Oinsured Details

If you have a business and you're hiring employees, you'll need to start filing Form 2155 with the IRS. This form is used to report wages and withholding taxes for your employees. It's important to file this form on time and accurately, so that your business can stay in compliance with IRS regulations. In this blog post, we'll go over what information is required on Form 2155, and we'll provide some tips on how to complete it correctly.

The following are some particulars about form 2155. There, you will find the details about the PDF you want to fill out, which includes the approximate time for you to fill it out as well as other details.

QuestionAnswer
Form NameForm 2155
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names2155-Rev, recoverable, Swenson, Deductable

Form Preview Example

 

 

 

 

Partners Mutual Insurance Company

APPLICATION FOR BOAT INSURANCE

 

 

 

 

20935 Swenson Drive

 

 

 

 

 

 

 

 

Waukesha, Wisconsin 53186-2057

MAIL TO:

o AGENT o INSURED

 

 

 

 

 

M U T U A L I N S U R A N C E

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM 1

 

o Single

o Widow(er)

 

 

 

 

 

 

 

Name __________________________________________________________________ Age _______

o Married

o Divorced

Address __________________________________________________________________________________________________________________

Occupation ______________________________________________________________ Employer ________________________________________

(If housewife, state husband’s occupation)

ITEM 2

CPO Plan Requested

o Yes

o No

o Yes

 

 

 

 

Term ___________________ Effective _____________ To

_______________

Payable Annually? o No

Total Amount of Insurance $ _________________________ Rate _______________ Premium ____________________________________________

Type of Policy Desired: oFull Coverage

o$25 Deductable

o$50 Deductable o$100 Deductable

o$250 Deductable

o$500 Deductable

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM 3 - DESCRIPTION OF PROPERTY TO BE INSURED

oOutboard

oInboard/Outboard

oInboard

 

oSail

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Make of Motor

 

 

 

 

 

 

 

 

Purchased by Applicant

 

 

 

Model Year

Make and Length

 

Horse

 

Model No., Serial No. and

 

 

 

New or

 

Amount of

Article

Model Name

of Boat

 

power

 

*Type of Starter

 

Month

Year

Used

Cost

Insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

*Recoil, electric, or electromatic

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ITEM 4 - UNDERWRITING INFORMATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List Drivers Other Than Applicant

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Married

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name

 

 

 

Age

 

Relation to Applicant

 

 

 

Percent of Use

Yes

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If Inboard-Outboard, maximum speed _______ M.P.H. (Acceptable up to 26 feet in length)

 

Explain YES answers

 

 

 

 

 

in REMARKS section

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is property ever loaned or rented to others?

 

 

 

 

 

 

oYes

oNo

 

100% Direct Bill

 

 

 

 

 

 

 

 

 

oYes

oNo

 

Send Policy To:

Has applicant sustained any losses in the last 5 years that would be recoverable under this policy?

 

 

oAgency

 

 

 

 

 

 

 

 

 

oYes

oNo

 

 

Has applicant ever been refused this kind or similar kind of insurance?

 

 

 

 

 

oInsured

Is trailer designed to carry the boat and motor listed above?

 

 

 

 

 

 

oYes

oNo

 

 

 

 

 

 

 

 

 

 

 

 

What are primary used of boat and motor? ______________________________________________________________________________________

In what waters is property used? ______________________________________________________________________________________________

Where is boat and motor kept in off season? _____________________________________________________________________________________

Policy numbers of present Partners Mutual Insurance held by applicant ________________________________________________________________

Loss payable clause to _____________________________________________________________ Mail address _____________________________

What is the auto driving record of operators of boat? _________________________ Birthdates ______________

License Nos. ________________

Name of agent or solicitor who solicited business? ___________________________________________________

Date: _______________________

Do you unqualifiedly recommend the applicant? __________________________________________________________________________________

ITEM 5 - REMARKS

_________________________________________________________________________________________________

Warranted that the above are True Statements which are made on the basis of the contract, should a Policy be issued.

Agency _________________________________________________________ Date Completed __________________________________________

Address _________________________________________________________ Signature of Applicant _____________________________________

Form 2155-Rev. 8

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