Fillable Artisan / Trade Contractors Product Application Form (Page 4 of 4) in pdf

Artisan / Trade Contractors Product Application Form Page 4

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charged, based on the Insurer’s underwriting guides. The Insurer is hereby authorized, but not required, to make any investigation and inquiry in connection with

the information, statements and disclosures provided in this Application. The decision of the Insurer not to make or to limit any investigation or inquiry shall not be

deemed a waiver of any rights by the Insurer and shall not estop the Insurer from relying on any statement in this Application in the event the Policy is issued. It is

agreed that this Application shall be the basis of the contract should a policy be issued and it will be attached and become a part of the Policy.

Applicant’s signature: ______________________________________________________________________ Title: _______________________________

President, Chairperson of the Board, Managing Member, or Executive Director

Date: ________________________________________________________________________________________________________________________

ATC 7/14 – USLI

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