Insurance Vehicle Policy

INSURANCE VEHICLE POLICY

Declarations — Insured and Policy Identifiers

Client Name:

Policy Details

Policy Number:

Policy Period Effective: / /   to   / /

Vehicle Information

Coverages (select applicable and enter limits/deductibles)

Bodily Injury Liability — Per person / Per accident: $

Property Damage Liability — Per accident: $

Collision Coverage — Deductible: $   Limit: $

Comprehensive Coverage — Deductible: $

Uninsured/Underinsured Motorist — Limit: $

Medical Payments — Limit: $

Rental Reimbursement — Limit / Daily: $ / $

Optional Endorsements / Riders

Exclusions and Limitations

The Insurer shall not be liable for loss or damage caused by intentional acts of the Insured, use of the vehicle for hire or public livery unless specifically endorsed, operation by an unlisted or excluded operator, racing, participation in a criminal act, war, nuclear hazard, or wear and tear. Coverage for accessories, aftermarket equipment, and non-factory modifications is limited to the lesser of replacement cost or actual cash value unless a specific endorsement providing agreed value is attached.

The Insured acknowledges the foregoing exclusions and agrees that payment under this policy is subject to proof of loss, cooperation with investigation, and the Insurer's right of subrogation against responsible third parties.

I acknowledge that I have read and understand the exclusions and limitations stated above.

Loss Payee / Beneficiary

Loss Payee/Additional Insured Name:

Claims Procedure — Notice and Proof

In the event of a loss, the Insured must provide prompt notice to the Insurer, protect the vehicle from further damage, cooperate with reasonable requests for information, and submit a sworn proof of loss when requested. Failure to provide timely notice or reasonable cooperation may result in denial or reduction of benefits.

Police report

Photographs of damage/scene

Repair estimate

Medical reports / bills (if applicable)

Policy Conditions, Cancellation and Subrogation

This policy is issued in reliance upon the representations in the application and any attached statements. The Insurer may cancel this policy in accordance with the cancellation provisions stated in the policy and applicable law. Premium refund shall be computed on a pro rata basis unless cancellation is for nonpayment of premium, in which case earned premium may be calculated differently as provided in the policy. The Insurer has the right to recover from any person liable for loss to the extent of payment made under this policy (subrogation).

If any insured knowingly misrepresents or withholds material facts, the Insurer may void coverage from inception. Disputes under this policy may be subject to arbitration if mutually agreed in writing after a dispute arises; otherwise, remedies may include declaratory relief or litigation where permitted by law.

Certification and Applicant Declaration

I, the undersigned applicant, declare that the statements and representations made in this policy application and declarations are true and complete to the best of my knowledge. I acknowledge that coverage is subject to the terms, conditions, exclusions, and endorsements of the policy. I authorize the Insurer to obtain and disclose underwriting information, including motor vehicle records, as necessary for underwriting, claim handling, or fraud investigation.

By signing below I certify under penalty of perjury that the foregoing statements are accurate and agree that this declaration forms part of the insurance contract between the Insurer and the Insured.

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