AUTHORIZATION AND SIGNATURE
The undersigned authorized representative of the Corporation represent, after inquiry, that the statements and representation set forth in this application, and all materials submitted to or requested by the Insurer in conjunctin with this application, are true. The undersigned authorized representative acknowledge that these statements, representations, and materials are relied on by the Insurer and that they are deemed material to the acceptance of the risk or hazard assumed by the Insurer under the insurance be effected. The undersigned authorized representative agree that if the information supplied via this application changes between the date of this application and the effective date of any insurance effected pursuant to this application, the undersigned will immediately notify the Insurer of such changes, and the Insurer may withdraw or modify any outstanding indications, quotations and/or authorization or agreement to effect the insurance.
Signing of this application does not obligate the Corporation or the Insurer to effect the insurance, but it is agreed that all materials submitted to or requested by the Insurer in conjunction with this application, are hereby incorporation by reference into this application and made a part hereof. It is further agreed that this application and all materials submitted to or requested by the Insurer in conjunction with this application are the basis of and are deemed attached to and incorporated into the policy effected pursuant to this application.
The undersigned authorized representative acknowledges that any personal information provided in connection with the insurance applied for, including but not limited to the informaiton contained in this application, has been collected in accordance with all applicable privacy legislation. The undersigned confirms that all necessary contents have been obtained for the collection, use, and disclosure of such information for the purposes of any investigation and inquiry in connection with this application for insurance, and if applicable, investigating and settling claims, detecting and preventing fraud, and acting as required or authorized by law.