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Owner’s insurance premium credit request – Garmin FA168CPS User Manual

Page 61

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OWNER’S INSURANCE PREMIUM CREDIT REQUEST

This form should be completed and forwarded to your homeowner’s insurance carrier for possible
premium credit.

A. GENERAL INFORMATION:

Insured’s Name and Address:

Insurance Company:

Policy No.:

FA168CPS / FA148CP

Other

______________________________________________________

(circle the appropriate model number)

Type of Alarm:

Burglary

Fire

Both


Installed by:

Serviced by:

Name

Name

Address

Address

B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device

Police Dept.

Fire

Dept.

Central Station

Name:

Address:

Phone:

C. POWERED BY: A.C. With Rechargeable Power Supply

D. TESTING:

Quarterly

Monthly

Weekly

Other

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