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GUARANTEED ASSET PROTECTION WAIVER Entered into by and between the Purchaser/Borrower (consumer, you, or your) and the Dealer, as shown below. CONSUMER DEALER ACCOUNT NUMBER ADDRESS ADDRESS CITY STATE ZIP CITY STATE ZIP HOME PHONE BUSINESS PHONE PHONE CONTACT YEAR MAKE MODEL VIN CURRENT MILEAGE MSRP/NADA LTV Ratio (LTV %) VALUE FINANCIAL AGREEMENT VEHICLE PURCHASE PRICE ASSIGNEE/LIENHOLDER DATE $ ❏ LOAN TERM OF THE FINANCIAL AGREEMENT IN ADDRESS MONTHS ❏ NEW ❏ USED AMOUNT FINANCED CITY STATE ZIP $ GUARANTEED ASSET PROTECTION WAIVER COST INTEREST RATE PHONE CONTACT $ AGREEMENT - This Waiver is a part of, and is incorporated into, your financial agreement. In the event of a total loss of the covered vehicle, the Dealer/Assignee/Lienholder agrees to waive all sums which represent the difference (deficiency) between the outstanding balance as of the date of loss and the actual cash value, subject to the limitations, exclusions, terms and conditions in this Waiver. That portion of a deficiency that results from an original purchase/refinance amount that exceeds 150% LTV ratio is not covered hereunder. The amount waived shall not exceed $50,000 in total. You always remain responsible for the payment of (1) all primary insurance deductibles over $1,000 (unless limited by State law) and (2) any past due amount(s). This Waiver expires upon the earliest of (1) the original termination date of the financial agreement; (2) the early termination (including refinance) of the financial agreement; (3) eighty-four (84) months after the date of this Waiver; or (4) the Waiver term disclosed below. No vehicle with a retail value greater than $100,000 as of the date of this Waiver is covered hereunder. CANCELLATION - YOU MAY CANCEL THIS WAIVER AT ANY POINT DURING THE ORIGINAL TERM OF THE FINANCIAL AGREEMENT PROVIDED YOU HAVE NOT SUBMITTED A DEFICIENCY. IF A CANCELLATION IS REQUESTED WITHIN THIRTY (30) DAYS OF THE DATE OF THE WAIVER, YOU WILL RECEIVE A FULL REFUND. A CANCELLATION REQUEST RECEIVED AFTER THIRTY (30) DAYS OF THE DATE OF WAIVER WILL BE REFUNDED BY PRO-RATA METHOD UNLESS OTHERWISE REQUIRED BY APPLICABLE STATE LAW. THE ASSIGNEE/LIENHOLDER WILL BE NAMED AS SOLE PAYEE ON ANY REFUND IF THIS WAIVER IS TERMINATED DUE TO REPOSSESSION OR CANCELLATION. MANDATORY DISCLOSURES, ACKNOWLEDGEMENT, AND ACCEPTANCE PURCHASE OF THIS PROTECTION IS OPTIONAL AND IS NOT A CONDITION OR REQUIREMENT TO OBTAIN CREDIT. YOU MAY OBTAIN GAP FROM AN ALTERNATIVE SOURCE, FROM YOUR PRIMARY INSURANCE CARRIER, OR CONSULT AN INSURANCE AGENT TO SEE IF SIMILAR COVERAGE MAY BE OBTAINED AND AT WHAT COST. YOU MAY CANCEL THIS WAIVER AT ANY TIME PRIOR TO A TOTAL LOSS AND RECEIVE A REFUND. THERE ARE ELIGIBILITY REQUIREMENTS, CONDITIONS AND EXCLUSIONS THAT COULD PREVENT YOU FROM RECEIVING BENEFITS. YOU SHOULD CAREFULLY READ THE WAIVER FOR A FULL EXPLANATION OF THE PROTECTION PROVIDED. I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND, AND ACCEPT ALL OF THE DISCLOSURES AND ALL OF THE PROVISIONS OF THIS WAIVER. I HEREBY AGREE THAT NO VERBAL REPRESENTATIONS HAVE BEEN MADE TO ME THAT DIFFER FROM THIS WAIVER. I UNDERSTAND THAT THE DEALER/ASSIGNEE/LIENHOLDER MAY RETAIN A PORTION OF THE COST PAID BY ME. I ACKNOWLEDGE THAT THE INFORMATION SHOWN ABOVE IS, TO THE BEST OF MY KNOWLEDGE, TRUE AND CORRECT AND IDENTICAL TO THE TERMS OF THE FINANCIAL AGREEMENT. THIS WAIVER IS NOT A WAIVER OF INSURANCE, AND IS NOT A SUBSTITUTE FOR AND DOES NOT PROVIDE BODILY INJURY, PROPERTY DAMAGE, LIABILITY, OR COLLISION INSURANCE AND DOES NOT COMPLY WITH ANY FINANCIAL RESPONSIBILITY LAW OR ANY OTHER LAW MANDATING MOTOR VEHICLE INSURANCE COVERAGE. COST TERM OF THIS WAIVER I ACCEPT THIS GUARANTEED (IN MONTHS) ASSET PROTECTION $ WAIVER X Consumer Signature(s) Date X Dealer Signature Title Date 1785 Hancock Street, Suite 100 • San Diego, CA 92110-2051 ]Telephone (619) 228-0100 • Fax (619) 228-0129 • (Indiana and Utah: (800) 822-8587) Program Administrator – • ADMINISTRATOR – WHITE LIENHOLDER – YELLOW DEALER – PINK CONSUMER – WHITE CWF-SB (1111) VEHICLE TYPE, ELIGIBILITY, AND OPTIONS Assignee/Lienholder means the creditor of the financial agreement. MOTOR VEHICLES – AUTO, VAN, or LIGHT TRUCK/SUV – SUV – Covered vehicle means the vehicle listed on the first page of this Waiver Includes