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/ Simtel MSDOS 1992 June / SIMTEL_0692.cdr / msdos / formgen / forms4ez.arc / INSURE.FRM < prev    next >
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Text File  |  1985-12-17  |  5.1 KB  |  65 lines
  1. ┌──────────────────────────────────────────────────────────────────────────────┐
  2. │                             INSURANCE RECORD                    ______YEAR   │
  3. │                                                                              │
  4. │                                                                              │
  5. │                                                                              │
  6. │HOMEOWNERS/RENTERS (POLICY#)_____________________(CLAIMS PHONE#)___________   │
  7. │                                                                              │
  8. │                                                 (SALES PHONE#)____________   │
  9. │                                                                              │
  10. │         INSURANCE FIRM ___________________________________________________   │
  11. │                                                                              │
  12. │         COVERAGE (DWELLING$)________________(OTHER)_______________________   │
  13. │                                                                              │
  14. │                  (PER. PROP.)_______________(LIVING EXP)__________________   │
  15. │                                                                              │
  16. │                  (LIABILITY)________________(GUESTS)______________________   │
  17. │                                                                              │
  18. │                  ---------------------------------------------------------   │
  19. │                                                                              │
  20. │                  ---------------------------------------------------------   │
  21. │                                                                              │
  22. │                                                                              │
  23. │HEALTH (POLICY#)__________________________(CLAIMS PHONE#)__________________   │
  24. │                                                                              │
  25. │                                          (SALES PHONE#) __________________   │
  26. │                                                                              │
  27. │       INSURANCE FIRM _____________________________________________________   │
  28. │                                                                              │
  29. │       COVERAGE ___________________________________________________________   │
  30. │                                                                              │
  31. │                ___________________________________________________________   │
  32. │                                                                              │
  33. │                ___________________________________________________________   │
  34. │                                                                              │
  35. │                ___________________________________________________________   │
  36. │                                                                              │
  37. │                                                                              │
  38. │AUTO (POLICY#)__________________________(CLAIMS PHONE#)____________________   │
  39. │                                                                              │
  40. │                                        (SALES PHONE#)_____________________   │
  41. │                                                                              │
  42. │       INSURANCE FIRM _____________________________________________________   │
  43. │                                                                              │
  44. │       DEDUCTABLE _________________________________________________________   │
  45. │                                                                              │
  46. │       COVERAGE (LIABILITY)________________________________________________   │
  47. │                                                                              │
  48. │                (UNINSURED MOTORIST)_______________________________________   │
  49. │                                                                              │
  50. │                (TOWING)___________________(PERSONAL INJURY)_______________   │
  51. │                                                                              │
  52. │                                                                              │
  53. │                                                                              │
  54. │ OTHER_____________________________________________________________________   │
  55. │                                                                              │
  56. │      _____________________________________________________________________   │
  57. │                                                                              │
  58. │      _____________________________________________________________________   │
  59. │                                                                              │
  60. │      _____________________________________________________________________   │
  61. │                                                                              │
  62. │                                                                              │
  63. │                                                                              │
  64. └──────────────────────────────────────────────────────────────────────────────┘
  65.