First Alert K5309-5V2 Instrukcja Użytkownika Pobierz pdf (Strona 61)

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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: Policy No.:

FA168CPS / FA148CP

Other ____________________________________________________

(circle the appropriate model number)

Type of Alarm:

Burglary

Fire

Both

Installed by: Serviced by:

Name Name

Address Address

B. NOTIFIES (Insert B = Burglary, F = Fire)

Local Sounding Device Police Dept. Fire Dept.

Central Station

Name:

Address:

Phone:

C. POWERED BY:

A.C. With Rechargeable Power Supply

D. TESTING:

Quarterly

Monthly

Weekly

Other

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First Alert K5309-5V2 Instrukcja Użytkownika Strona 61