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UP COST POLICY Application THIS IS AN APPLICATION FOR A CLAIMS-MADE POLICY. THE POLICY TO WHICH THIS APPLICATION APPLIES PROVIDES DEFENSE EXPENSES SEPARATE FROM THE LIMIT OF LIABILITY THAT APPLIES TO LOSS, CORRECTIVE ACTION AND CLEANUP COSTS. NOTICE: PLEASE ANSWER ALL QUESTIONS. ATTACH ADDITIONAL SHEETS OF PAPER IF NECESSARY. Requested Effective Date: 1. Named Insured: 2. Named Insured's Address: (please provide street address in addition to P.O. Box) Street P.O. Box State / Province: City: P.

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