Your Business Pak/BusinessPak2.iso/Pca/_SETUP.1/2980.BLD

Text File | 1997-07-22 | 6KB | 177 lines

#2980
@001 Enter the name of the insured:
~Please enter the name of the person who is the insured
~under the policy; this should be in the same form as on
~the policy
@002 Enter the name of the insurance company:
~State the name of the insurance company; this should exactly
~match the name on the policy since companies have multiple
~divisions
!300 Enter the TOTAL policy amount (limits):
~Enter the total policy limits in numerals without using the "$"
~symbol; for example 10000
@301 Enter the date of issuance of the policy:
~Please enter the that the policy became effective; you may use
~either numbers (8/1/94) or words (October 1, 1994)
@302 Enter the date of expiration of the policy:
~Please enter the date that the policy expires; you may use
~either numbers (12/1/95) or words (December 1, 1995)
@303/@303/@303/@303 Enter type of insurance:
~Select the type of policy; either personal property floater,
~homeowners, business, or if it is another type policy, select
~key in value and type in the name of the policy
Personal property floater
Homeowner's comprehensive
Business personal property
KEY IN VALUE:
@304/@034/@304/@304 Enter the reason for loss:
~Select the reason for the loss; if not included, select KEY
~IN VALUE and then type in the value
Fire
Theft
Vandalism
KEY IN VALUE
@305 Enter approximate time of loss:
~Enter the HOUR AND MINUTES when the loss took place; do
~not enter am/pm
@306/@306 The loss occurred:
~Select whether the loss occurred am/pm
A.M.
P.M.
@320 State the date of loss:
~Enter the date when the loss took place
@307 Enter cause for the loss:
~Enter the reason for the loss; for example, "fire"
@308/@308/@308 Enter occupancy of structure:
~Select how the building was used at the time of the loss
Personal residence
Tenant dwelling
KEY IN VALUE
@309/@309/@309 The property claimed was:
~Select whether the property was owned, held under a long term
~lease; if these cases do not cover the type of title held,
~then select KEY IN VALUE and type in the type of ownership
Ownership
Long term lease
KEY IN VALUE
@310/@310 Enter any change in use or occupancy:
~If there was a change in the occupancy of the building
~since the policy was taken out (such as from residential to
~commercial) select KEY IN VALUE and describe this; if no change
~took place, select NONE
None
KEY IN VALUE
!311 Enter the policy limits of the coverage:
~Enter in numerals the total limit of the policy; do not use
~the "$" symbol or commas
!321 Enter the total value of the damaged items:
~Enter in numerals the total value of the items which were
~damaged; this is NOT the amount of damage, instead the total
~value; do not use the "$" symbol or commas
!312 Enter the total amount of damages:
~Enter in numerals the total damage
!313 Enter the amount claimed:
~Enter in numerals the total damage claimed (usually total
~damage less the deductible, or maximum amount allowed by the
~policy); do not use the $ symbol or commas
@314 Enter state where executed:
~Enter the state where the proof of loss is being executed
@315 Enter county where executed:
~Enter the county, judicial district, parish or borough where
~the proof of loss is being executed
#end control section
#2980
/* Para 2980: Proof of loss, fire, theft */


Amount of policy: $@300 (!300 dollars)

Date policy issued: @301

Date policy expires: @302


                 SWORN STATEMENT IN PROOF OF LOSS


To the @002.

At time of loss, by the above indicated policy of insurance you
insured:

@001

against loss by @303, upon the property described by the
under Schedule "A," according to the terms and conditions of the
same policy and all forms, endorsements, transfers and
assignments attached thereto.


Time and origin: A @304 loss occurred about the hour of @305
@306, on the @320. The cause and origin of said loss were:

@307


Occupancy: The building described or containing the property
described, was occupied at the time of the loss as follows, and
for no other purpose whatever:

@308

Title and Interest: At the time of the loss the interest of your
insured in the property described therein was @309.

Changes. Since the said policy was issued there has been no
assignment thereof, or change of interest, use, occupancy,
location or exposure of the property described, except:

@310

Total insurance. The total amount of insurance upon the property
described by this policy was, at the time of the loss, $ @311
(!311 Dollars) as more particularly specified in the
apportionment attached under Schedule "C," besides which there
was no policy or other contact of insurance, written or oral,
valid or invalid.

The actual cash value of said property at the time of the loss
was $ @321 (!321 Dollars).

The Whole Loss and Damage was $ @312 (!312 Dollars)

The amount claimed under the above numbered policy is $ @313
(!313 Dollars)

The said loss did not originate by any act, design or procurement
on the part of your insured, or this affiant; nothing has been
done by or with the privity or consent of your insured or this
affiant, to violate the conditions of the policy, or render it
void; no articles are mentioned herein or in annexed schedules
but such as were destroyed or damaged at the time of said loss;
no property saved has in any manner been concealed, and no
attempt to deceive the said company as to the extent of said
loss, has in any manner been made. Any other information that
may be required will be furnished and considered a part of this
proof.

The furnishing of this blank or the preparation of proofs by a
representative of the above insurance company is not a waiver of
any of its rights.


State of @314

County of @315


Subscribed and sworn to before me this ______ day of __________

19______.





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