GAP INSURANCE WAIVER OF BENEFITS
I understand, that if my vehicle is a
total loss or stolen my auto
insurance policy only pays the actual cash value (fair
market value)
and that I am responsible for any remaining balance
and deductible
due the lender after the insurance settlement is paid.
The optional GAP Insurance benefits &
the one time $299 premium
(for the full loan term) have been explained to me but
I choose to decline these benefits.
__________________________________
Customer Signature
__________________________________
Agent or Customer Service
Representative
Date_______________
This form should be retained with
Customer’s Auto Policy.
