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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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