Auto Policy Declarations

Summary
NAMED INSURED(S)
Sample A Sample
123 West Street
Anywhere USA 12345-1234

YOUR ALLSTATE AGENT IS

Sample A Sample
(123) 456-7890

YOUR BILL
will arrive in a separate
mailing if you havent paid
your premium in full.

123 West Street

Anywhere USA 12345

POLICY NUMBER
1 23 456789 01/01
DRIVER(S) LISTED
Sample

VEHICLES COVERED
1. 05 Compact Car

Total Premium
Premium for 05 Compact Car

POLICY PERIOD
Jan. 1 to July 1 at 12:01 A.M. standard time
DRIVER(S) EXCLUDED
None

VEHICLE ID NUMBER
1ABCD12345E678901

TOTAL

LIENHOLDER
ABC Motor Credit Company (Retail)

$000.00
$000.00

Your total premium reflects a combined discount of $000.00

Your Policy Effective Date is Jan. 1

Information as of
February 1, 2005

Page
IL010NBD

*010001205020437000102202*

2202*

Policy Number : 1 23 456789 01/01

Policy Effective Date: Jan. 1

COVERAGE FOR VEHICLE # 1

2005 Compact Car

Your Agent: Sample A Sample (123) 456-7890

COVERAGE

LIMITS

Automobile Liability Insurance

Bodily Injury
Property Damage

DEDUCTIBLE

PREMIUM

Not Applicable
$00,000
$00,000
$00,000

$000.00

each person
each occurrence
each occurrence

Uninsured Motorists Insurance

Not Applicable
Bodily Injury
$00,000
each person
(Includes Underinsured
$00,000
each accident
Motorists Protection)
Uninsured Motorists Insurance limits of insured vehicles cannot be stacked or aggregated.

$00.00

Automobile Medical Payments

$0,000

Not Applicable

$00.00

Auto Collision Insurance

Actual Cash Value

$000

$000.00

Auto Comprehensive Insurance

Actual Cash Value

$000

$00.00

Rental Reimbursement Coverage

up to $00 per day for

a maximum of 00 days

Not Applicable

$00.00

each person

Total Premium for 05 Compact Car

DISCOUNTS

Your premium for this vehicle reflects the following discounts:

$00.00
Passive Restraint
$00.00
Premier Plus

Anti-theft
Antilock Brakes

$000.00

$0.00
$000.00

RATING INFORMATION
This vehicle is driven a maximum of 0,000 miles per year, 0-0 miles to work/school, unmarried female age 00, good driver
rate

0502043700010
41097042
spacer

2.25

in

Information as of
February 1, 2005

Page
IL010NBD