Common use of DECLARATION AND SIGNATURES Clause in Contracts

DECLARATION AND SIGNATURES. The submission of this Application does not obligate us to issue, or the Applicant to purchase, a policy. The Applicant will be advised if the Application for coverage is accepted. The Applicant hereby authorizes us to make any investigation and inquiry in connection with this Application that we deem necessary. The undersigned, acting on behalf of all Applicants, declare that to the best of their knowledge and belief, after reasonable inquiry, the statements set forth in this Application and in any attachments or other documents submitted with the Application are true and complete and no material facts have been withheld. A material fact is one in which the knowledge or ignorance of it would naturally and reasonably influence the judgment of an insurer in making the contract at all, in estimating the degree or character of the risk, in fixing the rate of premium, or would otherwise be deemed material under applicable law. The undersigned agree that the information provided in this Application and any material submitted herewith are the representations of all the Applicants and the basis for issuance of the insurance policy should a policy providing the requested coverage be issued, and that we will have relied on all such materials in issuing any such policy. The undersigned further agree that the Application and any material submitted herewith shall be considered attached to and a part of the policy. Any material submitted with the Application shall be maintained on file (either electronically or paper) with us. The undersigned hereby acknowledge they are aware that: 1) the information requested in this Application is for underwriting purposes only and does not constitute notice to us of a claim, or a potential claim, under any policy; and 2) the Limits of Insurance contained in the policy for which this Application is made shall be reduced, and may be completely exhausted, by the costs of legal defense and, in such event, we shall not be liable for the costs of legal defense or for the amount of any judgment or settlement to the extent that such exceeds the Limits of Insurance of the policy; and 3) legal defense costs that are incurred shall be applied against the Deductible amount. The undersigned further agree that if the information supplied on this Application changes between the date of this Application and the date of policy issuance, the Applicant shall immediately notify us of such changes. We may then withdraw or modify outstanding quotations and/or authorization or agreement to bind this insurance. Name: Signed: Date: Title:

DECLARATION AND SIGNATURES. The submission of this Application does not obligate us to issue, or the Applicant to purchase, a policyPolicy. The Applicant will be advised if the Application for coverage is accepted. The Applicant hereby authorizes us to make any investigation and inquiry in connection with this Application that we deem necessary. The undersigned, acting on behalf of all Applicants, declare that to the best of their knowledge and belief, after reasonable inquiry, the statements set forth in this Application and in any attachments or other documents submitted with the Application are true and complete and no material facts have been withheld. A material fact is one in which the knowledge or ignorance of it would naturally and reasonably influence the judgment of an insurer in making the contract at all, in estimating the degree or character of the risk, in fixing the rate of premium, or would otherwise be deemed material under applicable law. The undersigned agree that the information provided in this Application and any material submitted herewith are the representations of all the Applicants and the basis for issuance of the insurance policy Policy should a policy Policy providing the requested coverage be issued, and that we will have relied on all such materials in issuing any such policyPolicy. The undersigned further agree that the Application and any material submitted herewith shall be considered attached to and a part of the policyPolicy. Any material submitted with the Application shall be maintained on file (either electronically or paper) with us. The undersigned hereby acknowledge they are aware that: 1) . the information requested in this Application is for underwriting purposes only and does not constitute notice to us of a claim, or a potential claim, under any policyPolicy underwritten by us; and 2) . the Limits of Insurance contained in the policy for which this Application is made Policy shall be reduced, and may be completely exhausted, by the costs of legal defense and, in such event, we shall not be liable for the costs of legal defense or defense, for the amount of any judgment or settlement settlement, or any other costs and expenses, to the extent that such exceeds costs of legal defense, amount of any judgment or settlement, or any other costs and expenses, exceed the Limits of Insurance of the policythis Policy; and 3) . legal defense costs that are incurred shall be applied against the Deductible amount. The undersigned further agree that if the information supplied on this Application changes between the date of this Application is signed and the date of policy Policy issuance, the Applicant shall immediately notify us of such changes. We may then withdraw or modify outstanding quotations and/or authorization or agreement to bind this insurance. Name: Signed: Date: Title:

