Insurance Flood Binder

INSURANCE FLOOD BINDER

Binder Identification

Binder Number:    Issuing Agent:

Effective Date:    Expiration Date:

Insured / Applicant Information

Phone:    Email:    Date of Birth:

Property / Location to be Insured

Building Type:    Year Built:

Policy Details

Policy Type:    Policy Form/Program:

Coverage Selections (Check all that apply)

Building Structure Coverage Personal Property / Contents Coverage Loss of Use / Additional Living Expense Debris Removal and Clean-up Preservation of Property (reasonable emergency measures) Other Endorsements (describe below)

Exclusions, Limitations and Conditions

This Binder evidences temporary coverage subject to the terms, conditions, exclusions, and limitations of the policy form to be issued. Coverage does not apply to loss caused by earth movement, intentional acts, war, nuclear hazard, or other perils specifically excluded in the policy wording. Coverage is further limited by sublimits, waiting periods, and post-loss documentation requirements.

By accepting this binder, the Insured acknowledges and agrees that the binder is not a policy and that definitive coverage is subject to underwriting review, receipt of required premium, satisfactory proof of insurability, and any endorsements listed below.

Mortgagee / Loss Payee / Additional Interest

Mortgagee Name:

Beneficiary / Payee Designation

Relationship:    Share Percentage:

Claims / Notice of Loss Requirements

Documentation Checklist (for underwriting or claims)

Proof of ownership / deed Photographs of damaged property Repair estimates or contractor bids Official reports (if applicable) Other supporting documentation (specify below)

Endorsements and Pending Requirements

Declaration and Certification

I, the undersigned Applicant, declare that the information supplied in this Flood Binder application and supporting documents is true and complete to the best of my knowledge. I acknowledge that this binder is temporary evidence of coverage effective only for the binder period specified and that coverage is subject to the terms, conditions, limitations, and exclusions of the policy to be issued. Coverage shall be void in cases of material misrepresentation or failure to comply with post-loss duties described in the policy. The Insured authorizes the insurer and its representatives to obtain and disclose information necessary for underwriting and claims handling.

Acceptance of this binder is conditioned upon receipt of any required premium deposit, completion of underwriting requirements, and any inspections or surveys requested by the insurer. This binder does not modify or waive any provision of the policy form to be issued unless specifically stated in writing herein.

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