This Endorsement Changes the Policy. Please Read It Carefully.
Policy Number: <Policy Number>
Insured: <Insured Name>
NAMED DRIVER EXCLUSION ENDORSEMENT – TENNESSEE
The provisions of the policy apply unless modified by the endorsement.
SCHEDULE
The Named Driver Exclusion Endorsement applies with respect to the "named excluded driver" and the
coverages indicated below.
Name(s) Of "Named Excluded Driver":
<Excluded Driver Name>
Coverages To Which This Endorsement Applies:
This endorsement applies to all coverages.
I. Definitions
The following definition is added:
"Named excluded driver" means a person or
persons shown in the Schedule or in the
Declarations as a named excluded driver who is
excluded from coverage under the policy.
II. Named Driver Exclusion
With respect to all coverages under this Policy, we
will not pay damages, expenses or loss arising out
of the maintenance or use of any auto or trailer by
the "named excluded driver".
The undersigned acknowledges and understands that the Named Driver Exclusion Endorsement becomes
effective <Effective Date of this Endorsement – Month Day, Year,> and that it shall remain in effect for the term of
the policy and for each renewal, reinstatement, substitute, modified, replacement or amended policy, unless
discontinued by us.
Signature of Named Insured
Date Signed
Signature of Named Insured
Date Signed
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
CPA - 070 TN (9-15)
Cornerstone National Insurance Company
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