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Duty Restriction Income Protection (DRIP) Fraud Warning
The fraud warning that applies to you depends on the state in which you reside. Review the
notice for your state below, along with the applicant certification and signature requirements
that apply to every DRIP application.
Download the Fraud Warning
Download the printable fraud warning that applies to your state:
The full text of both notices also appears on this page below.
Fraud Warning for CO, HI, NE, OH, OK, OR, UT and VT
This notice applies to applicants in the following states:
CO
HI
NE
OH
OK
OR
UT
VT
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.
Applicant Certification and Signature
IMPORTANT: This application must be signed by the applicant. Signing this
form does not bind the company to complete the insurance.
By signing the application, the applicant certifies:
I HEREBY CERTIFY THAT ALL INFORMATION IS ACCURATE TO THE BEST OF MY KNOWLEDGE.
The signed application captures the applicant's printed name, signature and the date of signature.
IMPORTANT: A policy cannot be issued unless this application is properly
signed and dated.
Electronic and Reproduced Signatures
For purposes of creating a binding contract of insurance by this application or in determining the rights and obligations under such contract in any court of law, the parties acknowledge that a signature reproduced by either digital signature, facsimile or photocopy shall be the same force and effect as an original signature and that the original and any such copies shall be deemed one and the same document.
Fraud Warning for All Other States
ACORD General Fraud Statement
Not applicable in Colorado, Hawaii, Nebraska, Ohio, Oklahoma, Oregon, Utah and
Vermont. Applicants in those states should refer to the
state notice above.
Any person who knowingly and with intent to defraud any insurance company or another person files an application for 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 and subjects the person to criminal and [NY: substantial] civil penalties. In the District of Columbia, Louisiana, Maine, Tennessee and Virginia, insurance benefits may also be denied.
