Server: Netscape-Commerce/1.12 Date: Thursday, 18-Dec-97 09:45:36 GMT Last-modified: Tuesday, 07-Oct-97 20:10:20 GMT Content-length: 6843 Content-type: text/html Property Facultative Reinsurance Submission Worksheet

Send a Facultative Property Submission to TRC

Facultative Property Reinsurance Worksheet

Please provide the following information:

Assured (Account Name):

Location (Address of Risk):

Total Values: ACV/RCV Amount Subject:

Occupancy: Protection: NBFU ASNS

Construction: Private:

Loss Experience:

Coinsurance:

Coverage: BLDG CONTS STK BI TRANSIT EE

Other

Perils: FIRE EC VMM SL DIC AR FL EQ

Other

Policy Limit(s)

Premium this Policy Rates:

Deductible:

Ceding Company:

Policy #:


Sent by:

Title First NameLast Name

Company

NAIC Code #

Address

City State Zip -

Country

E-Mail Address

Telephone #

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