INSURANCE BINDER Home Insurance by zhangyun


									INSURANCE BINDER                                                                    FIRM’S CONTACT INFORMATION
Home Insurance                                                                      Address:

NAMED INSURED(S)                                                                   INSURER
Name(s):                                                                           Name:
                                                                                   Police no.:
Address:                                                                           Effective date:
                                                                                   Expiry date:

                                                                                   HYPOTHECARY CREDITOR
ADDRESS OF RISK (if different from mailing address)                                Name:

                     OBJECT OF INSURANCE                                                             FORM                                     DEDUCTIBLE
         Homeowner                      Secondary residence               Specified perils
         Condo unit owner               Seasonal dwelling                 Building – Comprehensive form/Contents –Specified perils
         Tenant                         Rented dwelling                   Comprehensive form                                                  $
                                                                          Fire and extended coverage
         Other:                                                           Other:

                                                               INSURING AGREEMENTS
                                  Cost of repairing
                                   or rebuilding          AMOUNTS                                                                           AMOUNTS

         SINGLE AMOUNT OF INSURANCE                   $                           Improvements and betterments                        $
         Building                                     $                           Loss assessment                                     $
         Detached private structures                  $
         Peronsal property                            $                           Legal liability                                     $
         Condo unit                                   $                           Excess liability insurance (Umbrella)               $

                                                          AMOUNTS                                                                           AMOUNTS

         Fuel oil                                     $                               Change in amount of insurance
         Building by-laws                             $                                                                           $
         Water damage –Ground water and sewers        $                                                                           $
         Water damage –Above ground water             $                               Miscellaneous property specified perils
         Tear out exterior parts                      $                                                                           $
         In-ground spa and pool                       $                                                                           $
         Above ground or semi-inground spa and pool   $                               Miscellaneous property all risks
         Earthquake                                   $                                                                           $
         Other:                                       $                                                                           $

                                                              ADDITIONAL INFORMATION
                                                                                                                                                           October 2010

Coverages are subject to the premiums, conditions, limits and exclusions of the contract issued by the insurer. This insurance binder will
temporarily replace your insurance policy for a period of         days; your insurance policy will be issued shortly. Coverage remains in effect
conditional on payment of your premium.

By:                                                              Date :
                  Certified representative’s signature                                                                    Form issued by:

Name:                                                            Telephone :


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