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Page 1 of <br /> <br /> <br /> <br /> <br />Extended Declarations Page <br />ISSUED BY: . <br />NAMED INSURED: <br />POLICY NUMBER: <br />POLICY PERIOD: <br />STATE SURPLUS LINES REQUIRED WORDING: <br />1 <br />ZNK >5:6dY :TZKXTGZOUTGR :TY[XKXY 7KVGXZSKTZ $::7% ROYZOTM UL <br />approved nonadmitted non-United States insurers. Ask your agent, <br />HXUQKX& UX bY[XVR[Y ROTKc HXUQKX ZU UHZGOT SUXK OTLUXSGZOUT GHU[Z <br />that insurer. <br />7. 6GROLUXTOG SGOTZGOTY G b<OYZ UL 5VVXU\KJ B[XVR[Y <OTK :TY[XKXY <br />$<5B<:%(c 5YQ _U[X GMKTZ UX HXUQKX OL ZNK OTY[XKX OY UT ZNGZ ROYZ& UX <br />view that list at the internet website of the California Department of <br />Insurance: www.insurance.ca.gov/01-consumers/120-company/07- <br />lasli/lasli.cfm. <br />8. If you, as the applicant, required that the insurance policy you <br />have purchased be effective immediately, either because existing <br />coverage was going to lapse within two business days or because you <br />were required to have coverage within two business days, and you did <br />not receive this disclosure form and a request for your signature until <br />after coverage became effective, you have the right to cancel this <br />policy within five days of receiving this disclosure. If you cancel <br />IU\KXGMK& ZNK VXKSO[S ]ORR HK VXUXGZKJ GTJ GT_ HXUQKXdY LKK INGXMKJ <br />for this insurance will be returned to you. <br />D-2 (Effective January 1, 2020)