Insurance Renter Policy

INSURANCE RENTER POLICY

Policy Declaration

Policy Number:    Insurer Name:

Applicant / Insured Information

Date of Birth:    Contact Phone:    Email:

Policy Details

Policy Period Start:    End:

Coverages (Select applicable)

Personal Property Coverage — covers on-premises personal property against covered perils, subject to limits and deductible.

Personal Liability — legal liability for bodily injury or property damage to others arising from insured's premises or actions.

Medical Payments to Others — pays necessary medical expenses to third parties injured on the premises, regardless of fault.

Additional Living Expense (ALE) — reimbursement for reasonable increases in living expenses when residence is uninhabitable due to a covered loss.

Endorsements and Optional Coverages

Scheduled Personal Property — list high-value items and scheduled limits below.

Water Backup/Sump Overflow Endorsement (if selected, specify sublimit)

Exclusions (Important Notice)

The following represent common policy exclusions. Coverage is subject to the full terms, conditions, limitations and exclusions contained in the policy. The insurer will not pay for loss or damage caused directly or indirectly by:

1. Intentional acts, fraud, or criminal acts by an insured;
2. Normal wear and tear, deterioration, inherent vice, or mechanical breakdown;
3. Flood, surface water, tidal water, tsunami, mudslide, earth movement and seismic activity unless an endorsement is purchased;
4. War, nuclear hazard, government action or seizure;
5. Losses resulting from failure to protect property after loss or from neglect to use all reasonable means to protect property from further damage.

I acknowledge that I have read and understand the exclusions listed above: Acknowledged

Claims Reporting and Documentation

Date of Loss:    Time of Loss (if known):

Documentation Checklist (attach copies to claim submission):

Police or incident report

Photographs of damage

Receipts or proof of ownership

Repair estimates or contractor statements

Beneficiary / Payee Designation

Beneficiary Name:    Relationship:    Percentage:

Declaration and Certification

The undersigned declares that the statements contained in this application and any attachments are true and complete to the best of the undersigned's knowledge and belief. Material misrepresentation, omission or concealment of fact may render this policy voidable or result in denial of a claim. The insured authorizes the insurer to obtain and verify information relevant to underwriting, rating and claims handling, including, but not limited to, inspection of the insured premises, and to share such information with reinsurers, adjusters and other insurers as permitted by law.

Coverage under this policy is subject to payment of premium and to all terms, conditions, limitations and exclusions contained in the policy form and any applicable endorsements. Cancellation, nonrenewal and changes in coverage will be governed by the provisions set forth in the policy and applicable law.

Fraud Warning: Any person who knowingly and with intent to defraud any insurance company submits an application or claim containing false, incomplete or misleading information may be guilty of insurance fraud and subject to civil and criminal penalties under applicable law.

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