I declare that, to the best of my knowledge: The above information is correct. I have not been refused this insurance elsewhere and that no other insurance is in effect. That I am the sole owner unless otherwise indicated. That insurance values requested are not in excess of fair market value or recent appraisal. That I have, to the best of my knowledge, made the examining veterinarian fully aware of any and all matters pertaining to the health status of this animal. WARNING: Any person who knowingly, and with the intent to defraud any Insurance Company or other person, files an application for insurance containing any false information; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.