Neighboring Premises of the insured Location
Do the premises contain any of the following fire fighting facilities
6. any Special Fire Protection Systems:
Please complete the following
Electrical Power Supply
Type of Energy
Please list five year loss history.
Risk Information & Values
Coverage Extensions Required
Photos are required with submission of this application form.
DECLARATION: We hereby declare that the statements made by us in this Proposal are, to the best of our knowledge and belief, complete and true, and we hereby agree that this Proposal forms the basis and is part of any policy issued in connection with the above risk(s)