Application Agreement

The following statement applies in all states except those noted below:

1.  I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.  I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.

3.  I have read the applicable Fraud Warning(s) provided in this application form.

Florida:

1.  I have read this Application and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.  I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.

3.  I have read the applicable Fraud Warning(s) provided in this application form.

Florida Agent Information:

Agent Name:__ Brad Watkins ___ 

Illinois:

1.  I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.  I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.

3.  I have read the applicable Fraud Warning(s) provided in this application form.

4.   If I elect to pay premiums on a monthly basis, I understand there is an installment fee of $3.00 per month.

5. I understand there is a one- time enrollment fee of $12.00 that applies to policyholders who enroll in Pet coverage for the first time. I further understand that if I elect to pay premiums on a monthly basis, the enrollment fee will be prorated. 

Iowa:

1.  I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.  I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.

3.  I have read the applicable Fraud Warning(s) provided in this application form.

New York:  

1.  I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.   I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.

3.   I have read the applicable Fraud Warning(s) provided in this application form

Fraud Warning Notice

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

South Carolina:

THE INSURER CAN CANCEL THIS POLICY FOR WHICH YOU ARE APPLYING WITHOUT CAUSE DURING THE FIRST 60 DAYS. THAT IS THE INSURER'S CHOICE. AFTER THE FIRST 60 DAYS, THE INSURER CAN ONLY CANCEL THIS POLICY FOR REASONS STATED IN THE POLICY.

1.    I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.    I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.

3.    I have read the applicable Fraud Warning(s) provided in this application form

4.    If I elect to pay premiums on a monthly basis, I understand there is an installment fee of $3.00 per month.

5.    I understand there is a one- time enrollment fee of $12.00 that applies to policyholders who enroll in Pet coverage for the first time. I further understand that if I elect to pay premiums on a monthly basis, the enrollment fee will be prorated. 

Tennessee:

    1.   I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

     2.  I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation made with actual intent to deceive in the application form may result in loss of coverage under the policy.

     3.  I have read the applicable Fraud Warning(s) provided in this application form.

Massachusetts:

1. I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.

2.  I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.

3.  I understand that the Pet Insurance policy will automatically renew on the Renewal Date shown on the policy’s Declarations page, unless I take action to cancel or non-renew the policy prior to the Renewal Date, or unless we exercise our right to not renew the policy. Upon renewal of the Pet Insurance policy the premium payment method on file will automatically be charged. If I wish to cancel or non-renew the policy, I can call MetLife Pet Insurance at [1-866-937-7387] or submit a cancellation request on the MetLife Pet Insurance website (www.metlifepetinsurance.com).

4.  I have read the applicable Fraud Warning(s) provided in this application form.