exhibit floater pa rou035 201104
8417 Patterson Avenue Richmond, Virginia 23229 Telephone: (804) 741-7999 WATTS: (800) 628-2967 Fax: (804) 741-9401 www.royaloakunderwriters.com
ROYAL OAK UNDERWRITERS, INC. Excess and Surplus Lines Insurance Wholesalers
EXHIBITION FLOATER APPLICATION APPLICANT INFORMATION Name Address City, State, Zip Telephone Policy Dates:
Business Description:
Years in business
Individual Partnership
Corporation
Other
Nature of Business
Property to be covered
Exhibitions - Include conventions, trade shows, etc. a)
Number and descriptions of exhibitions to be covered
b)
Dates
c)
Locations
d)
Limit per location
e)
Transit limit and method
f)
Security provided at locations
THREE YEAR LOSS EXPERIENCE Date
Losses (description and amounts paid and incurred)
Comments
Date:
Applicant Signature
Producer Name, Address & Signature
Reset Form rou035-201104
Submit by E-mail Page 1 of 1
Print Form
SAVE
Royal Oak Underwriters, Inc.
ROYAL OAK UNDERWRITERS, INC. Excess and Surplus Lines Insurance Wholesalers
EXHIBITION FLOATER APPLICATION APPLICANT INFORMATION Name Address City, State, Zip Telephone Policy Dates:
Business Description:
Years in business
Individual Partnership
Corporation
Other
Nature of Business
Property to be covered
Exhibitions - Include conventions, trade shows, etc. a)
Number and descriptions of exhibitions to be covered
b)
Dates
c)
Locations
d)
Limit per location
e)
Transit limit and method
f)
Security provided at locations
THREE YEAR LOSS EXPERIENCE Date
Losses (description and amounts paid and incurred)
Comments
Date:
Applicant Signature
Producer Name, Address & Signature
Reset Form rou035-201104
Submit by E-mail Page 1 of 1
Print Form
SAVE
Royal Oak Underwriters, Inc.
