Value Statement Form
Every company has assets both tangible and intangible which is used as a source of value and revenue generating tool. These assets are what makes a company grow and earn profit through its effective utilization. The value statement form is usually used to determine the total value of the entity along with its insured value and the calculated premium.
Sample Value Statement Form
Agency Name: Phone No:
Name of Company: Phone No:
Email- ID:
Insured/Applicant: HO Address:
If others (please specify):
Customer code:
Property details:
1.
A. Location/Address: _______________________________________________
B. Type : _______________________________________________
C. Actual Cash Value: _______________________________________________
D. Value at Hundred Percent: _______________________________________________
E. Rate Cost: _______________________________________________
F. Premium Paid: _______________________________________________
G. Policy Period: _______________________________________________
H. Policy Applicable for events like: ______________________________________________
2.
A. Location/Address: _______________________________________________
B. Type : _______________________________________________
C. Actual Cash Value: _______________________________________________
D. Value at Hundred Percent: _______________________________________________
E. Rate Cost: _______________________________________________
F. Premium Paid: _______________________________________________
G. Policy Period: _______________________________________________
H. Policy Applicable for events like: ______________________________________________
3.
A. Location/Address: _______________________________________________
B. Type of Property: _______________________________________________
C. Actual Cash Value: _______________________________________________
D. Value at Hundred Percent: _______________________________________________
E. Rate Cost: _______________________________________________
F. Premium Paid: _______________________________________________
G. Policy Period: _______________________________________________
H. Policy Applicable for events like: ______________________________________________
4.
A. Location/Address: _______________________________________________
B. Type of Property: _______________________________________________
C. Actual Cash Value: _______________________________________________
D. Value at Hundred Percent: _______________________________________________
E. Rate Cost: ______________________________________________
F. Premium Paid: _______________________________________________
G. Policy Period: _______________________________________________
H. Policy Applicable for events like: ____________________________________________
[Type would include if it building, Furnishings, for personal use, For Business Use, Operating or none operating Income, Rental]
All the Information furnished above is given in good faith and true to my knowledge
Applicant Signature: _______________________
Date: _______________________
Category: Statement Forms