DECLARATION AND SIGNATURES. The submission of this Application does not obligate us to issue, or the Applicant to purchase, a policy. The Applicant will be advised if the Application for coverage is accepted. The Applicant hereby authorizes us to make any investigation and inquiry in connection with this Application that we deem necessary. The undersigned, acting on behalf of all Applicants, declare that to the best of their knowledge and belief, after reasonable inquiry, the statements set forth in this Application and in any attachments or other documents submitted with the Application are true and complete and no material facts have been withheld. A material fact is one in which the knowledge or ignorance of it would naturally and reasonably influence the judgment of an insurer in making the contract at all, in estimating the degree or character of the risk, in fixing the rate of premium, or would otherwise be deemed material under applicable law. The undersigned agree that the information provided in this Application and any material submitted herewith are the representations of all the Applicants and the basis for issuance of the insurance policy should a policy providing the requested coverage be issued, and that we will have relied on all such materials in issuing any such policy. The undersigned further agree that the Application and any material submitted herewith shall be considered attached to and a part of the policy. Any material submitted with the Application shall be maintained on file (either electronically or paper) with us. The undersigned hereby acknowledge they are aware that: 1) the information requested in this Application is for underwriting purposes only and does not constitute notice to us of a claim, or a potential claim, under any policy; and 2) the Limits of Insurance contained in the this policy for which this Application is made shall be reduced, and may be completely exhausted, by the costs of legal defense and, in such event, we shall not be liable for the costs of legal defense or for the amount of any judgment or settlement to the extent that such exceeds the Limits of Insurance of the this policy; and 3) legal defense costs that are incurred shall be applied against the Deductible amount. The undersigned further agree that if the information supplied on this Application changes between the date of this Application and the date of policy issuance, the Applicant shall immediately notify us of such changes. We may then withdraw or modify outstanding quotations and/or authorization or agreement to bind this insurance. Name: Signed: Date: Title:

DECLARATION AND SIGNATURES. The submission of this Application does not obligate us to issue, or the Applicant to purchase, a policy. The Applicant will be advised if the Application for coverage is accepted. The Applicant hereby authorizes us to make any investigation and inquiry in connection with this Application that we deem necessary. The undersigned, acting on behalf of all Applicants, declare that to the best of their knowledge and belief, after reasonable inquiry, the statements set forth in this Application and in any attachments or other documents submitted with the Application are true and complete and no material facts have been withheld. A material fact is one in which the knowledge or ignorance of it would naturally and reasonably influence the judgment of an insurer in making the contract at all, in estimating the degree or character of the risk, in fixing the rate of premium, or would otherwise be deemed material under applicable law. The undersigned agree that the information provided in this Application and any material submitted herewith are the representations of all the Applicants and the basis for issuance of the insurance policy should a policy providing the requested coverage be issued, and that we will have relied on all such materials in issuing any such policy. The undersigned further agree that the Application and any material submitted herewith shall be considered attached to and a part of the policy. Any material submitted with the Application shall be maintained on file (either electronically or paper) with us. The undersigned hereby acknowledge they are aware that: 1) the information requested in this Application is for underwriting purposes only and does not constitute notice to us of a claim, or a potential claim, under any policy; and 2) the Limits of Insurance contained in the policy for which this Application is made shall be reduced, and may be completely exhausted, by the costs of legal defense and, in such event, we shall not be liable for the costs of legal defense or for the amount of any judgment or settlement to the extent that such exceeds the Limits of Insurance of the policy; and 3) legal defense costs that are incurred shall be applied against the Deductible amount. The undersigned further agree that if the information supplied on this Application changes between the date of this Application and the date of policy issuance, the Applicant shall immediately notify us of such changes. We may then withdraw or modify outstanding quotations and/or authorization or agreement to bind this insurance. Name: Signed: Date: Title: