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Get MT Laferla Insurance Agency Health Insurance Proposal Form

mt Insurers, their Agents and Insurance Associations share information with each other to prevent fraudulent claims and for underwriting purposes. In the event of a claim, some or all of the information you supply in this form and in any eventual Claim Form together with other information relating to the claim may be provided to other Insurers, their Agents and Insurance Associations. Your attention is brought to the fact that in this Proposal Form you should disclose any fact which may influe.

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