Chubb FI Folio New line app

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Unformatted text preview: use thereof is strictly software. All trademarks, difficulties utilizing the document, please contact the PERIOD. THE APPLICABLE LIMIT(S) OF LIABILITY If you experience technicalservice marks, and trade names are the marks of the Chubb Help Desk at 1-877-747-5266, "Option 2". TO PAY DAMAGES or SETTLEMENTS WILL BE agent or broker, please contact your local Chubb "DEFENSE prohibited. inquiries please contact ORpromote in any way you are an REDUCED AND MAY BE EXHAUSTED BY representative. does For all other Chubb does not endorseyour agent or broker. If the information found or products or services sold at other Websites. ChubbThe not warrant oris provided representation with regard to the WILL BE and their clients only. THE RETENTION AMOUNT. IN NO EVENT make any for licensed insuranceCOSTS" products or services of other companies. document COSTS" AND "DEFENSE agents and brokers APPLIED AGAINST WILL THE COMPANY BE LIABLE FOR “DEFENSE COSTS” OR THE AMOUNT OF ANY JUDGMENT OR “Chubb” refers to the member insurers of the Chubb Group of Insurance THAN WWW.CHUBB.COM, BY YOUR USE OF THE DOCUMENT, IF YOU ARE SETTLEMENT IN EXCESS OF THE APPLICABLE LIMIT(S) OF LIABILITY. READ THE ENTIRE APPLICATIONYOU ACCESSING THE DOCUMENT FROM A VENUE OTHER Companies. CAREFULLY BEFORE SIGNING. ARE AGREEING TO THE FOLLOWING, IF YOU DO NOT AGREE, DO NOT USE THE ELECTRONIC DOCUMENT: * Chubb does not warrant that the document will be free from viruses. You OK assume the entire cost of any necessary service, repair or correction. * The privacy of communication over the Internet cannot be guaranteed, because the Internet is not a secure medium. Chubb does not assume any responsibility for any harm, loss, or damage you may experience or incur by the sending of personal or confidential information over the Internet. APPLICATION INSTRUCTIONS: * Chubb is not responsible for any versions of the document that have been manipulated, altered or revised from the version of the document that appears on www.Chubb.com. Do not post the document on the Internet. 1. Whenever used in this Application, the term "Applicant" shall mean the Parent Organization and all organizations applying Chubb Group of Insurance Companies, Copyright notice: All rights reserved. “Chubb” refers to the member insurers of the for coverage. 2. I and attachments. Provide a complete response to all Include all requested underwriting information Agree questions and attach additional pages if necessary. I. GENERAL INFORMATION: 1. Name of Applicant: 2. Address of Applicant: City: ___________________ State: __________ Zip Code: ___________ Telephone: 3. Web address: 4. Name and Title of Primary Contact: Primary Contact: Officer designated, as agent of the Company and of all insured Directors and Officers, to receive any an all notices from the Insurer or their authorized representative(s) concerning this insurance. 5. Address of Primary Contact: City: _____________ 6. State: __________ Zip Code: ___________ Telephone: The Applicant has continuously been in...
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This document was uploaded on 03/30/2014.

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