Please reference the chart below for applicable premium amount
Applicant confirms that the answers and statements contained herein are true, complete, and accurate.
Applicant understands and agrees to the following
* It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of
defrauding the company.
I attest that any assertions made to the client regarding WellAway products are in accordance with the Policy Terms and
Conditions,Certificate of Coverage and other marketing materials provided by WellAway Limited.