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Selection of Citizens Property and Casualty Insurance Policy
and Notice of Possible Coverage Differences.
Property insurance may be available from Citizens Property Insurance Corporation (CPIC). A policy from Citizens may be less expensive
than those available from private market insurance company. In addition, policies issued by Citizens are subject to a greater potential
of assessment than that of other insurers. It is possible that your property may not qualify for coverage from
any available private insurance company, offering policies with standarized or enhanced coverage features.
I hereby acknowledge my decision to make application for or purchase an insurance policy for my property from Citizens
Property Insurance Corporation (Citizens). I understand that a policy with Citizens may contain less coverage than may
be available on a standarized or enhanced policy from a private market insurance company. I also understand the greater
potential for assessment as a Citizens insured. I have been advised and further acknowledge that I shold carefully
read the entire policy and should call my agent with any questions.
It will be presumed that this election and/or acknowledgement will apply to all future renewals, continuations, changes,
or replacements thereof.
| Name Insured |
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| Applicant's signature | Date |
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| Property Address |
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| Agent / CSR Signature | Date |
 » DOWNLOAD, PRINT & SIGN: CPIC Waiver.PDF
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