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CGL Application Form

This document is a public liability insurance application form. It requests information from applicants such as registered name, address, telephone number, nature of business, area of occupied space, details of coverage, limits of liability, annual premium, and deductible. The applicant must sign and date the form, and the insurance company's liability does not begin until the proposal is accepted, policy is issued, and premium is paid.

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Elarnie Cecilio
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152 views1 page

CGL Application Form

This document is a public liability insurance application form. It requests information from applicants such as registered name, address, telephone number, nature of business, area of occupied space, details of coverage, limits of liability, annual premium, and deductible. The applicant must sign and date the form, and the insurance company's liability does not begin until the proposal is accepted, policy is issued, and premium is paid.

Uploaded by

Elarnie Cecilio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PUBLIC LIABILITY INSURANCE

APPLICATION FORM

Registered Name: ______________________________________________________

Address:________________________________________________________________

________________________________________________________________________

Telephone No. __________________________Fax No. _______________________

Nature of Business:______________________________________________________

Area of Occupied space:_______________________________________________

Cover: _________________________________________________________________

Extension:______________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Limit of Liability:_________________________________________________________

Annual Premium:_______________________________________________________

Deductible:____________________________________________________________

_________________________ _______________________________________
Date Signature of proposer over printed name

The liability of the company does not commence until this proposal has been
accepted, the Policy is issued and the premium is paid.

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