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Seed Industry Plus™ 

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Errors & Omissions Application

Business Information

Application Completed For:

Form of Entity:



                                             

Seed Sales

Grain/Oil Seed Sales:
Forage Seed Sales:
Bagged Seed Sales:
Additional Insured's

Insurance History

Has applicant ever carried Seed Errors and Omissions insurance?

Has any insurer ever declined, cancelled or restricted coverage?

If yes, please explain:
Any previous losses in the past 5 years?

If you've had two or more claims, please call our office

Limits Required:

Select choices




I (We) hereby acknowledge that it is a direct consideration of the granting of insurance coverage provided by this program that all requirements and procedures set down by the Canadian Seed Institute regarding grading, sale, handling, shipping and storage of seed / seed products are adhered to.

Notice Concerning Personal Information

By typing below, you provide us with your consent for the collection, use and disclosure of your
personal information, including that previously collected, for the purposes of: communicating with
you; assessing your application for insurance and underwriting your policies; evaluating claims;
detecting and preventing fraud; analyzing business results and acting as required or authorized
by law.

Seed Industry Plus™ is a registered trademark of Westland Insurance