Proposed Insured Clause Samples
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Proposed Insured. The Company reserves the right to add additional items or make further requirements after review of the requested Affidavit.
Proposed Insured. Height Weight ------------ ------------ Amount of weight loss in past 12 months -------------- (IF WEIGHT LOSS, PLEASE EXPLAIN BELOW)
Proposed Insured. 🞏 Accountant/CPA 🞏 Banker 🞏 Attorney Producer 🞏 Other: 🞏 🞏
Proposed Insured. Height 6 Ft. 1 In. Weight 185 lbs. _______ ________ ______ Additional Insured: Height Ft. In. Weight lbs. _______ ________ ______
Proposed Insured. The estate or interest in the land described or referred to in this Commitment and covered herein is a Fee Simple, and title thereto is at the effective date hereof vested in: Consumers Energy Company, a Michigan corporation, formerly known as Consumers Power Company, a Michigan corporation
Proposed Insured. Fee Simple interest in the land described in this Commitment is owned, at the Commitment Date, by: ▇▇▇▇▇▇▇ OIL, INC.
Proposed Insured. (Print name as it should appear in policy) Questions below pertain to Proposed Insured unless otherwise indicated.
Proposed Insured. First Name Middle Initial Last Name 2. Your Income (Before Income Tax) CURRENT FISCAL PREVIOUS YEAR TO DATE FISCAL YEAR thru A. Salary or Wages......................................................... $ $ B. Bonuses and/or Commissions.......................................... C. Net Business or Professional Income (i.e. Gross Income less Business Expenses, but before Personal Income Taxes).......