NOTICE OF CANCELLATION OR NON RENEWAL
OF
AUTO
POLICY NO.
NOTICE OF CANCELLATION OR NONRENEWAL
OILFIEl.,QUMw
CANCEUATION OR TERMINATION Will TAKE EFFECT AT:
<DATE. (HOUR-STANDARD TIME)
OA TE OF NOTICE
ISSUEO THROUGH AGENCY OR OFFICE AT:
BA9288255
NEW ORLEANS, LA.
70119
09/05/85
09118185
12:01 A.M.
~~~. SENT TO NAMED INSURED
INSURANCE
COMPANY
NAME AND
ADDRESS
OF INSURED
CANCEL.
LATION
APPLICABLE
ITEM MARKED X
"X"
NON.
RENEWAL
IMPORTANT 0
NOTICE
INSURANCE .
COMPANY
NAME AND .
ADDRESS
OF LIEN-
HOLDER
RECEIVED
NATIONAL UNION FIRE INS. CO.
NEW YORK, NEW YORK
SEP 10 1985
SEA FORM SYSTEMS GULF
INC.
365 SOUTH VAN AVENUE
BOUMA'; TOlrnnANA70360
A. J. PI LET INSURANCE AGENCY
Cl'ty_C~WO OR~~; ~~=E~-.-,--- -7 (}1 @S
504/245-0453
COAST,
NON-PAVMENT TO AGENT
You are hereby notified in accordance with the terms and conditions of the above mentioned policy that your insurll1C1 will ClISI at and from thl hour and dl I'
mantioned above.
If the premium has been paid, premium adjustment will be made es soon as practicabJa after clllCelIation becomes effllctiva.
If the premium has not bean paid, a biI for the pramium eamad to the time of cancellation will be forwerded in dul course.
You are hereby notified in accordance with the tarms and conditions of the ebove mentioned policy that your insurance will clase at Ind from thl hour and dete mentioned abo e
due to nonpayment of premium.
A bill for the pramium earned to the time of cancallation will be forwarded in due course.
You are hereby notified in accordance with the terms and conditions of the above mentioned policY that the Ibovl mentionad policy will Ixpirl Iffactive at Ind from thl haur a d
date mentioned above and the policy will NOT be renewad.
In compliance with the Fair Credit Reporting Act (Public law 91.5081, you are herlby informed that the action takan abova is baing takan wholly or pertly blcluse of informal'
contained in a consumer report from the following consumer reporting agancy:
THE R IS K-E'X C Hf.rNGE',-rnC. ----- ..,
TO L1ENHOLOER:
You are hereby notified that the agreament under the loss Plyabla Clausl pay" to you IS lianhoIder, which is I pill of the lbove policy, issuad to_J~1 abova insurad, is herab I
cancelled (or terminatedl in accordance with the conditions of the policy, said cancellation (or termination) to bi.!f!tt~YI,\~I1".~,. !~~e~"~'hour an~menf
above. /';~~~,~....m___.m.i,
..- ~-L::-A~t~ IlIpreslllltativl
NATIONAL UNION FIRE INS. CO.
NEW YORK, NEW YORK
CITY OF CLEARWATER
P. O. SOX 4748
CLEARWATER, LA. 33518-4748
LIENHOLDER'S COPY
APS-06 (Ed 9/83)