第３章 参考文献2 CAMICO加入申込書
Firm_____________
Part Ⅷ:supplement checklist（補足的チェックリスト）
If your Firm Currently or during the past five years has performed the following services, or been involved with the issues listed below, please complete the supplemental application indicated.
| Supplement | Check if Applicable |
|
| The Film has reported a claim or incident | S-1 | □ |
| The Film has provided the following services: | ||
| Audit | S-2.1 | □ |
| Business Management | S-2.2 | □ |
| Personal Financial Planning/Investment Services | S-2.3 | □ |
| Business Investment Advice | S-2.3 | □ |
| SEC(Other than Broker/Dealers) | S-2.4 | □ |
| Computer Related Services | S-2.5 | □ |
| The Firm has provided Services for any of the following types of financial institutions: | ||
| Banks | S-3.1 | □ |
| Savings and Loans | S-3.1 | □ |
| Credit Unions | S-3.1 | □ |
| Thrifts | S-3.1 | □ |
| Insurance Companies | S-3.1 | □ |
| Any member of the Firm is acting as an Executor or Trustee | S-4.1 & S-4.2 | □ |
| Any member of the Firm holds an active professional license other than their CPA license | S-5 | □ |
| The Firm shares office space with any other business entity | S-6 | □ |
| The Firm has multiple offices | S-7 | □ |
| The Firm wishes Prior Acts coverage for any merged or acquired firm(s) for the past five years | S-8 | □ |
| The Film provides services that were indicated as“other”in question 25 | S-9 | □ |
| The Firm provides Assurance Services | S-9 | □ |
| Quote for Employment Practices Defense Coverage(available in most states) | S-10 | □ |
| Quote for Nonprofit Directors and Officers Defense Coverage(available in most states) | S-11 | □ |
2000 CAMICO Mutual Insurance Company
