Renters Insurance RCC

Renters Insurance RCC

Applicant / Insured Information

Policy Details

Policy Number:

Renters — Personal Property & Liability Liability Only Contents Only

Policy Period: From to

Annual Monthly Quarterly

ACH / Bank Draft Credit / Debit Card Check

Coverages

Personal Property Limit: $    Replacement Cost Coverage: Included

Personal Liability Limit: $

Medical Payments to Others: $

Additional Living Expenses (Loss of Use) Limit: $

Scheduled Personal Property (scheduling required)
Water Backup / Sump Overflow
Earthquake Limited Coverage
Identity Theft Expense Coverage

Schedule of High-Value Items

List items requiring special limits or scheduled coverage (make/model, serial number, descr., value):

Exclusions (Representative)

The following are examples of exclusions applicable to this renters policy unless specifically added by endorsement: intentional loss or dishonest acts by the insured; wear, tear, gradual deterioration, latent defect; mold, fungus, dry rot unless resulting from a covered peril; flood, surface water, tidal wave, storm surge, earth movement, sinkhole (except where an earthquake endorsement is purchased); nuclear hazard and war; government seizure; damage by pests or vermin. This list is illustrative and not exhaustive. Coverage is subject to the full terms, conditions and exclusions contained in the policy contract.

Claims / Loss Reporting

Documentation submitted with notice of loss (check all that apply):

Photographs Receipts / Invoices Repair Estimates

Beneficiary / Payment Recipient

Designated Payee for claim payments (if different from insured):

Declarations and Certification

I declare that the information provided in this application and schedule is true and complete to the best of my knowledge. I acknowledge that coverage is subject to the terms, conditions, limitations and exclusions of the policy issued by the insurer. Misrepresentation, concealment or fraudulent statements made by or on behalf of the insured with respect to any material fact shall be grounds for denial of coverage or rescission where permitted by law.

I authorize the insurer to obtain and share underwriting and claim-related information as reasonably necessary, including verification of loss, inspection of premises, and contact with other insurers for purposes of subrogation. I understand that proof of loss, documentation and cooperation are conditions precedent to any claim payment, and that failure to provide requested documentation in a timely manner may result in denial of a claim.

By signing below I consent to the policy terms, accept responsibility for payment of premium as indicated, and certify that the insured property described herein is occupied and maintained in accordance with the policy conditions.

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