personal use vehicles that are less than 12,500 pounds gross that meets the Vehicle Type, Eligibility, and Options section requirements. vehicle weight (GVWR) (10,000 GVWR in Texas) and have a retail value Date of loss means the date on which the actual physical loss or less than $100,000 as of the date of this Waiver. That portion of a damage occurred on the covered vehicle. deficiency that results from an original purchase/refinance amount that exceeds 150% LTV ratio is not covered. The term of the financial Deferred payment financing means the first scheduled payment is due agreement must be identical to the term of this Waiver. The maximum ninety (90) days or more after the date of the financial agreement. term of protection under this Waiver shall not exceed eighty-four (84) Deficiency means the amount of debt waived, which shall be the months. difference between the outstanding balance as of the date of loss and MOTOR VEHCLES – ONE TON TRUCK/VAN-Includes personal use the actual cash value subject to the limitations, exclusions, terms Ford F350 and F450, Chevrolet 3500 Series, GMC 3500 Series, Dodge and conditions in this Waiver. 3500 Series, Ford E350, Chevrolet Express, GMC Savana, Dodge 3500 Financial agreement means the document(s) to which this Waiver Ram Vans and Dodge 3500 Sprinter vehicles that are less than 12,500 attaches and becomes a part of evidencing your purchase, or refinancing pounds GVWR (10,000 GVWR in Texas) and have a retail value or of the covered vehicle, the terms of which must be identical to this amount financed less than $100,000 as of the date of this Waiver. That Waiver. portion of a deficiency that results from an original purchase/refinance amount that exceeds 150% LTV ratio is not covered. The term of the LTV ratio means the loan amount financed as a percentage of the retail financial agreement must be identical to the term of this Waiver. The value of the covered vehicle. maximum term of protection under this Waiver shall not exceed eight-four Outstanding balance means the amount in U.S. currency as of the date of (84) months. loss required to pay the financial agreement balance per the terms of the LIMITATIONS financial agreement as it existed on the date of the financial agreement. If the first payment is not scheduled and made within the EXCLUDED ITEMS – The deficiency shall not include any of the first forty-five (45) days, or deferred payment financing exists, then the following: (1) any proceeds that could be recovered from canceling outstanding balance means the calculated balance as of the date of loss items such as, but not limited to, a service waiver, credit insurance, based upon the presumption of equal monthly payments beginning forty- unpaid insurance premiums, and similar items in the financial five (45) days after the date of the financial agreement, amortized over no agreement; (2) loan amounts added after the purchase of the more than eighty-four (84) months. covered vehicle, unearned or future finance charges or interest, past due amounts, late charges and extensions of maturity; (3) prior Past due amount means any payment as required by the financial unrepaired damage, salvage, rental, deductible recoverable from agreement that remains unpaid for more than ten (10) days after the due the at fault insurance carrier, towing, storage, mileage, usage, date stated in the financial agreement. The past due amount will also applicable taxes and fees; (4) any unpaid parking tickets, tolls or include any late charges or interest that have accrued due to financial other violations for which the Lienholder is charged; or (5) trailers, agreement payments being past due. The past due amount will be specialized optional equipment, accessories, or body components; determined as of the date of loss. (6) accident tax, crash tax or any other fine or fee imposed by any Primary insurance means comprehensive and collision insurance governmental or quasi-governmental authority for responding to an coverage as required by the financial agreement. accident. Retail value means the retail valuation per the National Automobile EXCESS – This Waiver is excess over any valid and collectible Dealers Association (NADA) regional guide or equivalent market valuation insurance. This means all insurance, which covers the covered method