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Months or within the next four months)? Yes No If Yes, the financial adviser must discuss and complete the Replacement Policy Advice Record (MYRIAD013). Important note: The replacement of any insurance has various potentially detrimental consequences which your financial adviser should disclose to you. Momentum will not automatically cancel a Momentum policy(ies) on acceptance, unless the client submits a conditional termination form with this application form. Declaration by the financial a.

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