Transfer & Consent Form All forms are not effective unless either an electronic or physical signature of the owner or of the person authorized to act on behalf of the owner is received by Excess Markets (B.C.) Corporation.
	Insurance Company:
	Insured:
	Policy Number:
	Term:	From: To:
	Effective Date of Transfer:
	For value received, the above named Insured hereby transfers, assigns and sets over unto:
	New Insured:
	Mailing Address:
	All right, title and interest in this policy of insurance and all advantage to be derived therefrom.