for the covered vehicle model, including available standard or vehicle or you. Only when all such insurance is exhausted shall this optional equipment, factory approved conversion packages, and dealer Waiver apply. installed options. EXCLUSIONS – No waiver of debt will occur for a total loss: (1) Territory means the United States; its territories or possessions; and prior to the date of this Waiver; (2) in the event of fraud; (3) if Canada. the actual cash value exceeds the outstanding balance; (4) resulting from any race, speed or other contest; (5) to your personal Total loss means the covered vehicle is deemed a total loss by the property in or about the vehicle; (6) due to confiscation, forfeiture, primary insurance company due to an insured peril where the damages to seizure, destruction or risks of contraband by any governmental or the covered vehicle are greater than or equal to the retail value of the public authority; (7) resulting from the covered vehicle being utilized covered vehicle immediately prior to the date of loss. If there is no for any business or commercial purpose or if the motor vehicle primary insurance, then total loss means the damages to the covered was purchased, licensed, registered or insured in a business or vehicle and all options present at the time of purchase are greater than commercial name; (8) if the covered vehicle does not meet the or equal to the retail value of the covered vehicle immediately prior to Vehicle Type, Eligibility and Options requirements; (9) if the covered the date of loss or the covered vehicle is stolen and not recovered within vehicle is used for hire, rental, or taxicab service. thirty (30) days after the date of loss. DEFINITIONS Waiver means this Guaranteed Asset Protection Waiver that relates to your financial agreement. In this Waiver, the following terms shall have these meanings: You, Yours means the consumer(s) listed on the first page of this Waiver. Actual cash value means the gross settlement calculated by your primary insurance company less any physical damage deductible up ADDITIONALTERMS to $1,000 (unless otherwise limited by State Provisions.) If there is OTHER DISCLOSURES – This Waiver provides disclosures relating only to no primary insurance on the date of loss, then actual cash value this Waiver. For disclosures related to your loan, refer to your financial shall mean the retail value. agreement. ASSIGNMENT – The Assignee/Lienholder shall have the right to (f) Missouri – If this Waiver is cancelled within 15 days of purchase, then a full assign this Waiver at any time. Assignment of the financial refund will be issued. If this Waiver is cancelled after 15 days from the date of agreement by the Assignee/Lienholder shall not affect the terms purchase, then the refund will be the pro rata method. A refund is not require and conditions of this Waiver. You may transfer this Waiver upon a dif the amount of the refund is less than $1. transfer of equity if the financial agreement remains in effect and (g) Nebraska – If this Waiver is cancelled within thirty (30) days of also transfers. purchase and no benefits have been provided, then a full refund will be SUBROGATION – To the extent a deficiency exists, you agree that the issued. If this Waiver is cancelled within thirty (30) days of purchase and Program Administrator shall be subrogated to all rights of recovery benefits have been provided, then a full refund will be issued, less any you acquire against any person. This right of subrogation is benefits provided. If this Waiver is cancelled after thirty (30) days from the secondary to your right to have debt waived under this Waiver. You date of purchase, then the refund shall be calculated using the actuarial shall deliver and execute all necessary documents and take any method. You must provide written notice of cancellation to the Dealer or action required to facilitate enforcement of this subrogation right. Assignee/Lienholder within ninety (90) days of the event terminating the You shall not pay any fees or costs. Waiver or financial agreement. If cancellation occurs because of a default REIMBURSEMENT – To the extent a deficiency exists, you agree under the financial agreement, repossession of the covered vehicle or any other termination of the financial agreement, then the