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Resents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance may be guilty of a crime and may be subject to civil fines and criminal penalties. SECTION A SECTION A MUST BE COMPLETED BY THE LEGAL NEXT OF KIN. PLEASE BE SURE TO ENCLOSE EXECUTORSHIP PAPERS IF THE ESTATE IS BEING FILED THROUGH PROBATE. It is imperative that this form is completed in its entirety. Failure to do so may delay the claim. DATE OF BI.
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