Disclosures

Electronic Signature Conditions:

 

By selecting the “I understand and agree to the Electronic Signature Conditions” button, you are signing this application for insurance electronically, thereby providing your electronic signature. You agree your electronic signature is the legal equivalent of your manual signature and that your electronic signature constitutes your acceptance and agreement as if this application was signed by you in writing.


Furthermore, you consent to be legally bound by all statements made by you in this application for insurance. You also agree that no certification authority or other third party verification is necessary to validate your electronic signature and that lack of any such certification or verification will not in any way affect the enforceability of your electronic signature.

 

Fraud Warning:

 

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. (Fraud language varies by state.  For New York Residents:  Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.  For other state specific fraud warning notices, please see below)

 

For residents of California:  For your protection California law requires the following to appear on this form: a) Any person who knowingly present a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.   b) A false statement in an application shall not bar the right to recovery under the Policy unless such false statement was made with actual intent to deceive or unless it materially affected either the acceptance of the risk or the hazard assumed by the Company.

For residents of Colorado:  It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the department of regulatory agencies. 

For residents of Florida:  Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

For residents of Kansas: Any person who knowingly presents 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 insurance fraud as determined by a court of law and may be subject to fines and confinement in prison.

For residents of Kentucky:  Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

For residents of Maryland:  Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

For residents of Maine, Tennessee, Virginia and Washington:  It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits.

For residents of New Jersey:   Any person who includes any false or misleading information on an application for an insurance policy is subject to criminal and civil penalties.

 

For residents of New Mexico:  ANY PERSON WHO KNOWINGLY PRESENTS A FALSE OR FRAUDULENT CLAIM FOR PAYMENT OF A LOSS OR BENEFIT OR KNOWINGLY PRESENTS FALSE INFORMATION IN AN APPLICATION FOR INSURANCE IS GUILTY OF A CRIME AND MAY BE SUBJECT TO CIVIL FINES AND CRIMINAL PENALTIES.

For residents of Ohio and Oklahoma:  Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

For residents of Oregon:  Any person who knowingly presents 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 fines and confinement in prison.

 

For residents of Pennsylvania:  Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

For residents of Vermont:  Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.

 

Terms and Conditions of Electronic Delivery of
Insurance Documents

 

In order for Buddy (hereinafter referred to as “we” or “us) to conduct the policy fulfillment process electronically, to the extent permitted by law, you must first consent to us doing so. The insurance related documents you will receive in electronic format will have the same contractual force and effect as insurance‐related documents and communications sent to you in paper format. We reserve the right, in our sole discretion, to provide any insurance‐related documents and communications to you in paper form instead, and / or to discontinue this service or modify the terms of this agreement at our option. If we do, we will provide you with reasonable notice and you will have the option to withdraw your consent at that time.

 

YOUR CONSENT: By indicating I ACCEPT, you:

1. Consent to receive insurance‐related documents, including but not limited to, your policy documents, disclosures, notices, and other documentation, electronically to the email address you provide to us through the online consent form instead of receiving these records in a paper format from us.

2. Agree and acknowledge that your consent is provided and/or obtained in connection with a transaction affecting interstate commerce subject to the Electronic Signatures in Global and National Commerce Act and the Uniform Electronic Transactions Act, or a similar electronic transactions law, as adopted by state law.

3. Agree that the document(s) delivered to you electronically shall have the same meaning and effect as if you were provided a paper document, whether or not you choose to view the document(s), unless you previously withdrew your consent to receive documents via electronic means as provided below. Electronic document(s) are considered received by you at the time we send the email, unless we receive notice that the email notification was not delivered to you at the email address you provided.

 

YOUR RIGHT TO WITHDRAW YOUR CONSENT: If you consented to receiving insurance‐related documents electronically, you may withdraw your consent at any time. After we process your withdrawal of consent, you will begin receiving your insurance documents, in paper form. Contact us at 1‐833-463-8339 or via email to support@iambuddy.com to request to withdraw your consent.

 

YOUR RIGHT TO RECEIVE PAPER COPIES: You have the right to obtain paper copies of your insurance related documents at any time. Contact us at 1‐833-463-8339 or via email to support@iambuddy.com to request paper copies. YOUR OBLIGATIONS: If you consent to receive insurance documents and correspondence electronically, you are responsible for (i) providing Us with an updated and active e‐mail address through the contact listed below. You should be diligent in updating your email address with us in the event that your address changes; (ii) maintaining or having access to a computer capable of connecting to the internet; (iii) maintaining internet access; (iv) installing software on your personal computer to receive, access, store, and print in accordance with the Technical Requirements listed below; (v) an email service account that allows you to read, write, and send email; (vi) an active email address.

 

UPDATING YOUR CONTACT INFORMATION: It is your responsibility to provide us with a current, valid email address and to promptly update any changes to this information by contacting us at 1‐833-463-8339 or via email to support@iambuddy.com.

 

UNDELIVERABLE AND RETURN EMAILS: Any e‐mails returned as undeliverable will result in a suspension of electronic document delivery and a return to paper copies sent via U.S. mail.

 

TECHNICAL REQUIREMENTS: The following minimal technical requirements are necessary to receive electronic records:

Operating Systems – Windows ® 2000, Windows® XP, Windows Vista®; Mac OS® X

Browsers – Final release versions of Internet Explorer® 6.0 or above (Windows only); Mozilla Firefox 2.0 or above (Windows and

Mac); SafariTM 3.0 or above (Mac only)

PDF Reader – Acrobat® or similar software may be required to view and print PDF files

Screen Resolution – 800 x 600 minimum.