Insurance Products Disclosure Page 2
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1
2X ____________________________________ (SEAL)
Date: ______________________
X ____________________________________ (SEAL)
Date: ______________________
T
D
A
ELEPHONE
ISCLOSURE
CKNOWLEDGMENT
BY SIGNING BELOW, I ACKNOWLEDGE ON BEHALF OF THE LENDER THAT AN ORAL INSURANCE
PRODUCT
DISCLOSURE
WAS
MADE
TO
THE
APPLICANT/BORROWER
AND
THEY/HE/SHE
ACKNOWLEDGED RECEIPT OF THIS DISCLOSURE.
X ____________________________________
______________________
Lender’s Authorized Signer
Date
End of Form
FORM 5F.1
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