Fillable CRIME PROTECTION PLUS THIRD PARTY SUPPLEMENT (Philadelphia Insurance Companies)

Fill Online, Printable, Fillable, Blank CRIME PROTECTION PLUS THIRD PARTY SUPPLEMENT (Philadelphia Insurance Companies) Form

Use Fill to complete blank online PHILADELPHIA INSURANCE COMPANIES pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

CRIME PROTECTION PLUS THIRD PARTY SUPPLEMENT (Philadelphia Insurance Companies)

On average this form takes 8 minutes to complete

The CRIME PROTECTION PLUS THIRD PARTY SUPPLEMENT (Philadelphia Insurance Companies) form is 3 pages long and contains:

  • 0 signatures
  • 0 check-boxes
  • 32 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Philadelphia Insurance Companies forms online.

BROWSE PHILADELPHIA INSURANCE COMPANIES FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
CRIME PROTECTION PLUS
THIRD PARTY SUPPLEMENT
This is a supplement to the Philadelphia Insurance Companies Crime Protection Plus Application
Name of Applicant:
1.
What is the name of the client(s) you will be working for?
2.
What type of work will be performed for your client(s)?
3.
How many employees will be on the premises of your client(s)?
4.
Will your employees have access to client money, securities, banking systems, wire transfer
systems or any sensitive computer data?
Yes
No
If yes, please provide an explanation:
5.
Will your employees be performing services during normal business hours (i.e. 8am-5pm)
Yes
No
If no, at what time will they be performing their work?
6.
Will your employees be supervised and / or monitored by your client(s) when performing services
on their premises?
Yes
No
7.
Will your employees be required to wear I.D. badges or carry special identification in order to
identify themselves as “non-employees”?
Yes
No
8.
Do you perform background checks on your employees, including personal references, past
employment references, criminal records, drug testing?
Yes
No
If no, please provide an explanation:
9.
Are you aware of any incidence of employee theft reported to you by your clients?
Yes
No
If yes, please provide complete details to include a description of the loss, amount of the loss, and
corrective measures taken.
Crime Protection Plus
Third Party Supplement
Page 1 of 3
© 2017 Philadelphia Consolidated Holding Corp.
08/2017
Print Application
10.
If this coverage is for one specific client contract, please provide the expected start date and
completion date for this contract as well as the contract reference I.D. number (if applicable)
To enter more information, please use the separate page attached to the application.
I understand information submitted herein becomes a part of my Philadelphia Insurance Companies Crime Protection
Plus Application and is subject to the same conditions as stated on the application.
Name (Please Print)
Title
_______________________________________________
Signature
Date
Crime Protection Plus
Third Party Supplement
Page 2 of 3
© 2017 Philadelphia Consolidated Holding Corp.
08/2017
Print Application
ADDIITIONAL INFORMATION
This page 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
Crime Protection Plus
Third Party Supplement
Page 3 of 3
© 2017 Philadelphia Consolidated Holding Corp.
08/2017
Print Application
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

CRIME PROTECTION PLUS THIRD PARTY SUPPLEMENT (Philadelphia Insurance Companies)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 29 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document