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CO 04 10 09 93

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INTERESTS

Residence Premises

In addition to the Mortgagee(s)shown in the Declarations or elsewhere in this policy, the following persons or organizations also have an interest in the residence premises.

Name:
Address:
Description of Interest:
Effective Date of Interest:

Name:
Address:
Description of Interest:
Effective Date of Interest:

CANCELLATION AND NON-RENEWAL NOTIFICATION

If we decide to cancel or not to renew this policy, the persons or organizations named above will be notified in writing.

All other provisions of this policy apply

 

AUTOMOBILE CLUB FAMILY INSURANCE COMPANY