Document

Document technical information

Format doc
Size 75.3 kB
First found May 22, 2018

Document content analysis

Category Also themed
Language
English
Type
not defined
Concepts
no text concepts found

Persons

Organizations

Places

Transcript

EPL Immigration Practices Defense Coverage –
Application Supplement
Applicant: ___________________________________
Have any losses, lawsuits, administrative proceedings, governmental
investigations, hearings or demands been made against the Applicant or any
entity or person proposed for this insurance during the past five (5) years
alleging violations of the Immigration Reform Control Act of 1986 or any other
similar federal, state or local laws or regulations?
 Yes
 No
THE APPLICANT WARRANTS AFTER FULL INVESTIGATION THAT THE
STATEMENTS SET FORTH HEREIN ARE TRUE AND THE APPLICANT BELIEVES
IN GOOD FAITH THAT ALL EMPLOYEES ARE AUTHORISED TO WORK IN THE
USA.
___________
Date
__________________________________________________
Signature of Applicant’s Authorized Principal or Officer
×

Report this document