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CALIFORNIA SPECIAL CALIFORNIA RSVP Infinity Insurance society P.O. Box 830189 Birmingham, AL 35283-0189 / 1-800-782-1020 AUTO APPLICATION X policy NUMBER: 104630359764001 interlingual rendition: 8.03 12/15/2011 applicator elaboration Name: speak to: HERMUS SARMAS 8915 judicatory Dr PRODUCER education producer Code: 10463-26591 Name: send for: metropolis/State/ nix: anticipate: Ben Miller Insurance business office Inc 6400 medallion CANYON BLVD STE 125 N HOLLYWOOD CA 916061570 818-587-2400 city/State/Zip: Jamestown, CA 95327 Home Phone: 209-883-0324 SSN: store Information X Same as Mailing Address Garaging Address: 8915 Bench Dr Work Phone: Fax: 818-587-2401 metropolis/State/Zip: Jamestown CA 95327 GENERAL INFORMATION condition design typeface EFFECTIVE DATE EFFECTIVE m termination DATE EXPIRATION TIME 6 MONTHS RSVP 04/13/2012 14:21:15 10/13/2012 12:01:00 AM driver(S) AND/OR RESIDENT(S) OF HOUSEHOLD INFORMAT ION DRV NO DRIVER/RESIDENT RELATION TO applicant DATE OF nascency gender MARITAL STATUS All persons age 15 and older, exculpate OR NOT, who reside with the applicant, and any other drivers of the vehicle(s) on this application. LIVES WITH APPLICANT SR22 REQUIRED SR22 CASE NO 1 HERMUS SARMAS Self 06/13/1984 M Single Yes No DRIVER(S) AND/OR RESIDENT(S) OF HOUSEHOLD INFORMATION (continued) DRV NO DRIVER/RESIDENT DRIVERS LICENSE NUMBER realize MONTHS EXPERIENCE DRIVING CURRENT VALID LICENSE forward STATE DRV. LIC. NUM. POINTS 1 HERMUS SARMAS D4538536 142 CA N/A 0 diagonal INFORMATION All accidents guilty or non for the past 60 months must be shown. A chargeable accident is one where a person is 51% or more responsible and results in the injured partys end or damages exceeding a threshold of $1000.00 for occurrences on or after 12/11/11 or $750.00 for occurrences antecedent to 12/11/11. STATE OR DOES perfect core DRV DATE OF DESCRIPTION OF ACCIDENT IS ACCIDENT! TYPE OF ACCIDENT JURISDICTION WHERE OF DAMAGE EXCEED NO...If you want to establish a full essay, order it on our website: BestEssayCheap.com

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