File name: Acord 140 Fillable Pdf
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acord (/12) THE UNDERSIGNED IS AN AUTHORIZED REPRESENTATIVE OF THE APPLICANT AND REPRESENTS THAT REASONABLE INQUIRY HAS BEEN MADE TO . 2 premises #: building #: street address: inflation blanket subject of insurance amount coins % valuation causes of loss deductible forms and conditions to applyguard % coverage. acord (/10) agency customer id: remarks fraud notices page 3 of 3 in kansas, any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with . Download a fillable PDF of ACORD , a standard form for property insurance. The form contains sections for policy information, premises information, additional coverages, options, and interest. %PDF %µµµµ 1 0 obj >/Metadata 97 0 R/ViewerPreferences 98 0 R>> endobj 2 0 obj > endobj 3 0 obj >/ExtGState >/XObject >/ProcSet [/PDF. tm date (mm/dd/yyyy) producer phone applicant (a/c, no, ext): fax (first (a/c, no): named insured) effective date expiration date payment plan audit.
