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Building Insurance Application Form
This form shall be completed when a Branch or Division would like to insure a building or similar such structure.
Name of Navy League Branch // Nom de la Succursale de la Ligue:
*
Name of Navy League Member // Nom de Membre de la Ligue:
*
Navy League Member Phone Number // Le numero de Membre de la Ligue:
*
Email // Courriel:
*
Physical Location of the Building - Civic Address:
*
Value of Building (Limits):
*
Value of Contents (Limits):
*
Details on Construction of Building
Construction of Exterior Walls:
*
Construction of Roof:
*
Construction of Floors:
*
Year building was built:
*
Number of Storey's:
*
Type of Heating (Forced Air, Electrical):
*
List any building upgrades or improvements:
Details on Occupancy
Occupied as - By Insured: Percentage of Space
Occupied as - By Others (Renters):
Protection
Fire Protection:
*
Yes
No
Private Protection (Monitored):
*
Yes
No
Distance to Fire Hydrants:
*
Alarm Systems:
*
Exposures - Distance to Other Buildings
North
East:
West:
South:
Any Additional Information that you wish disclose:
*
Date Submitted:
*
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Please forward completed forms to the National Office - national@navyleague.ca or by fax at (613) 941-3755.