income
NACIO IN AND L
PLAN: CIVIL LIABILITY INSURANCE BROKERS
CURRENCY: UNIDAD DE FOMENTO
BRANCH: PROVIDENCIA
15/04/2022 14/04/2023 ENDORSEMENT 06-04-2022 1216652-1 1
FROM(12 Hrs.) Validity UNTIL (12 Hrs.) DOCUMENT DATE ISSUE POLICY-ITEM N* ENDORSEMENT
Intermediary: SUCURSAL PROVIDENCIA DIRECTO – Commission: 0.00 %
ASSURES JIMENEZ MERY MARIA EUGENIA R.U.T. 6.991.822-0
ADDRESS PRESIDENT RIESCO 3077, Dept. OF 14, LAS CONDES PHONE : 993345253 /
229346588
CONTRACTOR JIMENEZ MERY MARIA EUGENIA R.U.T. 6.991.822-0
ADDRESS PRESIDENT RIESCO 3077, Dept. OF 14, LAS CONDES PHONE 993345253 /
229346588
DESCRIPTION OF THE ENDORSEMENT
ENDORSEMENT REQUESTED BY : INSURED
START VALIDITY : 15/04/2022
POLICY COVERAGES ARE MODIFIED, AS INDICATED BELOW:
CAPITAL RATE EXTRA PREMIUM RATE
ANNUAL INSURED COVERAGE NET RISK ADJUSTMENT “TO GROSS
PROFESSIONAL LIABILITY FOR BROKERS 5,871.00 6.73 128 8.01
6,73 1,28 8,01
THERE IS A PREMIUM DECREASE OF 4.02 DEVELOPMENT UNIT
TEXT OF ENDORSEMENT 1:
BY MEANS OF THIS ENDORSEMENT, THE INSURED AMOUNT IS REDUCED BY UF 2,942 FOR
BE LEFT WITH TOTAL UF 5,871.
PREMIUM OF UF 3.38 + VAT REDUCED
RMA AGENT
DOC1216652.1LHR20220406092838 | Page 1 of 1
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