Policy Number. Increasing Amount: Yes No Plan Name: If increasing, ultimate amount: Birth Date Tobacco Pref Last Name First Middle M/D/Y Sex Class Use Joint Insured Life Specify others, e.g. Second Life, Waiver, ADB, etc. Previous inforce with co.: Of which we retain: Now applying for: Of which we will retain:
Policy Number. 002500684 Insured: Xxxxxxxx X. Xxxx Issue Age: 37 Date of birth: 5/28/55 Issue Date: 3/28/92 Face amount of policy: $250,000 Amount reinsured by SECURITY: $50,000 Premium: Same as in the Agreement
Policy Number. [_________]
Examples of Policy Number in a sentence
Legal Name of Training Provider Federal Tax ID Number Address City, State, Zip Training Provider Contact Name (First and Last) Contact Job Title Phone Number Extension Email Address Type of Organization ☐Non-profit ☐For-Profit ☐ Public Education ☐ Other _ Public Liability Insurance Carrier Policy Number Effective Dates of Policy Training Outcomes This training agreement will be performance-based to ensure that the program result in real outcomes for the participants.
If the Contractor elects the de minimis rate (10% indirect costs as indicated in Administrative Policy Number 86) a CAP is not required, but a cost policy statement would be required.
Home Phone ( ) Cell Phone ( ) Work Phone ( ) Mother’s Name Home Phone ( ) Cell Phone ( ) Work Phone ( ) Family Physician Name Phone Number ( ) Medical Insurance Co. Policy Number Allergic to Penicillin Aspirin Other Are you insured by any other health benefit plan such as an HMO, ETC.
More Definitions of Policy Number
Policy Number. 121476 Issued by: EMC Insurance Companies Providing for initial death benefit proceeds of $ 450,000 This policy is a life insurance policy on the life of Xxxxxxx X. Xxxxxxx. The policy also provides a death benefit on the life of Xxxxxxx X. Xxxxxxx in the amount of $350,000. 179 EXHIBIT "A"
Policy Number. G‐2021‐PREFERRED DIVE ACCIDENT (the “Policy”) Policyholder: XXX WORLD, LTD. (“XXX”) Policyholder Address: X.X. Xxx 00000, 000 Xxxxx Xxxxxx Xxx Xxxxxxxx Xxxxxxxx, Xxxxxxx Xxxxxx Xxxxxx Xxxx, Grand Cayman KY1 ‐1002 Cayman Islands POLICY DECLARATIONS Coverage is provided as described in the Benefit Schedule. Benefits payable for expenses incurred for all benefits shall not exceed the Benefit Limit or Sublimit shown for that benefit in the Benefit Schedule. Benefit Schedule XXX World ‐ Preferred Dive Accident Plan XXX TravelAssist Benefits Benefit Limit Emergency Medical Transportation up to US$150,000 Repatriation of Mortal Remains US$10,000 Sublimit Repatriation for Additional Care Included in US$150,000 Limit Local Burial US$10,000 Sublimit Visit of a Family Member or Friend (includes Traveling Companion) US$1,000 Sublimit Emergency Return Home – Family Death Included in US$150,000 Limit Return of Dependent Children Included in US$150,000 Limit Return of a Traveling Companion Included in US$150,000 Limit Dive Accident Benefits Benefit Limit Dive Accident Medical Expenses up to US$250,000 PO Accidental Death & Dismemberment up to US$25,000 Permanent and Total Disability up to US$25,000 Extra Transportation up to US$5,000 Extra Accommodations up to US$5,000 (US$400/day) Diving Vacation Cancellation up to US$5,000 Diving Vacation Interruption up to US$5,000 PO ‐ Per Occurrence COVERAGE TERRITORY The Coverage Territory is Worldwide, other than the Excluded Countries. Excluded Countries include, and no coverage is provided for losses that occur in, Afghanistan, Algeria, Chad, Iran, Iraq, Libya, Mali, North Korea, Niger, Nigeria, Somalia, South Sudan, Sudan, Syria, Pakistan, and Yemen. The list of excluded countries may be updated at any time by the Policyholder. NOTIFICATION AND PRE‐AUTHORIZATION You, or someone acting on your behalf, must contact the Policyholder (XXX) to obtain pre‐authorization to use any of the benefits and coverages available under this Policy. The Policyholder maintains a 24/7 hotline to confirm your coverage and provide necessary pre‐authorizations. If your situation is life‐ threatening, seek immediate medical attention. Once your situation has stabilized, you can contact the Policyholder (XXX) with the relevant details for any necessary approvals. If you fail to timely notify the Policyholder (XXX), the benefits available to you may be reduced or denied. XXX TravelAssist benefits (including medevac and other emergency travel assistance ...
