Application

Seedman's Errors & Omissions / Commercial General Liability

This application and policy was designed by seed growers for seed growers specifically. When the application is complete and signed, please mail it in the postage-paid envelope provided to Astro Insurance 1000 Inc, #100, 542 - 7th Street South, Lethbridge, AB, T1K 2H1 or fax it to Astro Insurance at 1-403-320-1962. It is important that the application be completed accurately and in full. Misrepresentation or omission in this application could invalidate a policy underwritten and issued on the basis of this information.


Farm Name: Farm Phone No:
Seedman Name: Farm Fax No:
Farm Address:

Seedman Errors and Omissions (E&O)

Total: Total Seed Sales (Include Seed, Treatment & Cleaning* - All Seed Sales): $
Break-down: Farm Produced seeds sales: $
(These 3 sum to Total)    
  Third party Resales: (Gross Receipts) $
Acres Farmed: Number of Employees:
     


Describe Previous E&O Claims related to your Seedman Business (Year, Description, Size of Settlement) - continue on additional pages as required.
 
 		  
Describe In-Process Circumstances or Occurrences related to your Seedman Business, that Could Lead to an E&O Claim *** - continue on additional pages as required.
  *** e.g. The receipt of notice from any person or entity of their intention to make a Claim against your seedman business for the results of any error or omission, or any circumstances of which you are aware that might reasonably be expected to give rise to a Claim.

Important Note:
Once you send in your application you will be contacted to discuss the transitioning of your existing coverage to the new coverage. It is important that you do not cancel your existing E&O policy or allow it to expire prior to the discussion of transitioning and confirmation of coverage under the new group plan to be sure there are no gaps in insured period.

Applicant's Signature: Date:
This signature verifies that the information provided on this
application is truthful, accurate and complete.