Elkridge Condominium Association

 You only need to use this form if your mortgage company requires a Certificate or Evidence of Property Insurance

If you get a request from your mortgage company for an Evicence of Insuranc, complete the following and fax back to:

USI Insurance Agency

Fax: 732-914-0647 or contact 732-349-2100

Date: __________     Closing Date:____________________

Requested by: _____________________________   Phone: _________________________

Association name: _____________________________________________

Unit owner name: - for re-fnance or Purchase Name for new sale:

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Adress of Unit; ____________________________________________________________________

Mortgage Company/ Lender Name and Adress ( mortgagee clause):

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Loan Number: ____________________________________________________

Indicate one please :   ___  Mail           ___ Fax                _____ Fax and Mail

To: _____________________________________________

      Fax #, Attention name

Fax this completed form to   732-914-0674