Selection of Citizens Property and Casualty Insurance Policy and Notice of Possible Coverage Differences
Property insurance may be available from Citizens Property Insurance Corporation (CPIC). A policy from Citizens may be less expensive than those available from private market insurance company. In addition, policies issued by Citizens are subject to a greater potential of assessment than that of other insurers. It is possible that your property may not qualify for coverage from any available private insurance company, offering policies with standardized or enhanced coverage features.
I hereby acknowledge my decision to make application for or purchase an insurance policy for my property from Citizens Property Insurance Corporation (Citizens). I understand that a policy with Citizens may contain less coverage than may be available on a standardized or enhanced policy from a private market insurance company. I also understand the greater potential for assessment as a Citizens insured. I have been advised and further acknowledge that I should carefully read the entire policy and should call my agent with any questions.
It will be presumed that this election and/or acknowledgement will apply to all future renewals, continuations, changes, or replacements thereof.
| Name Insured | |
| Applicant's signature | Date |
| Property Address | |
| Agent / CSR Signature | Date |
