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Elect. Check only one box)Cost: Application Eligibility:To be eligible to apply, I must meet the following conditions. By signing this Application, I am stating that: (1) I am under age 70; (2) if applying for Death or Disability protection: During the last 2 years, I have not been advised of or treated for: cancer, heart attack or coronary artery disease, stroke, cirrhosis, AIDS, or any disorder of my immune system, or had any test showing evidence of antibodies to the AIDS virus (a positive HIV test); (3) if applying for Disability or Involuntary Unemployment protection: I am presently working twenty-four (24) or more hours per week; (4) if applying for Involuntary Unemployment protection: I am not self-employed, and I have not received unemployment benefits within the past 2 years. BORROWER'S SIGNATURE I acknowledge and agree that: (a) I meet the eligibility requirements listed above. If it is discovered that I do not meet the eligibility requirements above, my participation in the Plan will be terminated, I will receive a refund of any fees paid, and an otherwise valid claim will be denied; (b) I have received the disclosures herein and have thoroughly read the Payment Protection Plan Agreement (“Agreement”), and agree to abide by the terms of the Agreement; (c) I authorize the Plan fees to be added to my loan each month; and (d) I understand that I may not be eligible for all benefits contained in the Plan. This document is hereby incorporated into Borrowers loan documentation as if fully set forth therein. There are eligibility requirements, conditions, and exclusions that could prevent you from receiving benefits under the Program. See the Program Agreement for details. BORROWER 1 SIGNATUREDATEXBORROWER 2 SIGNATURE (If applying for Joint Protection)DATEXPROGRAM AGREEMENT for PAYMENT PROTECTION PLAN - CREDIT CARDSAs used in this Payment Protection Plan Program Agreement (“Agreement”), “You”, “Your” or “Borrower” means the person(s) who are obligated to repay a loan to us who have purchased Payment Protection under this Agreement. “We”, “Our”, “Us” means, TwinStar Credit Union, 4525 Intelco Loop South East, Lacey, WA 98503. “Plan Administrator” means Minnesota Life Insurance Company, 400 Robert Street North, St. Paul, Minnesota, 55101, or one of its affiliates, or a contracted third party.This Agreement amends your loan or credit agreement. By enrolling in this Payment Protection Plan (“Plan”), you agree to abide by the terms of this Agreement. The Payment P...

Elect ronic Cop y. A copy of any notice sent in writing shall also be sent by e-mail. For the present, the Parties designate the following as the respective individuals for giving e-mail copy of notices: If to the Municipality:If to the Consultant:warren.hutmacher@johnscreekga.govwp.wright@ch2m.com

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