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 CO, FL, HI, MA, NE, OH, OK, OR, or VT; in DC, LA, ME, TN, VA and WA, insurance benefits may also be denied) IN FLORIDA, ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE.
THE UNDERSIGNED IS AN AUTHORIZED REPRESENTATIVE OF THE APPLICANT AND REPRESENTS THAT REASONABLE ENQUIRY HAS BEEN MADE TO OBTAIN THE ANSWERS TO QUESTIONS ON THIS APPLICATION. HE/SHE REPRESENTS THAT THE ANSWERS ARE TRUE, CORRECT AND COMPLETE TO THE BEST OF HIS/HER KNOWLEDGE.
I understand there are NO refunds from Veracity Insurance Solutions, LLC administrator of FLIPROGRAM.COM and its agents and/or affiliates since I am immediately enrolled into the system.
I understand that if my renewal payment is not made before my expiration date this will instantly cancel my insurance and all benefits associated with Veracity Insurance Solutions, LLC administrator of FLIPROGRAM.COM.
I understand any false or incorrect information on this application will not provide me the rights for a refund of any kind and is my sole responsibility once application/payment is submitted.
I also understand that Veracity Insurance Solutions, LLC administrator of FLIPROGRAM.COM has the rights to change this policy at its discretion without notice.
THIS IS A 100% EARNED POLICY AND THERE IS NO RETURN PREMIUM IF CANCELED.