UNDERTAKING TO PAY PREMIUMS AND ASSESSMENTS
I, of, in consideration of insurance on my buildings and personal property, insured to myself, my heirs and assigns by the Insurance Company, bind myself, and to the extent of their interest in the property my heirs and assigns, to pay to the company the premiums for such insurance and, within the period of time stated in the notice of assessment, my share of all legal assessments, if any, levied by the company, together with all legal costs and charges incurred in legal proceedings to collect any assessment levied upon me and statutory penalties for nonpayment, according to the statutes and the terms and conditions in the policy and any renewals thereof or of the insurance thereunder. My property covered by the insurance, both personal and real, shall be liable for that share, waiving all exemptions.
Dated this day of, 20
Witness
Agent
Applicants
ARTICLES OF INCORPORATION AND BYLAWS
It is hereby mutually understood and agreed by and between this company and the insured, that this policy is made and accepted with reference to the Articles of Incorporation and Bylaws, which are hereby declared to be part of this contract. This provision applies whether or not the Articles of Incorporation and Bylaws are included in this policy.
NOTICE
The insured is notified that by virtue of this Policy he or she is a member of the Insurance Company, of _________________, County, Wisconsin, and that the annual meetings of said company are held in_______________, County, Wisconsin, on the (date) in (month) of each year at _____o'clock__M.
Wis. Admin. Code Office of the Commissioner of Insurance Ins 13.04