FEPLI Enrollment
Plans and Rates
Payment Information
The applicant warrants that the statements and responses to the questions on this application are true and complete. This application does not bind the applicant or the company, nor does it obligate the company to issue a policy. Such policy may be cancelled by the company from inception upon discovery that the policy was obtained through a fraudulent statement, omission, or concealment of the facts material to the acceptance of the risk or hazard assumed.
Note:any matter arising out of any claim or any acts, errors, or omissions that have been disclosed or should have been disclosed in response to this application are excluded under the policy issued in response to this application.
1Payroll deduction is not eligible for 13-month policy offer.
Puerto Rico residents are not eligible for any special offers described herein.
NOTICE: This is a claims-made form: except to such an extent as may otherwise be provided herein, the coverage of this policy is limited to liability for only those claims that are first made against the insured and reported in writing to the company while the policy is in full force. Please review the policy carefully.