Notice of Proposed Insurance

I have applied for an extension of credit with you. You are soliciting, offering, or selling me an insurance product in connection with this extension of credit. I understand that the approval of my request for credit is not conditioned on my purchase of the offered insurance. I understand that if I have other insurance that covers the risk of loss, I may not want or need to purchase the offered credit insurance. Within the first thirty days after receiving my individual policy or group certificate, I may cancel the coverage and receive a refund or credit of all premiums I have paid. I further understand that following the first thirty days after I receive my individual policy or group certificate, I may cancel the coverage at any time and receive a refund of any of the unearned premium. If insurance coverage is required as a condition of the extension of credit, I may be required to offer evidence of alternative insurance acceptable to Lender at the time of my cancellation of the above offered coverage. If the premium or insurance charge is financed, it will be subject to finance charges at the rate applicable to the credit transaction. By clicking the "I accept" button below, I acknowledge that I have received a copy of this form.