refund will be paid that you will reimburse the Program Administrator if you fully directly to the Assignee/Lienholder, who may apply the refund to reduce recover your damages from a third party. The Program Administrator the amount owed under the financial agreement, unless you can show agrees to pay a portion of your fees or other costs to the extent any deficiency is recovered. that the financial agreement is paid in full. This Waiver is not insurance and is not regulated by the Nebraska Department of Insurance. This STATEPROVISIONS Waiver remains a part of the financial agreement upon the assignment, (1) State specific provisions: sale, or transfer of the financial agreement. If there is no primary insurance, then total loss means a qualified inspector declares the motor vehicle a (a) Georgia – To receive any refund due in the event of cancellation total loss pursuant to insurance industry standards in a prepared report or of this Waiver or early termination of the financial agreement after a law enforcement report declares the covered vehicle an unrecovered thirty (30) days from purchase of this Waiver, you must provide a theft. written request to cancel to the Dealer or Assignee/Lienholder within ninety (90) days after your decision to cancel this Waiver or the (h) Tennessee – If this Waiver is cancelled after thirty (30) days from the occurrence of the event terminating the financial agreement. date of purchase, the Dealer or Program Administrator must receive your written cancellation request within ninety (90) days after the requested (b) Indiana – The sale of this Waiver is not permitted if the amount cancellation date and the refund will be refunded by pro rata method. The financed, less the cost of this Waiver, less the cost of any credit Assignee/Lienholder will be named as sole payee and may apply the refund insurance, and less the cost of any warranties, is less than 80% of to reduce the outstanding balance, unless you can show that the MSRP (new) or NADA (used). If the amount financed exceeds the financial agreement has been paid in full. MSRP or NADA retail value limits stated in this Waiver, this Waiver may not cover the entire amount owing at the time of loss. You may (i) Texas The refund shall be based on upon the earliest of: (1) the be responsible for the amount not covered by this Waiver. After 30 prepayment of the Financial Agreement in full before the original days from the date of purchase, the refund is Pro Rata. maturity date; (2) a demand from the Assignee/Lienholder of payment in full of the unpaid balance or acceleration; (3) Your request for (c) Kansas – Exclusions 1, 2, 3, 4, 5, 6, 8, 9, 10, 11 and 15 are cancellation of this Waiver; or (4) the total denial of a request for deleted. benefits based upon an exclusion. A refund is not required if the amount Assignment of the Financial Agreement by the Lienholder shall not of the refund is less than $5. WE WILL CANCEL CERTAIN AMOUNTS affect the terms and conditions of this Waiver. All subsequent YOU OWE UNDER THIS WAIVER IN THE CASE OF A TOTAL LOSS Assignees agree, by acceptance of the Addendum to the Financial OF THE COVERED VEHICLE AS STATED IN THIS WAIVER. A Agreement by assignment, to waive Your liability covered by this complaint regarding this Waiver may be submitted to the Office of Waiver. Consumer credit Commissioner, 2601 N. Lamar Blvd. #201, Austin, TX 78705-4207 (800) 538-1579 http://www.occ.state.tx.us. The exclusions (d) Louisiana – The extender of credit hereby agrees by acceptance provision is replaced by the following: No waiver of debt will occur for a of this Waiver as an amendment to the Financial Agreement upon Total Loss of the Motor Vehicle; (2) any act of gross negligence by an assignment, to waive Your liability for the difference between the authorized driver that directly results in the Total Loss of the Motor Outstanding Balance (excluding past due amounts, payment Vehicle; (3) conversion, embezzlement, or concealment by any person extensions, insurance or other charges, as described in this Waiver) in lawful possession of the Motor Vehicle; (4) lawful confiscation by an under Your Financial Agreement and the Actual Cash Value. authorized public official; (5) operation, use, or maintenance of th Motor (e) Michigan – To receive any refund due in