Common use of Consent Disclosure Clause in Contracts

Consent Disclosure. Where (a) an Applicant for this contract provided false particulars to the prejudice of the Insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated therein; or (b) the Insured contravenes a term of the contract or commits a fraud; or (c) the Insured willfully makes false statement(s) in respect to a claim, the claim will become invalid and the Insured rights to recover are forfeited. The Applicant(s) have reviewed all parts and attachments of this application and acknowledge that all information is true, correct and understand that this application of insurance is based on the truth and completeness of this information. Any and all individual that have provided personal information in this document and otherwise may in the future provide further personal information. Some of this personal information may include, but is not limited to credit information and claims history. I/we authorize the broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to the brok er or insurance company’s policy regarding personal information, for the purposes of communication, assessing the application for insurance underwriting, evaluating claims, detecting and preventing fraud, and analyzing business results. Any and all individuals whose personal information is contained in this document have authorized that and agree to the above. I/we hereby apply for insurance in the selected amount indicated on the application. I/we have voluntarily elected to purchase the insurance available through TOWERS REALTY GROUP LTD.. I/we have read the Coverage Summary on pages 3 to 4 of this agreement and understand that the insurance applied for under the Master Policy underwritten by XN Financial does have SPECIAL LIMITATIONS AND EXCLUSIONS. PRINT NAME: PRINT NAME: SIGNATURE: SIGNATURE: DATE: DATE: FOR ALL QUESTIONS ABOUT YOUR INSURANCE COVERAGE: PLEASE CALL 1 83 BFL CANADA Insu 3 351 6825 or email xxxxxxxxxxxxxx@xxxxxxxxx.xx rance Services Inc – ask for Tenant Program specialist TOWERS REALTY GROUP LTD. and their staff are not an Insurance Agent Please do not address questions regarding the insurance to the Manager/Landlord. Beneficiary Coverage Summary attached to Group Policy 4-449-1-0029‌ CERTIFICATE PERIOD: This insurance is effective 12:01am Standard time on the first day of insured move in date and after the first payment of premium unless otherwise stated. This insurance expires on the last day of the month that was paid for in full unless otherwise stated or canceled by the Broker or Insurer at which point cancellation date will be stated.

Consent Disclosure. Where (a) an Applicant for this contract provided false particulars to the prejudice of the Insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated therein; or (b) the Insured contravenes a term of the contract or commits a fraud; or (c) the Insured willfully makes false statement(s) in respect to a claim, the claim will become invalid and the Insured rights to recover are forfeited. The Applicant(s) have reviewed all parts and attachments of this application and acknowledge that all information is true, correct and understand that this application of insurance is based on the truth and completeness of this information. Any and all individual that have provided personal information in this document and otherwise may in the future provide further personal information. Some of this personal information may include, but is not limited to credit information and claims history. I/we authorize the broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to the brok er or insurance company’s policy regarding personal information, for the purposes of communication, assessing the application for insurance underwriting, evaluating claims, detecting and preventing fraud, and analyzing business results. Any and all individuals whose personal information is contained in this document have authorized that and agree to the above. I/we hereby apply for insurance in the selected amount indicated on the application. I/we have voluntarily elected to purchase the insurance available through TOWERS REALTY GROUP LTD.. I/we have read the Coverage Summary on pages 3 to 4 of this agreement and understand that the insurance applied for under the Master Policy underwritten by XN Financial does have SPECIAL LIMITATIONS AND EXCLUSIONS. PRINT NAME: PRINT NAME: SIGNATURE: SIGNATURE: DATE: DATE: FOR ALL QUESTIONS ABOUT YOUR INSURANCE COVERAGE: PLEASE CALL 1 83 BFL CANADA XXXXXX XXXX 0 00 XXX XXXXXX Insu 3 351 6825 or email xxxxxxxxxxxxxx@xxxxxxxxx.xx rance Services Inc – ask for Tenant Program specialist TOWERS REALTY GROUP LTD. and their staff are not an Insurance Agent Please do not address questions regarding the insurance to the Manager/Landlord. Beneficiary Coverage Summary attached to Group Policy 4-449-1-0029‌ CERTIFICATE PERIOD: This insurance is effective 12:01am Standard time on the first day of insured move in date and after the first payment of premium unless otherwise stated. This insurance expires on the last day of the month that was paid for in full unless otherwise stated or canceled by the Broker or Insurer at which point cancellation date will be stated.

