INSURANCE BINDER
Effective Date and Hour……………………..
Insured……………………………………
Address……………………………………
Organization……………………………………
Premium……………………………………
……………………………………
Coverage……………………………………………
……………………………………………
……………………………………………
……………………………………………
This binder is an indication that ………………………has placed the described insurance with the above Organization for the amount set forth. This binder shall remain in force for ….days from the date of commencement of liability hereunder or when, if earlier, it is replaced by a policy of the Organization, and is subject to all the terms and conditions of said policy as customarily issued by the Organization. This binder may be cancelled by the Insured by mailing to the Organization written notice stating when thereafter such cancellation shall be effective. This binder may be cancelled by the Organization by mailing to the named insured at the address shown in this binder written notice stating when not less than twelve days hereafter such cancellation shall remain effective.
………………………….
By………………………..
Dated……………………..