Administrator: Evans, Simpson & Associates, Inc.Gap Waiver Agreement • October 16th, 2013
Contract Type FiledOctober 16th, 2013This certifies that you, as a Lessee/Enrollee or Borrower/Enrollee, are enrolled for coverage under the following terms and conditions. This Agreement contains specific benefits, definitions and limitations which you should read. If you do not fully understand any portion of this GAP Waiver Agreement, contact the above listed Administrator for an explanation. THIS FORM MUST BE TYPED OR LEGIBLY PRINTED. ALL INFORMATION IS REQUIRED.