This section is from the book "The Law Of Contracts", by William Herbert Page. Also available from Amazon: Commercial Contracts: A Practical Guide to Deals, Contracts, Agreements and Promises.
The X Y Company Of
In consideration of the warranties and the premium hereinafter mentioned does insure the assured named and described herein upon the body, machinery and equipment of the automobile described herein while within the limits of the United States (exclusive of Alaska, the Hawaiian Islands and Porto Rico) and Canada, including while in building, on road, on railroad car or other conveyance, ferry or inland steamer, or coastwise steamer between ports within said limits, for the term herein specified and to an amount not exceeding the amount of insurance herein specified, against direct loss or damage caused while this policy is in force, by the perils specifically insured against.
Form No. 2 - Non-Valued Fire, Theft and Transportation
Agency at -------- Attached to and made
___________________ THE X Y COMPANY part of policy
___________________ No. --------
Rate at --------% Old policy No. --------
Amount, $---------- Premium, $--------
Does insure A. B., address --------, from --------, 19-, at noon, standard time, to --------, 19-, at noon, standard time, to an amount not exceeding
Warranties - The following are statements of facts known to and warranted by the Assured to be true, and this policy is issued by this Company relying upon the truth thereof: Business of Assured -------- [state occupation or means of support; if assured is a married woman, state husband's occupation!.
The following is the description of the automobile:
Factory or Motor Number
Type of Body
(1' Truck State
Advertised Horse Power
Modal, year, letter or Into
The facts with respect to the purchase of the automobile described are as follows:
Purchased by the Assured
Actual Cost to Assured Including Equipments
The Automobile Described- is Fully Paid for by Km
Assured and is not Mortgaged or otherwise
Encumbered, Except as Follows:
New or Second hand
The uses to which the automobile described are and will be put, are--------.
The automobile described is usually kept in -------- [state whether private or public] garage, located, No. --------, Street --------, City --------, State.