Insurance Binder

INSURANCE BINDER
Effective Date and Hour__________________________
Insured__________________________________________
Address__________________________________________
Company__________________________________________
Premium__________________________________________

__________________________________________
Coverage___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________
This binder is evidence that ___________________________has

placed the described insurance with the above Company for

the amount set forth. This binder shall remain in force

for ____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_____________________________
Dated__________________________