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    Certificate of Insurance Template

    Cloned 498
    A certificate of insurance is a non-negotiable document issued by an insurance company or its broker, declaring that the policy has been issued to an insured person for certain types of risks. An insurance guarantees compensation for certain loss, damage, illness, or death in return for a payment of payment called Premium.

    The Certificate of Insurance PDF Template provides for use comprehensive details what is usually contained in an Insurance Policy. This certificate of Insurance Template contains information on types and limits of coverage, policy number, the policy holder's name, the named beneficiaries, insurance company, the policies' effective periods, and other important details to the policy.

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    Certificate of Insurance Template
    100%
    Certificate of Insurance Template
    Policy Information
    Policy Number
    554200
    Date
    February 15, 1981
    General Information
    Policy Initial Owner / Applicant
    Kacy Michaels Ervine
    Birthplace of Applicant
    Curabitur at
    Birthday of Applicant
    April 22, 1955
    Residence Address of Applicant
    3 Elmside Lane, 84616 Sloan Dri
    Springfield, Illinois, 62794
    United
    Age of the Applicant at issuance of policy
    33
    Name of Employer
    Lorem ipsum dol
    Nature of Business
    Lorem ip
    Estimated Annual Income
    153094
    Home Phone
    (95) 3316315
    Mobile Phone
    (64) 4560544
    Business Phone
    (64) 4560544
    Business Address
    99785 Huxley Te
    Oxnard, Cali, 93034
    United Stat
    Information of the person's life insured
    Name of Life Insured
    Rebekkah Williams Iveson
    Birthday of Insured
    Sunday, February 15, 1981
    Residence Address of Insured
    3 Elmside Lane, 84616
    Spring, Illinoi, 6279
    United Stat
    Birthplace of Insured
    Vestibulum
    Age of the Insured at issuance of policy
    55
    Certificate of Insurance Template
    Name of Employer
    Lorem ipsum d
    Nature of Business
    Cura
    Estimated Annual Income
    153094
    Home Phone
    (89) 6615503
    Business Phone
    (64) 4560544
    Mobile Phone
    (64) 4560544
    Business Address
    3 Elmside Lane, 84616 Sloan Dri
    Springfield, Il, 62794
    United
    Policy Details
    Effectivity Date
    Tuesday, March 3, 1970
    Maturity Date
    Friday, April 22, 1955
    Beneficiary
    Named Primary Beneficiary
    Relationship
    Named Secondary Beneficiary
    Relationship
    Summary of benefits payable
    Basic Benefit Premium
    55420
    Accidental Death
    336
    Total Disability
    336
    Total Annual Premium Payable
    15309
    Certificate of Insurance Template

    Acknowledgement

     

    I acknowledge that I have applied with Signature Insurance, Inc. for an Insurance Policy an have reviewed the provisions shoiwng how a life insurance policy performs using the company's assumptions based on the Insurance Commissioner's guidelines on interest rates.

    I likewise understand that the performance of fund may vary, the values of my units are not guaranteed and will depend on the actual performance of a given period. The value of my policy could be less than the premiums paid. 

    I understand that the risks of invesment under this policy shall be borne by me, as the policy owner.

    signature
    Name of Applicant
    Rebekkah Michaels Iveson
    Date signed
    Sunday, February 15, 1981
    Certificate of Insurance Template

    Provisions

    The Contract
    The proposals, the application form, any endorsements and amendments agreed upon in writing after this policy is issued shall constitute the entire Contract. The benefits payable shall be based on the performance fo the investment funds chosen by you.
    Effectivity
    The effectivity of this policy initiates upon the initial payment of its Premium and the delivery of the Policy to the Owner while the Insured is in good health.

    Currency and Place of Payment

    All amounts payable either to or by us will be in the currency specified in the Policy details. Acceptance of placement of payments shall be at any of our offices or such other location as determined by us from time to time

    Incontestability

    After two years from the time of effectivity or from last reinstatement of the contract, the said contract shall be incontestable except for non-payment of Premium and Insurance Charges or any other ground recognized by law.

    Suicide

    No liability shall be borned by the Company if in case the life insured dies by suicide. However, if the death by suicide happens in the state of insanity, the life insured shall be compensated regardless of the date of the commission, within the period of effectivity of this Policy.

    In case the death benefit is not payable, the liability of the Company shall be limited to:

    1. The Basic Premium
    2. The value of the account based on the Unit price of the relevant fund, not including bonuses.
    3. Premiums paid under any part of the Contract for which the benefit of death is not payable.
    Certificate of Insurance Template

    Beneficiaries

    The assigned or named beneficiaries shall be as named  or assigned in the application. 

    The benefit proceeds are payable to the Beneficiaries named, or in his absence, the Contingents. In cas no beneficiary is indicated, the benefit proceeds shall be payable to the life insured, if living, or to his estate.

    Separability Clause

    Should any provision of this Contract be held invalid by any competent court, the same shall apply only to the provision involved and the remaining provisions hereto shall remain valid and enforceable.

    Agreement Modification

    No modification or alteration of this Contract shall be considered as having been made unless executed in writing and duly signed by the parties hereto.

     
    Signature of President
    Signature of Corporate Secretary
    Certificate of Insurance Template

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