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Reliable
Policy Management South Carolina Product
Listing, Forms and Documentation
The
following products are available:
Manufactured/Mobile Home Insurance - not writing new business
in all counties
Prime AD and Family Plan Accidental Death & Dismemberment
(AD&D)
Hospital Indemnity Travel Plan
Motor Club Membership
Travel Trailer Insurance
Forms
and Documentation:
The date following the product is
the last update.
Aegis
Security Insurance Company (Manufactured/Mobile Home &
Travel Trailer Insurance - not writing new business in all counties)
Aegis SC Manufactured
Home Insurance:
Underwriting
Edition 9-(10/08)
Rates Pages:
Rates
(pages 1 - 25) (8/08)
Rates
(pages 26 - 52) (7/08)
Special Forms:
Special
Forms (7/08)
Agency/Agent
Licensing Forms Package (8/08)
Acknowledgment
of No Coverage Bound
Acknowledgment/Personal
Liability Exclusion
Affidavit
of Inspection and No Existing Damage
Agency
Fact Sheet (8/08)
Agent
Appointment Form (8/08)
Application - SC Manufactured Home (8/08)
Cancellation
Form (8/08)
Checklist
for Manufactured Home Components
Claim Form - Manufactured Home/Travel Trailer (8/08)
General
Change Form (8/08)
No
Loss Statement (8/08)
Permission
to Check Credit History Form
Quote Sheet - SC Manufactured Homes (8/08)
Rental
Unit Description Form
Rule
A Questionnaire
Supplemental
Heating Device and Wood/Coal
Burning Stove Report
Supply
Order Form (8/08)
W-9
Form
Policy Forms:
Policy
Forms (8/08)
Additional
Insured
All
Terrain Vehicle Exclusion
Amendment
of Policy Provisions (8/08)
Animal
Injury Exclusion
Arbitration
Agreement
Exclusion
- Mold Liability
Exclusion
of Certain Computer - Related Losses
Fire
Department Service Coverage
Full
Repair Cost Endorsement
Hurricane,
Tropical Cyclone or Tropical Storm Deductible
Manufactured
Home Policy
Mold
- Extension of Coverage
Outside
Radio or Television Antennas
Personal
Property Replacement Cost
Premises
Liability - Rented to Others
Replacement
Cost Coverage (home)
Scheduled
Personal Property Endorsement
Secured
Interest Protection Endorsement
Special
Limit for Animal Liability
Trampoline
Exclusion
$500
Water Damage Deductible
$500
Windstorm/Tornado and Hail Deductible
Windstorm/Tornado/Hail
Exclusion
SC Travel Trailers:
Travel
Trailers (1/05)
Application - SC Travel Trailer (8/08)
Rates
& Underwriting
Special
Provisions
Trail-Blazer
Policy Deletion of Collision or Roll Over Coverage
Your
Aegis Trail-Blazer Policy
Life
of the South Insurance Company (Prime AD):
Prime
AD - Agent Guidelines Edition 8-(4/08)
Agency/Agent Licensing Forms Package (8/08)
Agency Fact Sheet (8/08)
Cancellation
Request Form (8/08)
Claim Form (8/08)
Endorsement
Form (8/08)
Forms Package - all SC Prime AD forms (8/08)
Supply
Order Form (8/08)
Lyndon
Southern Insurance Company (Family Plan):
Family
Plan- Agent Guidelines Edition 8-(4/08)
Agency/Agent
Licensing Forms Package (8/08)
Agency Fact Sheet (8/08)
Cancellation
Request Form (8/08)
Claim Form (8/08)
Endorsement
Form (8/08)
Forms Package - all SC Family Plan forms (10/08)
Supply
Order Form (8/08)
Nation
Safe Drivers (HITP):
Nation Safe Drivers (HITP) Agent
Guidelines Edition 4-(10/08)
Agency/Agent Licensing Forms Package (8/08)
Agency Fact Sheet (8/08)
Cancellation
Request Form (8/08)
Endorsement
Form (8/08)
Forms Package - all NSD-HITP forms (8/08)
Forms
to Order from Nation Safe Drivers (8/08)
Supply
Order Form (8/08)
• Claims:
HITP claim forms - Call 1-800-338-2680, ext. 1, then select option #1
SC Roadmaster (Motor Club)
- underwritten by Nation Safe Drivers:
Motor
Club Guidelines Edition 2-(8/08)
Agency/Agent
Licensing Forms Package (8/08)
Agency
Fact Sheet (8/08)
Agent
Application
Agent Appointment Cancellation Form
Cancellation
Request Form (8/08)
Claim
Form
Forms Package - all SC Roadmaster forms (8/08)
Member
Address Change Form (8/08)
SC Motor Club Service Act
Supply
Order Form (8/08)
Transmittal
Form
W-9
Form
Note:
Adobe Reader version 6.0 or later is required to view and print
these forms.

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