No Obligation Consultation
The defendant hereby warrant(s) that the foregoing declarations made and answers given are the truth without reservation and are made for the purpose of inducing the Surety to become surety or to procure suretyship on the bond or undertaking applied for herein, with the intent and purpose that they be fully relied on.
WARNING: Any person who knowingly and with intent to injure, defraud, or deceive any insurer, files a statement of claim or and application containing any false, incomplete or misleading information is guilty of a felony of the third degree.