SCI Insurance - Hunter's Info. Service


Application


SCI Insurance | Application | Inventory | Rating Policy


To complete application, print and complete the following forms:
(This application forms part of the policy.)
  • APPLICATION FORM - Print and complete Application Form below. (Preferred print font for this document is Times New Roman - 12)

  • INVENTORY FORMS - Complete Trophy Inventory Form(s) (click here for forms). Print form(s) and circle applicable limit of liability. Total limits of liability. (Values of trophies)

  • RATING POLICY FORM - Print and complete Rating Policy Form (click here for form). Total rating: multiply total limit of liability (value of trophies) by rate. (Include off premises taxidermy cost, if chosen.)

  • RETURN entire Application Form, Inventory Form(s), Rating Policy Form, and a premium check payable to

         
    Lechner & Stauffer, Inc.
    Attn: John R. Kauffman, CPCU., ARM., CPIA., CIC.
    589 Main Street, PO Box 26, Pennsburg, PA 18073
    (215) 679-9568
        (800) 227-3907

    Underwritten by Bankers Insurance Group


    APPLICATION FORM

    1. Are you a member of Safari Club International? (Please check) Yes_____ No_____
      (If you are not a member, you can join.
    2. Please click here for more information.)

      Safari Club International Chapter_____________________________________
      Safari Club International Identification Number__________________________

    3. Name________________________________________________________

    4. Mailing Address ________________________________________________

    5. Business Phone _________________ Home Phone ____________________

    6. Location and Address of Covered Property:

      Primary Residence
      __________________________________________________________________
      Secondary/Primary Residence
      __________________________________________________________________
      Business
      __________________________________________________________________
      Storage
      __________________________________________________________________

    7. How many years at current address? _____________________

    8. Please list all property losses within the last three years at residence (primary and secondary) and business
      ___________________________________________________________________
      ___________________________________________________________________
      ___________________________________________________________________

      Date of Loss ______________________

      Description _________________________________________________________

      Amount Paid ______________________

    9. Do you have a separate trophy room? (Please check) Yes ____ No ____

    10. * Number of trophies in this room. (This question not applicable if your answer to question #8 was No) _______________

    11. Age of Home __________________
      Construction of Home (Please check) Frame ____ Masonry ____

      Age of Office __________________
      Construction of Office (Please check) Frame ____ Masonry ____

    12. Please check if you have any of the following:

      Burglar Alarm:
      ___Primary Residence ___Secondary/Primary Residence ___Business ___Storage

      Sprinkler System:
      ___Primary Residence ___Secondary/Primary Residence ___Business ___Storage

      Smoke Detectors:
      ___Primary Residence ___Secondary/Primary Residence ___Business ___Storage

      Dead Bolts:
      ___Primary Residence ___Secondary/Primary Residence ___Business ___Storage

    13. *Optional: Off premises taxidermy coverage; (Please check)
      ___25,000 limit - cost $150 ___50,000 limit - cost $225

    14. Signature __________________________________________________

    Effective date of coverage is 5 business days after your check and application have been received. The descriptions made in this application are for underwriting and rating purposes. For exact coverage information you must refer to your policy.

    *NEW: Your policy can now cover your trophies while at a taxidermy studio in the United States.