Insurance Protection Plan Agreement

Insurance Protection Plan Agreement

This Insurance Protection Plan Agreement (“Agreement”) is made between Insurer Name: and Client Name: . Effective Date:

1. Applicant / Insured Information

2. Policy Details

3. Coverage Selections

Select the coverages included in this Protection Plan. Limits shown at issuance will be reflected in the policy schedule.

4. Exclusions and Limitations

The following exclusions are material terms of this Agreement. Insurer shall not be liable for loss or damage caused directly or indirectly by: intentional acts or criminal conduct of the Insured; wear and tear, gradual deterioration, or inherent vice; war, insurrection, nuclear reaction, or radiation; fraudulent or dishonest acts by the Insured not disclosed to Insurer; losses arising from pollution unless specifically endorsed; and losses for which coverage is excluded by endorsement or statute.

Insured acknowledges receipt of the applicable exclusion provisions contained in the policy. Insured confirms they have read and understand the exclusions and limitations.

5. Beneficiary Designation

Designate payee(s) for any proceeds payable under the terms of this policy in the event of a covered loss requiring beneficiary designation.

6. Claim Reporting and Documentation

In the event of a loss for which coverage may be sought, Insured must provide prompt written notice to Insurer and cooperate in the investigation and settlement of the claim. Failure to provide timely notice or to cooperate may void coverage to the extent prejudice occurs.

Documentation Checklist (select all documents included):

7. Declarations, Representations and Conditions

The Insured declares and warrants that all statements and particulars provided in connection with this Agreement are true, complete and accurate to the best of the Insured’s knowledge. Material misrepresentation, omission, concealment of a material fact, or fraudulent act by the Insured shall entitle Insurer to void coverage or deny claims as permitted by law.

Coverage under this Agreement is subject to payment of premiums when due. Insurer may cancel or non-renew this policy in accordance with the terms of the policy and applicable law. Acceptance of any premium by Insurer does not constitute a waiver of Insurer’s rights under this Agreement.

Insured authorizes Insurer to obtain and disclose information reasonably necessary to underwrite and administer the policy, including but not limited to inspection reports, claims history, and loss runs. Insured agrees to cooperate with investigation and allows Insurer to pursue subrogation rights against responsible third parties.

This Agreement, together with the policy documents and any attached endorsements, constitutes the entire agreement between the parties regarding the insurance described herein. Any amendment must be in writing signed by an authorized representative of Insurer.

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the jurisdiction in which the policy is issued, without regard to conflict of law principles.

8. Acknowledgment and Certification

By signing below, the Insured certifies that: (a) the information in this Agreement is true and complete; (b) the Insured has read and understands the terms, conditions, exclusions, and duties contained herein; and (c) the Insured consents to the terms required for issuance of the policy. The Insured understands that coverage is conditioned upon Insurer’s acceptance and issuance of the policy documents.

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