INITIAL DISABILITY CLAIM FORM
~ny insurance.company .or other.person files an application for insurance or statement of claim contammg any materially false mformat,on or conceals for !lie purpose of mi~leiiding, jnformation ~oncerning any fact ma\erjal thereto. c.ommits.a fraudulent insurance act, which 1s a crime, and subJects sucli person to criminal and c1vll penalties.
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