NCIP Registration Form

Option 1
Contents of Every Description Including Flood and Earthquake
(Flood coverage excluded in AB, Earthquake coverage excluded in BC)		 $10,000
On/Off premises endorsement As Per Attached
Misc Property Floater $25,000
Profits – ALS (18 Months) Included
3D Crime Including Employee Dishonesty $10,000
Commercial General Liability $2,000,000
Tenants’ Legal Liability $500,000
Non Owned Auto $2,000,000
Legal Liability for damage to Hired Automobile $50,000
Advertising Liability $2,000,000
DAS (Legal Advice) Included
Padlock – Cyber & Data Protection Included
Total Premium $700
Option 2
Misc Property Floater $25,000
Commercial General Liability $2,000,000
Tenants’ Legal Liability $500,000
Non Owned Auto $2,000,000
Legal Liability for damage to Hired Automobile $50,000
Advertising Liability $2,000,000
DAS (Legal Advice) Included
Padlock – Cyber & Data Protection Included
Total Premium $525
Option 3
Commercial General Liability $2,000,000
Tenants’ Legal Liability $500,000
Non Owned Auto $2,000,000
Legal Liability for damage to Hired Automobile $50,000
Advertising Liability $2,000,000
DAS (Legal Advice) Included
Total Premium $400
NCIP Registration Form

General Information

Liability Insurance

Property Insurance

If Other Please Specify

Loss Payable: Name of All Lender(s) and Lessor(s), if any, which must be named in "Loss Payable" Clause

Claim Experience

Crime Insurance

Signature

The insured represents that the information furnished in this application is complete, true and correct. Any misrepresentation, omission, concealment or incorrect statement of material fact, in the application or otherwise, shall be grounds for rescission of any policy issued in reliance upon such information. I hereby declare that to the best of my knowledge and belief, the above statements and particulars are true, that I have not suppressed or misstated any material facts and I agree that this declaration shall form the basis of the insurance contract prepared on my behalf by the Insurer.