Applicant’s Affidavit and Signature: I hereby represent that the aforementioned statements and answers are correct and complete. I further understand that my answers and statements will be the basis for determining my insurability and premium for the applied coverage. I further understand that the completion and signing of this application does not bind the applicant or the company to compete the insurance and supplemental information may be requested to produce a binding quote.
The statements, information and warranties contained on this application, and submitted in conjunction with this application in total make up the ‘application for insurance’ and are material to the risk assumed by the insurer. Any policy issued is issued in reliance of the truth of this information.
The parties acknowledge that a signature reproduced by facsimile, photocopy, or scanned document shall have the same force and effect as an original signature.