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Application Agreement

The following statement applies in all states except those noted below:

  1. I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.
  2. I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.
  3. I have read the applicable Fraud Warning(s) provided in this application form.

Illinois:

  1. I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.
  2. I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.
  3. I have read the applicable Fraud Warning(s) provided in this application form.
  4. If I elect to pay premiums on a monthly basis, I understand there is an installment fee of $3.00 per month.
  5. I understand there is a one- time enrollment fee of $12.00 that applies to policyholders who enroll in Pet coverage for the first time. I further understand that if I elect to pay premiums on a monthly basis, the enrollment fee will be prorated.

South Carolina:

THE INSURER CAN CANCEL THIS POLICY FOR WHICH YOU ARE APPLYING WITHOUT CAUSE DURING THE FIRST 60 DAYS. THAT IS THE INSURER'S CHOICE. AFTER THE FIRST 60 DAYS, THE INSURER CAN ONLY CANCEL THIS POLICY FOR REASONS STATED IN THE POLICY.

  1. I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.
  2. I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation in the application form may result in loss of coverage under the policy.
  3. I have read the applicable Fraud Warning(s) provided in this application form
  4. If I elect to pay premiums on a monthly basis, I understand there is an installment fee of $3.00 per month.
  5. I understand there is a one- time enrollment fee of $12.00 that applies to policyholders who enroll in Pet coverage for the first time. I further understand that if I elect to pay premiums on a monthly basis, the enrollment fee will be prorated.

Tennessee:

  1. I have read this enrollment form and declare that all information I have given is true and complete to the best of my knowledge and belief. I understand that this information will be used by MetLife to determine insurability.
  2. I certify that I have read, or had read to me, the completed application form and that I realize that any false statement or misrepresentation made with actual intent to deceive in the application form may result in loss of coverage under the policy.
  3. I have read the applicable Fraud Warning(s) provided in this application form.