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Insurance Binder
S A M P L E
Effective Date and Hour:
Insured:
Address:
Company:
Premium:
Coverage:
This binder is evidence that [name of insured], has placed
the described insurance with the above Company for the
amount set forth. This binder shall remain in force for [#]
days from the date of commencement of liability hereunder
or when, if earlier, it is replaced by a policy of the Company,
and is subject to all the terms and conditions of said policy
as customarily issued by the Company. This binder may be
cancelled by the Insured by mailing to the Company written
notice stating when, thereafter, such cancellation shall be
effective. This binder may be cancelled by the Company by
mailing to the named insured at the address shown in this
binder written notice stating when not less than ten days
hereafter such cancellation shall be effective.
________________________________
By: _____________________________
Dated: __________________________
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Copyright © Horizons Unlimited Group
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