Insurance Full Policy Form

INSURANCE FULL POLICY FORM

Policy Number:   Effective Date:   Expiration Date:

APPLICANT / INSURED INFORMATION

Individual   Corporation   LLC   Partnership

POLICY DETAILS

Policy Type:   Auto Homeowners Commercial Professional Liability Cyber

Payment Frequency: Monthly Quarterly Annually

COVERAGE SECTIONS

Select coverages applicable to this policy and specify limits/deductibles where required.

General Liability Limit:   Deductible:

Property / Building Coverage Amount:   Deductible:

Business Interruption Limit:

Cyber Liability Limit:   Retention:

Flood Limit:

EXCLUSIONS

The following are standard exclusions under this policy unless expressly added by endorsement: intentional loss or criminal acts by the insured; wear and tear, gradual deterioration, or latent defect; nuclear hazard; war, hostile or warlike action; punitive damages where prohibited by law; losses arising from dishonest or fraudulent acts by insured employees not covered except as required by endorsement. Coverage for pollution, mold, and professional advice is excluded unless specifically scheduled.

BENEFICIARY DESIGNATION

Designate primary beneficiaries for proceeds where applicable. Percentages must total 100% where required by policy terms.

ENDORSEMENTS / RIDERS

DECLARATIONS, REPRESENTATIONS AND CERTIFICATION

By signing below the applicant certifies that the statements and material facts set forth in this form are true and complete to the best of the applicant's knowledge. The applicant represents that no material information has been omitted and acknowledges that any material misrepresentation, omission or concealment of fact may void coverage or permit the insurer to rescind or cancel this policy in accordance with applicable law.

Premium payment is due as specified by the policy’s billing schedule. Failure to pay premium when due may result in lapse, nonrenewal, or cancellation in accordance with the policy terms. The insurer retains all rights of subrogation and salvage to the extent permitted by law.

Claims arising under this policy must be reported promptly. The insured must cooperate with the insurer in any investigation, settlement, or litigation. The insurer may deny coverage for claims arising from fraud, intentional acts, or willful violations of law by the insured.

Arbitration: Except where prohibited by law, disputes concerning coverage under this policy may be resolved by binding arbitration if both parties agree in writing after a covered loss arises. Choice of law provisions in the policy will govern interpretation, except where overridden by mandatory statutory requirements.

Acknowledgement: I certify that the information provided in this form is complete and accurate and I understand the consequences of misrepresentation or omission.

NOTICE OF INSURER RIGHTS & CANCELLATION

This policy is subject to cancellation, nonrenewal, modification, or endorsement as permitted by the policy terms and applicable law. The insurer will provide required notices of cancellation or nonrenewal in accordance with statutory requirements. Acceptance of any endorsement or change to coverage is effective only when issued in writing by the insurer or its authorized representative.

AUTHORIZATION TO OBTAIN INFORMATION

The applicant authorizes the insurer or its agents to obtain and exchange underwriting, claims, and loss information from others for the purpose of underwriting and administering this policy. This authorization shall remain in effect for the duration of the policy and as necessary for claim resolution.

Consent to Electronic Delivery: The insured authorizes delivery of policy documents, notices, and endorsements electronically where permitted by law, unless a written request for paper delivery is received by the insurer.

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