Disclaimer
Coverage is not bound by submitting this form. This information is required for an underwriting evaluation from Seven Seas. The statements by the applicant are warranted to be true and are considered official material to the application. Any resulting insurance proposal will be based on the information provided.

Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.