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I declare to the best of my knowledge and belief that the particulars given above are true and correct. I understand and agree that any misrepresentation in this application will invalidate any benefit under this policy and that I undertake to abide by the terms and conditions of the Policy and with which I undertake to comply. The insurer shall not be liable for any amount until it has accepted first premium. I understand that I will not be covered for the months that I do not pay premiums, and that premiums are payable in advance. I further irrevocably authorize any doctor or other person who may be in possession of and/ or hereafter acquire any information concerning my health to disclose such information to the insurer and agree that this authority shall remain in force even after my death. I know and understand the contents of this declaration and I have no objection to consider it to be binding on my conscience.
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