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This application is to request to add an additional insured to your Berxi policy.
About Your Policy:
Is your policy an individual or group policy?
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Individual
Group
I don't know
If you're not sure, call Berxi support
833-242-3794
to help you complete this form.
Enter your group's business name:
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Your first name:
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Your last name:
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Enter your email address:
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How many additional insureds do you wish to add?
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1
2
3
4
6
7
8
9
10
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