PI-PLSP-APSUPP NC 11/11 Page 2 of 2
7. Does the Applicant purchase items that they appraise for re-sale? Yes No
If yes, is a written recommendation rendered for the owner to get an independent
appraisal? Yes
No
8. Does the Applicant perform inventory liquidations? Yes No
9. Does the Applicant appraise financial instruments such as, but not limited to, receivables,
contracts or insurance policies, and/or provide business evaluation services? Yes
No
If yes, indicate the percentage of the Applicant’s gross annual revenue derived from such
activity:
%
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companies Cover-Pro
sm
application and is subject to the same conditions as stated on that application.
Name (Please Print/Type) Title
(MUST BE SIGNED BY A PRINCIPAL PARTNER OR OFFICER)
_______________________________________
Signature Date
ADDITIONAL INFORMATION
This section may be used to provide additional information to any question on this application. Please
identify the question number to which you are referring.
__________________________________________
Signature Date
