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Note to the Applicant:This form must be completed in full and submitted to your auto insurer if you wish to establish that you have suffered a catastrophic impairment as a result of your motor vehicle
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This must be completed is a form that needs to be filled out.
Anyone who meets the requirements set by the governing body.
You can fill out this form either online or by submitting a physical copy.
The purpose of this form is to gather specific information for regulatory purposes.
You must report your personal details and any relevant financial information.
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