the event of cancellation of Vehicle in any race or speed contest; (6) war, whether or not declared, this Waiver or early termination of the financial agreement after thirty invasion, insurrection, rebellion, revolution, or an act of terrorism; (7) (30) days from purchase of this Waiver, you must provide a written use of the Motor Vehicle for primarily commercial purposes; (8) damage request to cancel to the Dealer or Assignee/Lienholder within ninety that occurs after the Motor Vehicle has been repossessed; (9) damage (90) days after your decision to cancel this Waiver or the occurrence to the Motor Vehicle before the purchase of this Waiver; (1) any loss of the event terminating the financial agreement. If a cancellation occurring outside the Territory; (11) an act occurring after the original occurs because of a default under a financial agreement, maturity date or date of the holder’s acceleration of the Financial repossession or any other termination of the financial agreement, any Agreement; (12) normal wear and ear, freezing, or mechanical or refund due may be paid directly to the Assignee/Lienholder, who electrical breakdown or failure; (13) damage related to any personal may apply the refund as a reduction of the amount owed under property attached to or within the motor Vehicle; (14) damages the financial agreement, unless you can show that the financial associated with falsification of documents by any person not associated agreement has been paid in full. with the dealer/creditor or other person cancellation Your deficiency; (15) any unpaid debt resulting from exclusions in Your Primary Insurance policy not included in this Waiver; (16) abandonment of Expiration – This Waiver expires upon the earliest of: (1) cancellation by the Motor Vehicle by You, only if You voluntarily discard, leave you; (2) payment in full of the financial agreement (including refinance); behind, or otherwise relinquish possession of the motor Vehicle to (3) any term defined in the Vehicle Type, Eligibility and Options section; (4) the extent the relinquishment shows intent to forsake and desert expiration of any redemption period after a repossession or surrender of the Motor Vehicle so that the Motor Vehicle may be appropriated the covered vehicle. Cancellation – You may cancel this Waiver at any by any other person; (17) any Motor Vehicle that has been time and receive a refund; however, no refund will be provided upon salvaged or branded in whole or in part, used for emergency cancellation if a GAP benefit has been paid or will be paid. If this Waiver is services, rare, exotic, unusual, limited-production, one-of-a kind, kit cancelled within thirty (30) days of purchase, a full refund of the GAP cost or customized; (18) if the Actual Cash Value exceeds the will be issued. If this Waiver is cancelled after thirty (30) days from Outstanding Balance; (19) if the Motor Vehicle does not meet the purchase, the refund of the GAP cost shall be calculated using the pro rata Motor Vehicle Type requirements; (20) if the Motor Vehicle is used method. for livery, used for hire, rental or as a taxi. STATE LAW – If any provision of this Waiver conflicts with the laws of the (j) Utah – A creditor may not condition an extension of credit or the state in which it is issued, then the provision(s) is severable and hereby terms of the related vehicle sale or lease on the purchase of this amended to conform to state law. The remaining provisions of this Waiver. If a creditor assigns, sells or transfers a Financial Agreement, Waiver remain in full force. a guaranteed asset protection waiver remains a part of the Financial REQUESTINGBENEFITS Agreement. You may contact the Program Administrator toll-free by calling (800) 822-8587. This Waiver is subject to limited IT IS YOUR RESPONSIBILITY TO KEEP YOUR ACCOUNT CURRENT UNTIL regulation by the Utah Insurance Commissioner. A complaint THE DEFICIENCY IS WAIVED. regarding this Waiver may be submitted to the Utah Insurance TOTAL LOSS – Request for a deficiency determination must be submitted Commissioner. If this Waiver is cancelled within thirty (30) days of within sixty (60) days from the issuance of the primary insurance settlement purchase and no benefits have been provided, then a full refund will check. You shall provide the following