Owner's Insurance Premium Credit Request - Honeywell Lyric User Reference Manual

OWNER'S INSURANCE PREMIUM CREDIT REQUEST

This form should be completed and forwarded to your homeowner's insurance carrier for possible premium credit.
A. GENERAL INFORMATION:
Insured's Name and Address:
Insurance Company:
Lyric™ Controller
Type of Alarm: Burglary
Installed by:
Name
Address
B. NOTIFIES (Insert B = Burglary, F = Fire)
Local Sounding Device
Central Station Name:
Address:
Phone:
C. POWERED BY:
A.C. with Rechargeable Power Supply
D. TESTING:
Quarterly
E. SMOKE DETECTOR LOCATIONS
Furnace Room
Basement
F. BURGLARY DETECTING DEVICE LOCATIONS:
Front Door
1st Floor Windows
All Accessible Openings, Including Skylights, Air Conditioners and Vents
G. ADDITIONAL PERTINENT INFORMATION:
Signature:
Policy No.:
_______________________ Other
Fire
Police Dept.
_________________________________________________________________________
Monthly
Kitchen
Living Room
Basement Door
All Windows
Both
Serviced by:
Name
Address
Fire Dept.
Weekly Other
Bedrooms
Dining Room
Rear Door
Interior Locations
Date:
75
Attic
Hall
All Exterior Doors