payable benefits)

Beneficiary 1 Name: Relationship: Share %:

Beneficiary 2 Name: Relationship: Share %:

If multiple beneficiaries are named, total percentages must equal 100%. Any beneficiary designation supersedes prior beneficiary designations for this policy.

Claims — Notice & Documentation

Date/Time of Incident: Month Day Year Time

Documentation checklist (check items attached):

Police Report
Video Footage Available
Photographs of Damage
Repair Estimates / Invoices

Declarations, Authorizations & Conditions

By signing this Insurance Dashcam Policy, the Applicant certifies that all information supplied on this form is true and complete to the best of Applicant's knowledge. Applicant authorizes the insurer and its representatives to inspect the dashcam, related equipment, vehicle, and any relevant recordings for purposes of underwriting and claim investigation. Applicant agrees to cooperate with the insurer's reasonable requests for evidence, to preserve footage and metadata pending insurer instructions, and to provide access to any service provider maintaining cloud storage for the dashcam when requested for a claim.

Applicant acknowledges that coverage is provided only as set forth in this policy and applicable endorsements and is subject to limits, deductibles, exclusions, and conditions herein. The insurer's liability for any claim is limited to the lesser of the applicable coverage limit or the actual cost to repair or replace covered equipment, less any deductible. This policy does not create an obligation for the insurer to reproduce or provide copies of footage other than as permitted by law and internal procedures; the insurer will retain footage only as necessary for investigation and claims handling in accordance with its retention policy.

Applicant further represents that the dashcam was installed and maintained in accordance with the manufacturer's instructions and that any modification, removal, or alteration has been disclosed. Applicant understands that failure to notify the insurer of a claim within thirty (30) days of discovery or to cooperate in the claims process may result in denial of coverage to the extent the failure prejudices the insurer.

Consent to Use of Footage: Applicant grants the insurer a limited license to use recorded footage and associated metadata solely for claim handling, subrogation, fraud prevention, and policy administration. Any further use requires separate written authorization unless required by law.

Acknowledgement

I certify under penalty of perjury that the information provided in this application is true and complete. I understand that any material misrepresentation may be grounds for rescission or denial of claims. I have read, understand, and accept the terms, conditions, exclusions, and obligations stated in this policy document.

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