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Permanent General Assurance Corporation

80-OK 3895080
07/12/2020 to 03/17/2021 12:01 A.M.
12 MONTHS

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN

Vehicle: 2009 NSSN ALTIMA BASE/S/SE/SL


1N4AL21E99N400744
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN

Vehicle: 2009 NSSN ALTIMA BASE/S/SE/SL


1N4AL21E99N400744
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.
Permanent General Assurance Corporation

80-OK 3895080
07/12/2020 to 03/17/2021 12:01 A.M.
12 MONTHS

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN
LATONIA R LIEN
Vehicle: 2009 NSSN ALTIMA BASE/S/SE/SL
1N4AL21E99N400744
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN
LATONIA R LIEN
Vehicle: 2009 NSSN ALTIMA BASE/S/SE/SL
1N4AL21E99N400744
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.
Permanent General Assurance Corporation

80-OK 3895080
07/12/2020 to 03/17/2021 12:01 A.M.
12 MONTHS

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN

Vehicle: 2008 CHEV COLORADO EXTENDED CAB


1GCCS199588219824
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN

Vehicle: 2008 CHEV COLORADO EXTENDED CAB


1GCCS199588219824
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.
Permanent General Assurance Corporation

80-OK 3895080
07/12/2020 to 03/17/2021 12:01 A.M.
12 MONTHS

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN
LATONIA R LIEN
Vehicle: 2008 CHEV COLORADO EXTENDED CAB
1GCCS199588219824
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.

OKLAHOMA PERSONAL AUTOMOBILE INSURANCE


OWNER'S SECURITY VERIFICATION FORM

Policy Number: 80-OK 3895080


Effective From: 07/12/2020 To: 03/17/2021 12:01 A.M.
Insured: LAIRD R LIEN
LATONIA R LIEN
Vehicle: 2008 CHEV COLORADO EXTENDED CAB
1GCCS199588219824
Agency: THE GENERAL AUTO INS SVCS, INC
P. O. BOX 305054
NASHVILLE,TN 37230-5054
Company: NAIC Code: 37648
PERMANENT GENERAL ASSURANCE CORPORATION
2636 ELM HILL PIKE, STE 510
NASHVILLE, TN 37214-3169 (800) 280-1466
Excluded Drivers:

Examine policy exclusions carefully. This form does not constitute any
part of your insurance policy.

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