Consent Disclosure. Where (a) an Applicant for this contract provided false particulars to the prejudice of the Insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated therein; or (b) the Insured contravenes a term of the contract or commits a fraud; or (c) the Insured willfully makes false statement(s) in respect to a claim, the claim will become invalid and the Insured rights to recover are forfeited. The Applicant(s) have reviewed all parts and attachments of this application and acknowledge that all information is true, correct and understand that this application of insurance is based on the truth and completeness of this information. Any and all individual that have provided personal information in this document and otherwise may in the future provide further personal information. Some of this personal information may include, but is not limited to credit information and claims history. I/we authorize the broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to the brok er or insurance company’s policy regarding personal information, for the purposes of communication, assessing the application for insurance underwriting, evaluating claims, detecting and preventing fraud, and analyzing business results. Any and all individuals whose personal information is contained in this document have authorized that and agree to the above. I/we hereby apply for insurance in the selected amount indicated on the application. I/we have voluntarily elected to purchase the insurance available through TOWERS REALTY GROUP LTD.. . I/we have read the Coverage Summary on pages 3 to 4 of this agreement and understand that the insurance applied for under the Master Policy underwritten by XN Financial does have SPECIAL LIMITATIONS AND EXCLUSIONS. PRINT NAME: PRINT NAME: SIGNATURE: SIGNATURE: DATE: DATE: FOR ALL QUESTIONS ABOUT YOUR INSURANCE COVERAGE: PLEASE CALL 1 83 BFL CANADA Insu 3 351 6825 or email xxxxxxxxxxxxxx@xxxxxxxxx.xx rance Services Inc – ask for Tenant Program specialist TOWERS REALTY GROUP LTD. and their staff are not an Insurance Agent Please do not address questions regarding the insurance to the Manager/Landlord. Landlord PLEASE CALL 0 000 000 0000 or email xxxxxxxxxxxxxx@xxxxxxxxx.xx BFL CANADA Insurance Services Inc – ask for Tenant Program specialist Beneficiary Coverage Summary attached to Group Policy 4-449-1-0029‌ CERTIFICATE PERIOD: This insurance is effective 12:01am Standard time on the first day of insured move in date and after the first payment of premium unless otherwise stated. This insurance expires on the last day of the month that was paid for in full unless otherwise stated or canceled by the Broker or Insurer at which point cancellation date will be stated.0029‌

