Policy Number: Policy Period: 8/6/2016 2/6/2017

Transcription

1 SIGENV PO Box 3199 Winston Salem, NC RAMONA DANCY 1734 ELMWOOD ST NEW BERN NC <Post Net > Underwriting Company: Integon National Insurance Company Date: 8/4/2016 Policy Number: Policy Period: 8/6/2016 2/6/2017 Dear Ramona Dancy, Thank you for continuing to allow National General Insurance to serve your insurance needs! Your policy has recently been changed and we have included an amended declarations page that reflects your current coverage, vehicles and drivers. For your convenience, we ve outlined the documents you ve just received: ACTION NEEDED FROM YOU! Here are a few item(s) that need your immediate attention. Please return these at your earliest convenience. Failure to submit the requested information could lead to an increase of your policy premium. If you have already provided this information to your agent, please disregard this section. o The Consent to Rate form must be signed by the Named Insured. Included in this packet - Please review the information contained in this packet: o o o Your Declarations Page Your Insurance Identification Cards Your Updated Billing Schedule Please take a moment to verify that the information is correct, and then store your documents in a safe place. Thank you again for choosing National General Insurance. We appreciate your business! ( ) Phone: Fax: Visit us at

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3 5630 University Parkway Winston-Salem, NC Ramona Dancy 1734 Elmwood St New Bern, NC IMB Underwriting Company: IMPORTANT! MANDATORY CONSENT NOTICE Policy Number: Policy Period: 08/6/ /6/2017 Dear Ramona Dancy Please read and sign the coupon below, and return it to us in the enclosed envelope. Thank you, Customer Service DETACH AND RETURN Integon National Insurance Company 5630 University Parkway Winston-Salem, NC Enclosed is the endorsement to your policy adding physical damage coverage. Thank you for purchasing the insurance on your automobile(s) from Integon National Insurance Company. North Carolina statutes require us to have your signature on the "Consent to Rate" in order for us to continue your coverage. Date: INSURED: Ramona Dancy STD: $ PROP: $ POLICY NUMBER: COVERAGE EFFECTIVE DATE: 08/6/2016 APPLICANT PLEASE READ, SIGN AND RETURN IN THE ENVELOPE PROVIDED CONSENT TO RATE I, the undersigned having voluntarily but unsuccessfully attempted to secure the coverages checked above at manual rates hereby make application to the above designated company. I understand that all such coverages are based upon rates in excess of those promulgated in the State of North Carolina, but do not exceed 550% of the rate I would be charged if I had no driving record points. X Insured s Signature A ( ) Service@NGIC.com Phone: Visit us at

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5 INVOICEBEGIN <LOGO> Policy Number: <PolicyNum> <FirmAddr> <FirmCityStateZip> Account Number: <AcctNum> Policy Period: <DateEff> <DateExp> Date of Notice: <Today> <AgtTxt> <AgtName> <InsNames> RAMONA DANCY <AgtPhone> <InsAddr1> 1734 ELMWOOD ST <InsAddr2> NEW BERN NC <InsCityStateZip> «InsuredPostNet» Convenient ways to pay: Pay Online at Pay By Phone by calling <IVRPaymentPhone> Mail your payment with coupon below <para1> This is your endorsement bill reflecting recent changes made to your policy. Please pay the amount due to avoid interruption in your coverage. PAYMENT OPTIONS Pay in full Automatic Payments Save Money! Avoid installment fees by paying your account balance in full. Enrollment required. See reverse side for more information on enrollment. Pay Now $1, $ Installment Due Date 8/6/2016 $ Note: If received in our office after the due date, a $8.00 late charge may apply <st> ( ) Payment Coupon Policy Number: Minimum Amount Due Payment Due Date Amount Enclosed: Named Insured: [INSURED RAMONA DANCY NAME] [Insured 1734 ELMWOOD Mailing Address1] ST [Insured NEW BERN Mailing NC Address2] [Insured Mailing Address3] If mailing, please detach this portion and return with your payment. Please mail 7 days in advance.,. <PolicyNum1> <PartialPay> $ <DueDate> Check for address change or paperless enrollment. Please note your changes on reverse side. Our records show the following: <NamedInsured ><none please provide on reverse> Phone: <NamedInsuredPhone><none please provide on reverse> For automated payments please visit or call [CustServPhone] If mailing, please make check payable to: <FirmName> GMAC INSURANCE PO BOX CLEVELAND WINSTON SALEM OH NC <OCRLine>