Policy Number. [ ] Signed at Aetna's Home Office in Hartford, Connecticut Date of issue: [ ] on the date of issue. To take effect: [ ] Policy delivered in: New York This policy will be construed in [ line with the law of the State of delivery. President] Based on timely premium payments Aetna agrees with the New York State United Teachers Benefit Trust, to pay benefits [ accordance with the policy terms. Secretary] The duties and the rights of the policyholder will be based solely on the terms of this policy. This [ policy is non-participating. Registrar]
Policy Number. Effective Form:_________ To:____________ Verified By:____________________________ 39 ISSUE DATE (02/11/09) ACORX EVIDENCE OF PROPERTY INSURANCE -------------------------------------------------------------------------------- THIS IS EVIDENCE THAT INSURANCE AS IDENTIFIED BELOW HAS BEEN ISSUED, IS IN FORCE, AND CONVEYS ALL THE RIGHTS AND PRIVILEGES AFFORDED UNDER THE POLICY -------------------------------------------------------------------------------- PRODUCER COMPANY PARKXX, XXITX & XEEK, XXC. FIDELITY & GUARANTY INSURANCE COMPANY 999 Xxxxx Xxxxxx, 00xx Xxxxx Xxxxxxx, Xxxxxxxxxx 00000 (006) 000-0000 Xode Sub-Code Agency Customer ID# -------------------------------------------------------------------------------- INSURED LOAN NUMBER POLICY NUMBER BSQUARE CORPORATION N/A 1MP 30137731800 3633 - 000XX XXXXX XX XXXXXXXX, XXXXXXXXXX 00000 EFF. DATE EXP. DATE CONTINUOUS 6/16/97 06/16/98 UNTIL THIS REPLACES PRIOR EVIDENCE TERMINATED IF DATED:________________ CHECKED __ -------------------------------------------------------------------------------- PROPERTY INFORMATION LOCATION/DESCRIPTION BLANKET LIEN ON BUSINESS PERSONAL PROPERTY. COVERAGE INFORMATION -------------------------------------------------------------------------------- Coverages/Perils/Forms Amount of Ins. Deductible Blanket Business Personal Property $ 1,550,000 $250 Causes of Loss - Special Form Replacement Cost/Agreed Value REMARKS (INCLUDING SPECIAL CONDITIONS) IMPERIAL BANK IS INCLUDED AS LOSS PAYEE PER ENDORSEMENT 438BFU ATTACHED. The Policy is subject to the premiums, forms, and rules in effect for policy period. Should the Policy be terminated, the Company will give the additional interest identified below 45 days written notice, and will send notification of any changes to the policy that would affect that interest, in accordance with the Policy provisions or as required by law. CONDITIONAL INTEREST IMPERIAL BANK __Mortgagee __Additional Insured 9920 XXXXX XXXXXXXXX XXXX., XXXXX 000 X Loss Payex XXXXXXXXX, XX 00000 Loan #N/A ATTENTION: LENDING SERVICES ------------------------------------- Authorized Representative /s/ KAREX X. XXXXXXXX ACORX XXXPORATION 40 LENDERS'S LOSS PAYABLE ENDORSEMENT
Policy Number. Effective From:______________To:________________ Verified by:____________________________________ ------------------------------------------------ -------------------------------------------------------------------------------- IMPERIAL BANK CALIFORNIA'S BUSINESS BANKS AUTOMATIC DEBIT AUTHORIZATION MEMBER FDIC -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- To: IMPERIAL BANK Re: LOAN # ___________________________________ You are hereby authorized and instructed to charge account No. ______________ in the name of VIEWLOCITY, INC., FRONTEC AMT, INC., AND VIEWLOCITY AB -------------------------------------------------------------------------------- for principal and interest payments due on above referenced loan as set forth below and credit the loan referenced above. ____ Debit each interest payment as it becomes due according to the terms of the note and any renewals or amendments thereof. ____ Debit each principal payment is at becomes due according to the terms of the note and any renewals or amendments thereof. This Authorization is to remain in full force and effect until revoked in writing. -------------------------------------------------------------------------------- ---------------------------------------------------- --------------------------- Agent Signature Date ---------------------------------------------------- --------------------------- ---------------------------------------------------- --------------------------- ---------------------------------------------------- --------------------------- IMPERIAL BANK/BOSTON OFFICE Phone: (000) 000-0000 CLIENT AUTHORIZATION Fax (000) 000-0000 -------------------------------------------------------------------------------- GENERAL AUTHORIZATION I hereby authorize Imperial Bank to use my company name, logo, and information relating to our banking relationship in its marketing and advertising campaigns which is intended for Imperial Bank's customers, prospects and shareholders. Imperial Bank will forward any advertising or article including client for prior review and approval. ------------------------------------------------------ Signature ------------------------------------------------------ Printed Name Title VIEWLOCITY, INC., FRONTEC AMT, INC., AND VIEWLOCITY AB ------------------------------------------------------ Company ------------------------------------------------------ Maili...
Policy Number. 821900 1018712