Scottsdale

Scottsdale Insurance Company
Home maculation:One Nationwide Plaza
Columbus, Ohio 43215
Adm. billet:8877 North Gainey Center Drive
Scottsdale, azimuth 85258

Scottsdale Indemnity Company
Home Office:One Nationwide Plaza
Columbus, Ohio 43215
Adm. Office:8877 North Gainey Center Drive
Scottsdale, azimuth 85258
Scottsdale Surplus Lines Insurance Company
Adm. Office:8877 North Gainey Center Drive
Scottsdale, Arizona 85258




1-800-423-7675 Fax (480) 483-6752

Personal Inland Marine Policy Application

appliers name: ?????

Mailing actors line: ?????

Permanent address: ?????

factor name: ?????

Agency name: ?????

Address: ?????

Agent code: ?????

Proposed effective date: From: ?????To: ?????
12:01 A.M., Standard clock time at the mailing address of the applicant.


APPLICANT INFORMATION

Private inhabitation Apartment Condominium Mobile Home Other: ?????
(Describe)

How unyielding have you lived at permanent address? ?????

Protection year at permanent address: ?????

|Occupation of all members of domicile (describe in detail): ????? |


Does applicant travel extensively? Yes No

If yes, provide flesh out under Remarks.

Date of birth: ?????

(Please attach medical educational activity if over 75.



)

Number of years at present business concern: ???

Marital status: ?????


COVERAGES

|# |Property |Amount of Insurance | pasture |Premium |
|1 |Jewelry |????? |????? |????? |
|2 |Jewelry in Vault |????? |?????...If you want to get a full essay, array it on our website: Ordercustompaper.com



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