6 PAYMENT SCHEDULE Due Date Scheduled Amount 8/6/ /6/ /6/ /6/ /6/ /6/ Billed installments include a $3.00 installment charge. Please note in accordance with Federal Reserve guidelines we may process your payment electronically via the automated clearing house (ACH). Enrolling for Automatic Payments Step 1: Make your upcoming payment online at by mail or with your agent. Step 2: Complete the Automatic Payments authorization form by phone at or contact your agent. After your Automatic Payments enrollment has been processed on your policy, we will send you an Automatic Payments schedule. To avoid a cancellation of your coverage, please make sure that your payment is received by the due date. The Company may process a Notice of Cancellation if payment is not received by the Company on or before the due date. Postmark is not sufficient. If your check is returned by the bank for insufficient funds or for any other reason, a Notice of Cancellation will be immediately processed. If you have questions or need assistance with your policy, please call your agent at the phone number listed at the top of your statement or call customer service at Thank you for choosing Integon National Insurance Company. We appreciate the opportunity to give you the coverage you need and the service you deserve. Has your address or changed? Please update your contact information below. Insured First Name Initial Last Name ( ) Street Address or PO Box City State Zip Home Phone used for Customer communication only Garaging Address Change Mailing Address Change Both - Enroll in Electronic Delivery - Would you like to simplify your life and enroll in electronic bills and documents? Yes, I d like to receive all my bills and documents electronically. Please provide address above. INVOICEEND

7 IDBEGINS Thank you for insuring with us! Here are your identification cards for proof of insurance. NORTH CAROLINA AUTOMOBILE INSURANCE CARD KEEP THIS CARD IN YOUR MOTOR VEHICLE Integon National Insurance Company NAIC NUMBER Report all accidents immediately to: PO Box 3199 Winston Salem, NC National General Insurance INSURED POLICY NUMBER Toll free at: Glass Claims: <Glass> Ramona Dancy Jahyra Dancy 1734 Elmwood St New Bern, NC Customer Service : EFFECTIVE DATE 8/6/2016 EXPIRATION DATE 2/6/2017 YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER 2002 PONT GRAND AM 1G2NF52F22C AGENCY: Down East Insurance Svcs Inc (252) PO Box New Bern, NC MOD: NC ( ) Cut On Solid Line Fold On Dotted Line NORTH CAROLINA AUTOMOBILE INSURANCE CARD KEEP THIS CARD IN YOUR MOTOR VEHICLE Integon National Insurance Company NAIC NUMBER Report all accidents immediately to: PO Box 3199 Winston Salem, NC National General Insurance INSURED POLICY NUMBER Toll free at: Glass Claims: <Glass2> Ramona Dancy Jahyra Dancy 1734 Elmwood St New Bern, NC Customer Service : EFFECTIVE DATE 8/6/2016 EXPIRATION DATE 2/6/2017 YEAR MAKE MODEL VEHICLE IDENTIFICATION NUMBER 2013 HYUN ELANTRA KMHDH4AE9DU AGENCY: Down East Insurance Svcs Inc (252) PO Box New Bern, NC MOD: NC ( ) IDENDS

