Amend your cover

Stateside APM Hazard & Liability Insurance program

Use this form to amend the cover of an existing insured property under the bulk billing arrangement for .

Hi ,

Please complete the property details and select the amendments you wish to make.

BI Amend Property Details (Bulk Billing)

Property to be amended

BI Policy Number

Not the address

Street *

Amendment Date *

Select the amendments you wish to make

Change in sum insured

Change in occupancy

Change in owner name

Change in owner email address

Change in additional insured

Sum Insured *

Occupancy *

Occupied

Vacant

Owner Name

Owner Email Address

Additional Insured

Add another property Remove this property

By submitting this application, I/we agree to be bound by the terms and conditions of Stateside APM and its insurance carriers. This amendment applies to a property that is currently insured on the bulk billing arrangement for .

I/We further agree that it is solely my/our responsibility as the property manager of this property to ensure that the owner is fully aware of the policy terms and conditions and have provided the owner with instructions how to view them. I/We further agree to hold harmless Stateside APM should I/we fail to do so.

I agree that any change in premium will apply from the date of this amendment and will be charged on my next invoice. I/We also understand that some amendments may require the cover to be reissued.

Full details of the policy terms and conditions and claims procedures, together with any additional terms and conditions imposed by Stateside APM are available at portal.statesideapm.com/iptc

Submitted by *

On behalf of (Company)

Date

Confirmation will be sent to this emmail address *

Confirm Confirmation will be sent to this emmail address *

If you are human, leave this field blank.