documentation to the Program be issued. If this Waiver is cancelled after thirty (30) days from the Administrator at the address shown below. All copies must be complete date of purchase, the refund shall be calculated using the pro rata and legible. method. You must provide written notice of cancellation to the Dealer or Assignee/Lienholder within ninety (90) days of termination (1) A copy of the primary insurance company claim settlement check(s) of the financial agreement. If cancellation occurs because of a and settlement valuation and worksheet. default under the financial agreement, repossession of the covered (2) A copy of the police report made for the incident if the covered vehicle vehicle or any other termination of the financial agreement or this was stolen. Waiver, then the refund will be paid directly to the Assignee/Lienholder, unless you can show that the financial (3) A copy of the original financial agreement and all addenda, including agreement is paid in full. The Assignee/Lienholder may apply the the covered vehicle valuation documentation identifying model type and refund to reduce the amount owed under the financial agreement. options at the time of purchase, bill of sale, and proof of proceeds recovered from cancellation of refundable items, such as a service waiver, (k) Vermont – You may bring an action to enforce the terms of the credit insurance, or other similar items. Waiver (4) A complete payment history. (5) A copy of this Waiver. or otherwise challenge any denial of benefits. (6) A copy of the primary insurance policy (if needed). (l) Wisconsin – This Waiver is between you and the Assignee/Lienholder, or if assigned, the assignee. Term and You may direct all inquiries regarding this Waiver to: Program Administrator 1785 Hancock Street, Suite 100 • San Diego, CA 92110-2036 • Phone (619) 228-0100 • Fax (619) 228-0129 CWF-SB (1111) BENEFIT INFORMATION — BENEFIT SUMMARY — GUARANTEED ASSET This Waiver waives debt if your Motor Vehicle is damaged beyond repair or is stolen and can not be recovered, and PROTECTION WAIVER the proceeds of your insurance or amounts you received from third persons is not sufficient to satisfy what you owe under your Motor Vehicle financing agreement. — IMPORTANT DISCLOSURES — IMPORTANT and settlement valuation and worksheet. WAIVER IS OPTIONAL KEEP THIS WITH YOUR YOU ARE NOT REQUIRED TO PURCHASE THIS WAIVER AS A CONDITION OF OBTAINING CREDIT. Whether or not you FINANCIAL AGREEMENT purchase this Waiver will not affect your application for 2. Copy of the police report if the covered vehicle was stolen. credit or the terms of any existing credit agreement you 1. Copy of the primary insurance company claim settlement check(s) model type and options at the time of purchase, bill of sale, and have. If you wish to purchase this Waiver on a purely including the covered vehicle valuation documentation identifying 3. Copy of the original financial agreement and all addenda, voluntary basis, you may do so by reviewing this Waiver and then signing the Mandatory Disclosures, Acknowledgement, and Acceptance section of this Waiver. DIRECT ALL INQUIRIES TO items. REFUND OF FEE PAID IN LUMP SUM HOW TO REPORT A CLAIM You may cancel this Waiver at any time prior to a total loss 5. Copy of this Waiver. and receive a refund. 4. A complete payment history. Guaranteed Asset Protection REQUIREMENTS, CONDITIONS AND EXCLUSIONS There are requirements, conditions, and exclusions that Program Administrator 6. Copy of primary insurance policy (if needed). could prevent you from receiving benefits. You should 1785 Hancock Street, Suite 00 carefully read this Waiver for a full explanation of the San Diego, CA 92110-2051 terms. INDIANA CONSUMERS: Contact Program Administrator at 800-822-8587. For additional information Telephone: (619) 228-0100 or complaints, contact: Indiana Department of Financial Fax: (619) 228-0129 Institutions at 800-382-4880 or by mail to 30 South Mail or fax to the Program Administrator, complete and legible copies of the following within sixty (60) days from the date of loss: proof of proceeds recovered from cancellation of refundable items, such as a service contract, credit insurance, or other similar Meridian Street, Suite 300, Indianapolis, IN 46204-2759.
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