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I hereby DECLARE, UNDERSTAND and AGREE that:
All information provided by me for this claim is complete and true to the best of my knowledge and belief.
I confirm I am (i) a Group Life and Health policy insured member ("Insured Member") and/or (ii) a Individual Insurance policy owner. The identity information I provide herein is either owned by me as the Insured Member or Individual Insurance policy owner as part of this claim submission process.