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Click ‘Get Form’ to open it in the editor.
Begin by entering the date at the top of the form. This is essential for record-keeping.
In the 'Named Insured' section, confirm that 'The University of Texas System Board of Regents' is pre-filled. Then, specify your UT Institution and Department.
Fill in the camp name and mailing address, ensuring all fields are complete for effective communication.
Provide contact details including name, email, phone number, and fax number to facilitate inquiries.
Indicate the effective and expiration dates of coverage to clarify the insurance period.
Specify the age range of campers and describe the sports or activities involved in your camp.
Calculate premiums based on camper classification, eligible numbers, days, and rates. Ensure accuracy as this will be audited post-camp.
List any facilities requiring Additional Insured certificates with complete details for compliance.
Finally, ensure that the Camp Director/Coordinator/Coach signs at the bottom to authorize binding coverage.
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Re: Issuance of a special risk insurance license to - NY DFS
The issuance of a special risk insurance license authorizes the insurer to write both Class 1 and Class 2 special risks; no separate licenses are issued.Read more
SPECIAL RISK ACCIDENT AND SICKNESS CLAIM FORM. INSTRUCTIONS: 1.) You must have SECTION A fully completed by a designated official of the Policyholder.Read more
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