# SUBJECT TO:

- Receipt of signed UM-UIM Rejection forms within thirty (30) days of the effective date of coverage.
- Receipt of binders for underlying policies
- Receipt of signed TRIA acceptance/declination documents at binding
- Receipt and favorable review of underlying policies within sixty (60) days

**This binder contemplates Chubb forms and endorsements.**

The binder offered includes a charge for terrorism per the attached disclosure letter; we reserve the right not to bind coverage without coverage for terrorism as provided in the Terrorism Risk Insurance Program Reauthorization Act of 2015.

The policy to which this form is attached has been issued using Rates, Rules, and/or Contract Provisions and Forms that are exempt from the filing and approval requirements of the Department of Insurance in your state of domicile.

Please read this binder carefully, as the limits, coverage and other terms and conditions may vary significantly from those requested in your submission and/or from the expiring policy. Terms and conditions that are not specifically mentioned in this binder are not included. The terms and conditions of this binder supersede the submitted insurance specifications and all prior proposals and binders. Actual coverage will be provided by and in accordance with the policy as issued.

This binder is not bound by any statements made in the submission purporting to bind the insurer unless such statement is reflected in the policy or in an agreement signed by someone authorized to bind the insurer.

This binder has been constructed in reliance on the data provided in the submission. A material change or misrepresentation of that data voids this binder.

**Electronic Delivery:** Acceptance of this binder indicates the insured's consent to accept delivery of the policy by electronic means, including delivery of the policy to the email address shown above. If the insured would like to withdraw their consent to electronic delivery and exclusively receive a printed paper copy of the policy, please contact the undersigned.

Please note that we require copies of underlying policies. Please forward copies of these policies as soon as they have been issued for completion of our underwriting file.

**Sri Kundur**
**Senior Underwriter**
(212) 801-4019
Sri.Kundur@chubb.com
Edition Date: 05/18/2020

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