INSURANCE
BINDER
Effective Date and
Hour:
Insured:
Address:
Company:
Premium:
Coverage:
This binder is
evidence that [r-Name] has placed the described insurance with the
above Company for the amount set forth. This binder shall remain in
force for [s-NumberDays] days from the date of commencement of
liability hereunder or when, if earlier, it is replaced by a policy
of the Company, and is subject to all the terms and conditions of
said policy as customarily issued by the Company. This binder may be
cancelled by the Insured by mailing to the Company written notice
stating when thereafter such cancellation shall be effective. This
binder may be cancelled by the Company by mailing to the named
insured at the address shown in this binder written notice stating
when not less than ten days hereafter such cancellation shall be
effective.
_____________________________________
By
By
_____________________________________
Dated
Dated
