18. Board Fire rate for terminal premises: 19. Premiums and Losses sustained by applicant last five years: LOSSES Year Premiums Fire Theft Collision Any other physical Loss 20 20 20 20 20 20. Description of Vehicle: (Specify Truck, Tractor, Trailer, Semi.) Item Trade Model Year Type (Truck, Serial No. Motor No. Gas (G) or Original Amount of No. Name Tractor, Diesel (D) Cost New Insurance Trailer, Plus Desired Truck Equipment, Type Tractor) Alterations and Additions 1 2 3 4 5 6 7 8 9 10 This application shall not be binding on the Underwriters unless and until a contract of insurance shall be issued and delivered in accordance herewith and then only as of the commencement date of said Insurance and in accordance with all terms thereof and the said Applicant hereby covenants and agrees to and with the Underwriters that the foregoing statements and answers are a just, full and true exposition of all the facts and
18. Board Fire rate for terminal premises: 19. Premiums and Losses sustained by applicant last five years: LOSSES Year Premiums Fire Theft Collision Any other physical Loss 20 20 20 20 20 20. Description of Vehicle: (Specify Truck, Tractor, Trailer, Semi.) Item No. Trade Name Model Year Type (Truck, Tractor, Trailer, Truck Type Tractor) Serial No. Motor No. Gas (G) or Diesel (D) Original Cost New Plus Equipment, Alterations and Additions Amount of Insurance Desired 1 2 3 4 5 6 7 8 9 10 This application shall not be binding on the Underwriters unless and until a contract of insurance shall be issued and delivered in accordance herewith and then only as of the commencement date of said Insurance and in accordance with all terms thereof and the said Applicant hereby covenants and agrees to and with the Underwriters that the foregoing statements and answers are a just, full and true exposition of all the facts and
TUMI%20Auto%20Physical%20Damage.docx