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APPLICANT'S STATEMENT:
I HAVE READ THE ABOVE APPLICATION AND INFORMATION PROVIDED. I DECLARE THAT THE INFORMATION IS TRUE, COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. THIS IS BEING OFFERED TO THE COMPANY AS AN INDUCEMENT TO ISSUE PER MY OWN REQUEST A FREE NON-OBLIGATED QUOTE PROPOSAL FOR WHICH I AM APPLYING.

 

DISCLAIMER: PLEASE BE ADVISED THAT THIS WILL BE A FREE, NON-OBLIGATED ESTIMATED QUOTE PROPOSAL. THIS IS NOT A POLICY OF INSURANCE, A BINDER OR OFFER TO INSURE. THIS ESTIMATE WILL REFLECT RATES IN EFFECT AS OF THE DATE OF THIS ESTIMATE AND IS SUBJECT TO UNDERWRITING GUIDELINES, INCLUDING VERIFICATION OF INFORMATION PROVIDED AND AN INSPECTION, PERSONAL INFORMATION ABOUT YOU MAY BE COLLECTED IN CONNECTION WITH THIS ESTIMATED QUOTE PROPOSAL