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Fair Credit Report Act Notice:
Personal information about the applicant, including information from a credit or other investigative report, may be collected from persons other than the applicant in connection with this application for insurance and subsequent amendments and renewals. Such information as well as other personal and privileged information collected by the insurer or the insurer’s agents may in certain circumstances be disclosed to third parties without the applicant’s authorization. Credit scoring information may be used to help determine either the applicant’s eligibility for insurance or the premium the applicant will be charged. The insurer may use a third party in connection with the development of the applicant’s score. The applicant has the right to review the applicant’s personal information in the insurer’s files and can request correction of any inaccuracies. A more detailed description of the applicant’s rights and the insurer’s practices regarding such information is available upon request. Contact the applicant’s agent or broker for instructions on how to submit a request to the insurer.Fraud Warning:
Any person who knowingly and with intent to defraud any Insurance Company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and [NY: substantial] civil penalties. (Not applicable in AL, AR, CO, DC, FL, KS, KY, LA, MD, ME, NJ, NM, NY, OH, OK, OR, PA, RI, TN, VA, WA, and WV) (insurance benefits may also be denied in LA, ME, TN, and VA.)