|  | The user certifies that they are the individual who will be identified as the “Applicant” and that they are the same individual who is completing this application on-line. The user also acknowledges that they are aware that they are applying for a “Claims Made & Reported” Liability Insurance Policy for Individual Life Insurance Agents and Related Professionals. 
 The user acknowledges and accepts that the completion and submission of an application does not bind SRCSAIC - Canadian Branch, its subsidiaries and affiliates to the issuance of a policy.
 
 
 
 
 
 
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