Westan insurance po box 840 union city tn 38281 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the 'Named Insured' in the designated field. This should be the name of the individual or entity declining coverage.
3. Next, fill in the 'Coverage / Policy' section with details about the specific coverage being declined.
4. In the 'Insuring Company' field, specify the name of the insurance company offering the coverage.
5. Enter the 'Effective Date' for when this declination takes effect.
6. Indicate the date on which coverage was offered to the insured in the provided space.
7. Have the Proposed Insured sign in the designated area, confirming their decision to decline coverage.
8. The Witness must also sign and print their name in their respective fields to validate this document.
9. Finally, ensure that an Agent from Westan Insurance Group, Inc. signs and dates the form to complete it.

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