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9 PO Box 3199 Winston Salem, NC Policy Number: Date of Notice /4/2016 Named Insured: RAMONA DANCY Policy Period: 12:01 A.M. 8/6/2016-2/6/2017 RAMONA DANCY 1734 ELMWOOD ST NEW BERN NC NOIBM Policy Underwritten By: Integon National Insurance Company 24 Hour Claim Reporting: For Policy Information: Your Agent: Down East Insurance Svcs Inc PO Box New Bern NC (252) NC PERSONAL AUTO DECLARATIONS PAGE Endorsement Effective 8/6/2016 The following changes were made to your policy - Policy Level Change, Loss Payee Added, Vehicle(s) Added Drivers and Household Residents #1 Ramona Dancy Driver Status License # Lic. State Date of Birth Gender Marital Status Driver Pts Yrs. Licensed Rated Driver XXXX6190 NC 4/1/1977 Female Single 0 14 #2 Jahyra Dancy Operator: Principal Driver Veh # - 1 Driver Status License # Lic. State Date of Birth Gender Marital Status Driver Pts Yrs. Licensed Rated Driver XXXX2006 NC 7/6/1999 Female Single 0 0 Insured Vehicle(s) and Schedule of Coverages # PONT GRAND AM VIN: 1G2NF52F22C Usage: To/From Work or School Less Than 10 Miles - 1B Garaging Location: Coverages Provided Limits / Deductibles Premium Bodily Injury $30,000 Each Person / $60,000 Each Accident $ Property Damage $25,000 Each Accident $ Medical Payments $1,000 Each Person / Each Accident $75.00 Uninsured Motorist Bodily Injury $30,000 Each Person / $60,000 Each Accident $17.00 Uninsured Motorist Property Damage $25,000 Each Accident $3.00 Total For This Vehicle $ # HYUN ELANTRA VIN: KMHDH4AE9DU Usage: To/From Work or School Less Than 10 Miles - 1B Garaging Location: Loss Payee Address Consumer Portfolio Services, Inc PO Box 57071, Irvine CA Coverages Provided Limits / Deductibles Premium Bodily Injury $30,000 Each Person / $60,000 Each Accident $69.34 Property Damage $25,000 Each Accident $75.34 Medical Payments $1,000 Each Person / Each Accident $10.00 Uninsured Motorist Bodily Injury $30,000 Each Person / $60,000 Each Accident No Cost Uninsured Motorist Property Damage $25,000 Each Accident No Cost Other Than Collision $250 Deductible $ Collision $250 Deductible $ Rental Reimbursement $30 Per Day/$900 Max $ NC ( )

10 Towing & Labor $100 Per Disablement $3.00 Total For This Vehicle $ Discounts Applied Policy Level Multi Car Discount Vehicle Level #2 Airbag Discount Combined Vehicle Premium $1, Pay Plan Setup Charge $20.00 Total 6 Month Policy Premium $1, Important Notice Online Policy Documents: Your policy form and coverage endorsements may be viewed by going to our website: Click on the Policy Documents link at the top and enter your Policy Number and Last Name. Additional Policy Information Tier Select If your policy includes coverage for DAMAGE TO YOUR AUTO, the rate for OTHER THAN COLLISION AND COLLISION coverage are greater than those rates that are applicable in the state of North Carolina. NCRB Manual Physical Damage Rate: $ Disclosure of Possible Additional Charges The amounts below are authorized for use in this state. However, they are only charged if they apply to your policy. Cancellation Charge $20.00 Late Charge $8.00 Nonsufficient Funds Charge $20.00 Reinstatement Charge $25.00 Forms and Endorsements Endorsement Edition NC AMENDMENT OF POLICY PROVISIONS NC OTHER PRODUCTS ENDORSEMENT NC FEDERAL EMPLOYEES USING AUTOS IN GOVERNMENT BUSINESS NC EXTENDED TRANSPORTATION EXPENSES COVERAGE NC TOWING AND LABOR COSTS COVERAGE NC PERSONAL AUTO POLICY PERSONAL AUTO - BOOKLET COVER Authorized Signature 10039NC ( )

11 Integon National Insurance Company This Endorsement Applies Only If Form Number NC 0304 ( ) Appears in the Declarations. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. TOWING AND LABOR COSTS COVERAGE NC Coverage is provided under this endorsement only when noted in the Declarations of this policy. All the provisions of this policy apply to the coverage provided by this endorsement except as modified herein. If a dollar limit is shown under Limit of Coverage Per Disablement for the coverage option applicable to your covered auto, we will pay towing and labor costs incurred each time your covered auto or any nonowned auto is disabled or keys are lost, broken or accidentally locked in the auto, up to the amount shown in the schedule or the Declarations for the applicable option. We will only pay for labor performed at the place of disablement. If no dollar limit is shown under Limit of Coverage Per Disablement for the coverage option applicable to your covered auto, we will pay reasonable costs you incur for your covered auto or any non-owned auto: 1. for mechanical labor up to one hour at the place of a mechanical breakdown of the auto. 2. for lockout services up to $100 per lockout if keys to the auto are lost, broken or accidentally locked in the auto. 3. if it will not run, for towing to the nearest place where the necessary repairs can be made. The cost of towing out a stuck vehicle will only be paid if the vehicle is stuck on or immediately next to a public road. 4. for delivery of gas, oil, loaned battery, or change of tire. We do not pay for the cost of the gas, oil, loaned battery or tires.

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