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IL N 018 01 22 <br />CALIFORNIA FRAUD STATEMENT <br />For your protection, California law requires the following to appear on this form: Any person who knowingly <br />presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for the <br />payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. <br />=m„e, <br />' <br />PJA mawganad Dmsicna <br />REvie &Araeov®ay: <br />" =Mow:, <br />Ruk Management SpeciAist <br />Of <br />IL N 018 0122 © Insurance Semites Office, Inc., 2021 Page 1 of 1 <br />