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GNED BY APPLICANT. SECTION I. WRONGFUL EVICTION/PERSONAL INJURY 1. Is the applicant or anyone for whom this incurance will apply aware of any: a. Wrongful eviction/personal injury claim made against them in the past 5 years? b. Fact, circumstance, act or omission, which might reasonably be expected to be the basis of of a wrongful eviction/personal injury claim or suit against them? Yes No Yes No SECTION II. PREMISES PREFERRED 2. Need applicant s complete location address. Please.

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