Consent Disclosure. Where (a) an Applicant The Tenant for this contract provided false particulars to the prejudice of the Insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated therein; or (b) the Insured Tenant contravenes a term of the contract or commits a fraud; or (c) the Insured Tenant willfully makes false statement(s) in respect to a claim, the claim will become invalid and the Insured Tenant(s) rights to recover are forfeited. The Applicant(sTenant (s) have reviewed all parts and attachments of this application and acknowledge that all information is true, correct and understand that this application of insurance is based on the truth and completeness of this information. Any and all individual that have provided personal information in this document and otherwise may in the future provide further personal information. Some of this personal information may include, but is not limited to credit information and claims history. I/we authorize the broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to the brok er broker or insurance company’s policy regarding personal information, for the purposes of communication, assessing the application for insurance underwriting, evaluating claims, detecting and preventing fraud, and analyzing business results. Any and all individuals whose personal information is contained in this document have authorized that and agree to the above. I/we hereby apply for insurance in the selected amount indicated on the application. I/we have voluntarily elected to purchase the insurance available through TOWERS REALTY GROUP LTD.. Towers Realty Group I/we have read the Coverage Summary on pages 3 to 4 5 of this agreement and understand that the insurance applied for under the Master Policy underwritten by XN Financial does have SPECIAL LIMITATIONS AND EXCLUSIONS. PRINT NAME: PRINT NAME: SIGNATURE: SIGNATURE: DATE: DATE: THE UNDERWRITERS REPRESENTATIVE IS: XN Financial Services (Canada) Inc THE INSURANCE BROKER IS: BFL CANADA Risk and Insurance Services Inc FOR ALL QUESTIONS ABOUT YOUR INSURANCE COVERAGE: COVERAGE PLEASE CALL 1 83 BFL CANADA Insu 3 351 6825 0 000 000 0000 or email xxxxxxxxxxxxxx@xxxxxxxxx.xx rance Services Inc – ask for Tenant Program specialist TOWERS REALTY GROUP LTD. Towers Realty Group and their staff are not an Insurance Agent Please do not address questions regarding the insurance to the Manager/Landlord. Beneficiary Coverage Summary attached to Group Policy 4-449-1-0029‌ CERTIFICATE PERIOD: This insurance is effective 12:01am Standard time on the first day of insured move in date and after the first payment of premium unless otherwise stated. This insurance expires on the last day of the month that was paid for in full unless otherwise stated or canceled by the Broker or Insurer at which point cancellation date will be stated.0029

Consent Disclosure. Where (a) an Applicant for this contract provided false particulars to the prejudice of the Insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated therein; or (b) the Insured contravenes a term of the contract or commits a fraud; or (c) the Insured willfully makes false statement(s) in respect to a claim, the claim will become invalid and the Insured rights to recover are forfeited. The Applicant(s) have reviewed all parts and attachments of this application and acknowledge that all information is true, correct and understand that this application of insurance is based on the truth and completeness of this information. Any and all individual that have provided personal information in this document and otherwise may in the future provide further personal information. Some of this personal information may include, but is not limited to credit information and claims history. I/we authorize the broker or insurance company to collect, use and disclose any of this personal information, subject to the law and to the brok er or insurance company’s policy regarding personal information, for the purposes of communication, assessing the application for insurance underwriting, evaluating claims, detecting and preventing fraud, and analyzing business results. Any and all individuals whose personal information is contained in this document have authorized that and agree to the above. I/we hereby apply for insurance in the selected amount indicated on the application. I/we have voluntarily elected to purchase the insurance available through TOWERS REALTY GROUP LTD.. . I/we have read the Coverage Summary on pages 3 to 4 of this agreement and understand that the insurance applied for under the Master Policy underwritten by XN Financial does have SPECIAL LIMITATIONS AND EXCLUSIONS. PRINT NAME: PRINT NAME: SIGNATURE: SIGNATURE: DATE: DATE: FOR ALL QUESTIONS ABOUT YOUR INSURANCE COVERAGE: PLEASE CALL 1 83 BFL CANADA Insu 3 351 6825 or email xxxxxxxxxxxxxx@xxxxxxxxx.xx rance Services Inc – ask for Tenant Program specialist TOWERS REALTY GROUP LTD. and their staff are not an Insurance Agent Please do not address questions regarding the insurance to the Manager/Landlord. Landlord XXXXXX XXXX 0 XXX XXXXXX Insu 000 000 0000 or email xxxxxxxxxxxxxx@xxxxxxxxx.xx rance Services Inc – ask for Tenant Program specialist Beneficiary Coverage Summary attached to Group Policy 4-449-1-0029‌ CERTIFICATE PERIOD: This insurance is effective 12:01am Standard time on the first day of insured move in date and after the first payment of premium unless otherwise stated. This insurance expires on the last day of the month that was paid for in full unless otherwise stated or canceled by the Broker or Insurer at which point cancellation date will be stated.