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THE PERSONAL AUTO INSURANCE POLICY |
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INTERACTIVE - AUTOMOTIVE INSURANCE POLICY DECLARATIONS PAGE EXAMPLE
Instructions: Click on any portion of it to find out more information on each section or coverage.
(For your convenience, the  help windows and Linked help windows will pop up in a new window so that you dont have to use your back button repeatedly or lose the spot on the form you were viewing.)
ABC INSURANCE COMPANY
123 Main St.
Anywhere, USA 99999
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PERSONAL AUTO COVERAGE
| ----------------------------------------------------------------PREMIUM SUMMARY------------------------------------------------------------- |
| Reason for Transaction |
NEW BUSINESS |
Base Coverage Premium |
$1,348.00 |
| Transaction Effective Date |
01/01/2008 |
Additional Coverage Premium |
$120.00 |
| Premium for this Transaction |
$1,238.00 |
Credits and Debits |
$-190.00 |
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Total Coverage Premium |
$1,278.00 |
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| -----------------------------------------------------------------VEHICLES COVERED ------------------------------------------------------------- |
| Veh |
Yr |
Make |
Model |
Vehicle ID Number (VIN) |
Sym |
Type |
St Amt |
C/New |
| 001 |
1997 |
Jeep |
Wrangler Sp |
1J4FY19S1VP123456 |
15 |
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| 002 |
2006 |
Acura |
TL |
19UUA66266A123456 |
18 |
H |
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| ------------------------------------------------------------BASE COVERAGES AND PREMIUMS--------------------------------------------------- |
| Insurance is provided where a premium entry is shown for the coverage |
| LIABILITY COVERAGES |
Limits of Liability |
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Premium |
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VEH 001 |
VEH 002 |
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Bodily Injury |
$ |
100,000 |
Each Person and |
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$ |
300,000 |
Each Accident |
139.00 |
131.00 |
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Property Damage |
$ |
100,000 |
Each Accident |
63.00 |
59.00 |
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Medical Payments |
$ |
5,000 |
Each Person |
111.00 |
104.00 |
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Uninsured Motorist |
$ |
100,000 |
Each Person and |
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Bodily Injury |
$ |
300,000 |
Each Accident |
45.00 |
45.00 |
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Underinsured Motorist |
$ |
100,000 |
Each Person and |
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Bodily Injury |
$ |
300,000 |
Each Accident |
49.00 |
49.00 |
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| Physical Damage Coverages |
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Premium |
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Other Than Collision |
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Actual Cash Value |
72.00 |
157.00 |
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VEH 001 |
VEH 002 |
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Less Deductible of: |
$1,000 |
$500 |
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Collision |
VEH 001 |
VEH 002 |
74.00 |
222.00 |
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Less Deductible of: |
$1,000 |
$500 |
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Towing and Labor |
VEH 001 |
VEH 002 |
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Limit Per Disablement |
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$75 |
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$8.00 |
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Optional Limits |
$ |
30 |
Per Day and |
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Transportation Exp |
$ |
900 |
Maximum |
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20.00 |
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| ---------------------------------------------------------------------CREDITS AND DEBITS ----------------------------------------------------------- |
| Veh |
Title |
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Premium |
| 001 |
PASSIVE RESTRAINT DISCOUNT
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$ |
-33.00 |
| 001 |
ANTI-THEFT DISCOUNT
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$ |
-4.00 |
| 002 |
ANTI-LOCK BRAKES DISCOUNT
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$ |
-42.00 |
| 002 |
PASSIVE RESTRAINT DISCOUNT
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$ |
-31.00 |
| 002 |
ANTI-THEFT DISCOUNT
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$ |
-80.00 |
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| ----------------------------------------------------------------VEHICLE PREMIUM SUMMARY----------------------------------------------------- |
| Veh |
Base Premium |
Additional Coverages |
Credits and Debits |
Total Premium |
| 001 |
$ |
553.00 |
$ |
60.00 |
$ |
-37.00 |
$ |
576.00 |
| 002 |
$ |
795.00 |
$ |
60.00 |
$ |
-153.00 |
$ |
702.00 |
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Total Coverage Premium |
$ |
1278.00 |
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| ------------------------------------------------------------------DRIVER INFORMATION--------------------------------------------------------- |
| Veh |
Driver |
License Number |
St |
Op |
DOB |
M/F |
M/S |
GS |
DT |
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| 001 |
01 John Smith |
X2213D4213 |
US |
P |
3/4/74 |
M |
M |
N |
N |
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| 002 |
02 Jane Smith |
X2213D4214 |
US |
P |
4/4/75 |
F |
M |
N |
N |
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| ----------------------------------------------------------------ADDITIONAL INTERESTS-------------------------------------------------------- |
COMPASS BANK
PO BOX 192
BIRMINGHAM, AL 35201-0192 |
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