Audit Forms

Home About SMIC Products Audit Forms Agents Claims FAQS Contact Us Links


Audit Forms

All events/activities scheduled to take place within the policy period will need to be reported on the original application's second page Activities Worksheet.  We realize and understand that some events/activities may not yet be scheduled when applying for coverage, so please use your best guess estimates. Actual To and From dates are especially helpful.   If any events/activities that were not originally reported should be scheduled, please notify us in writing.

This is required information that is used to verify that the insurance company has a record of events/activities covered in the instance where a claim should occur.  The carrier and/or claims office will verify with us that a covered event /activity was held on the Date of Injury.  If we do not have the estimated listings with dates, a claim could possibly be denied.

Once a previously reported event/activity has been held, the audit forms can be submitted.  Depending on your events/activities schedule, audits can be submitted either weekly, monthly or quarterly, along with any premium due.

Final Audits and any premium due will need to be submitted within 2 weeks of the last day of the last activity / event.

Adventure Sports, Snow Sports and Work Activities can be added for additional premium.  May be included in standard rate for some products.

Adventure Sports include mountain climbing, rappelling, spelunking, whitewater rafting, whitewater canoeing, wind surfing, jet skiing, scuba/skin diving, rodeo participation and Paintball.

Snow Sports include downhill skiing, bobsledding, snowmobiling, snow boarding, tobogganing, and tubing.

Work Activities include remodeling, dry walling, plastering, roofing, plumbing, brick and block laying, electrical work, concrete work, and using scaffolds, ladders, and power or chain saws.

For audited policies, the Minimum Premium and the Policy Administration Fee are due on or before the effective date.  SMIC now accepts credit card payments.

Current accounts must use the rates sent with the renewal letters.

4-H Yearlong Accident

Blanket Tour

4-H Overnight Camp

Blanket Yearlong

Assemblies of God-Camp

Camps, Conferences & Retreats

Assemblies of God-Tour

Day Camps

Assemblies of God-Yearlong

Kids Across America

Blanket Church Activities

 

To view and print forms, you must have Adobe Acrobat Reader installed on your computer.  Click on the Adobe logo below to download the latest version of the free Acrobat Reader.