AK ALTA Endorsement 33-06 (Disbursement) 2-3-11

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AK ALTA Endorsement 33-06 (Disbursement) 2-3-11

Form Document
V 1


ATTACHED TO POLICY NUMBER ______________________

Issued By


Order Number: ____________

Date:  _______________

Premium: $________

1. The Date of Coverage is amended to _________________________.

a. The current disbursement is: $_______________________.

b. The aggregate amount, including the current disbursement, recognized by the Company as disbursed by the Insured is: $_______________________

2. Schedule A is amended as follows:


3. Schedule B is amended as follows:

Part I


Part II


This endorsement is issued as part of the policy. Except as it expressly states, it does not (i) modify any of the terms and provisions of the policy, (ii) modify any prior endorsements, (iii) extend the Date of Policy, or (iv) increase the Amount of Insurance. To the extent a provision of the policy or a previous endorsement is inconsistent with an express provision of this endorsement, this endorsement controls. Otherwise, this endorsement is subject to all of the terms and provisions of the policy and of any prior endorsements.

Signed under seal for the Company, but this endorsement is to be valid only when it bears an authorized countersignature.


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