Fraud Warning. Any person who knowingly, and with intent to injure, defraud, or deceive an insurance company, files a statement of claim containing any false, incomplete, or misleading information is guilty of insurance fraud, which is a felony.
Fraud Warning. Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law. The signatures below apply to this authorization, the policy application, and any supplements to the policy application. Proposed insured signature Proposed insured name (please print) X Date City (signed at) State Owner signature if other than proposed insured (give title if signed on behalf of a business or trust) Owner name (please print) X Date City (signed at) State Co-owner signature if other than proposed insured (give title if signed on behalf of a business or trust) Co-owner name (please print) X Date City (signed at) State Is replacement of existing life insurance or annuity involved in this application? ☐ Yes ☐ No I believe that the information provided by the owner and proposed insured is true and accurate. I certify I have accurately recorded all information given by the owner and proposed insured(s). Licensed representative signature Licensed representative name (please print) Date X
Fraud Warning. Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense under state law. Signed, sealed and delivered this day of , 20 Signature of Defendant:
Examples of Fraud Warning in a sentence
Fraud Warning: Any person who knowingly and with intent to defraud any insurance company or other person files a 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.
GENERAL PROVISIONS section is amended to include the following provisions: Fraud Warning as required for District of Columbia Residents: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person.
Fraud Warning – I acknowledge the applicable fraud warning for my state as shown on the Fraud Warning Notices Page.
Colorado Fraud Warning: It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company.
Arizona Fraud Warning: For your protection, Arizona Law requires the following statement to appear on this form.
More Definitions of Fraud Warning
Fraud Warning. Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense under state law. I have read, understand, and agree to all of the terms and conditions set forth in this document, including all terms set forth on each page. SIGNED, SEALED AND DELIVERED at , this date: . Witness Sign: Print Name:
Fraud Warning. Any person who knowingly, and with intent to injure, defraud, or deceive an insurance company, files a statement of claim containing any false, incomplete, or misleading information is guilty of insurance fraud, which is a felony. Alabama: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly present false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof.
Fraud Warning. Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud and may be guilty of a criminal offense and subject to penalties under state law. -------------------------------------------------------------------------------- Proposed insured signature Date City State X -------------------------------------------------------------------------------- Owner signature (if other than proposed insured) Date City State (give title if signed on behalf of a business) X -------------------------------------------------------------------------------- Parent/conservator/guardian signature Date City State (juvenile applications) X -------------------------------------------------------------------------------- I believe that the information provided by this applicant is true and accurate. I certify I have accurately recorded all information given by the Proposed Insured(s).
Fraud Warning. Any person who, with an intent to knowingly defraud or knowingly facilitate a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement or a material fact, may be guilty of insurance fraud. Pennsylvania Fraud Warning: Any person who knowingly and with intent to defraud any insurance company or other 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 such person to criminal and civil penalties. Puerto Rico Fraud Warning: Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall incur a felony and, upon conviction, shall be sanctioned for each violation with the penalty of a fine of not less than five thousand dollars ($5,000) and not more than ten thousand dollars ($10,000), or a fixed term of imprisonment for three (3) years, or both penalties. If aggravating circumstances are present, the penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are present, it may be reduced to a minimum of two (2) years. Rhode Island Fraud Warning: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. Tennessee Fraud Warning: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.
Fraud Warning. Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law. Insured signature Insured name (please print) Date City State Owner signature if other than proposed Owner name (please print) insured (give title if signed on behalf of a business or trust) Date City State Owner signature if other than proposed Owner name (please print) insured (give title if signed on behalf of a business or trust) X Date City State Parent/conservator/guardian signature for Parent/conservator/guardian name juvenile applications signature (please print) Date City State IS REPLACEMENT OF EXISTING LIFE INSURANCE OR ANNUITY INVOLVED IN [ ]YES [ ]NO THIS APPLICATION? I believe that the information provided by the owner and proposed insured is true and accurate. I certify I have accurately recorded all information given by the owner and proposed insured(s). Licensed representative Licensed representative Date signature name (please print) X
Fraud Warning. Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. Proposed insured signature Date City State Owner signature (if other than proposed insured) Date City State (give title if signed on behalf of a business) Parent/conservator/guardian signature Date City State (juvenile applications) X I believe that the information provided by this applicant is true and accurate. I certify I have accurately recorded all information given by the Proposed Insured(s). Licensed representative signature Date
Fraud Warning. Any person who knowingly and with intent to defraud any insurance company or other person files an application of insurance 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. I declare that the statements and answers on this application are full, complete, and true, to the best of my knowledge and belief, and shall form a part of the annuity contract issued hereon. I understand and agree that any fees or taxes will be deducted from my contract value or purchase payment, as applicable. I understand that when contract values and annuity payments are based on investment performance of the Separate Account, the dollar amounts cannot be predicted or guaranteed. I also understand that withdrawals from the Guaranteed Interest Period Fixed Account Option before the end of the Guaranteed Period will be subject to a market value adjustment that will increase or decrease the cash surrender benefit. Variable annuity contracts should be purchased for long-term retirement purposes. --------------------------------------------------------------- --------------------------------------- Signature of Owner Signed in City, State --------------------------------------------------------------- --------------------------------------- Signature of Joint Owner (if applicable) Date -------------------------- --------------------------------------------------------------------------------------------------------- 11. TSA INFORMATION Employer Name _________________________________________________________________________________________ Address________________________________________________________________________________________________ Street City State Zip Code Please verify that the TSA Plan Information Sheet is on file with the SAFECO Life Home Office. This application cannot be processed without verification of Employer's eligibility to sponsor a 403(b) Plan.