i ERRORS AND OMISSIONS INSURANCE
1. Have you purchased real estate errors and omissions insurance for yourself?
0 Yes 0 No If so, what is your annual premium? $
e 2. Have you purchased real estate errors and omissions insurance for other real estate licensees
associated with your firm? 0 Yes 0 No If so, how many licensees are covered?
e What is your annual premium per person $
Please list below the name/address of the insurance agency from which you purchased
e 3. the policy:
Clip and return to N.C. Real Estate Commission, P.O. Box 17100, Raleigh, NC
27619-7100, Attention: Administrative Secretary.