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BY AMOUNTS INCURRED FOR LEGAL DEFENSE. FURTHER NOTE THAT AMOUNTS INCURRED FOR LEGAL DEFENSE SHALL BE APPLIED AGAINST THE DEDUCTIBLE. Application Instructions. A. B. Please type or complete the application in ink. If additional space is needed, please use your firm's letterhead. General Applicant Information 1. Name of Applicant: 2. Principal Address: 3. City: 4. Phone Number: 5. Does the Applicant practice from additional offices? County: State: Zip Code: Fax Number: Yes.

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