FINANCIAL HARDSHIP AFFIRMATION

PURSUANT TO TWENTY-THIRD MODIFICATION OF THE DECLARATION OF A STATE OF EMERGENCY FOR THE STATE OF DELAWARE

As the owner, officer or authorized representative (“Representative”) of the Named Insured under the policy listed herein (the “Policy”), I request a premium payment extension pursuant to the 23rd Modification of the Declaration of a State of Emergency for the State of Delaware. Specifically, I request that any premium owed on the Policy that is past-due as of the date of this request be allowed to be paid in equal installments over a 90 day period to commence no sooner than the later of July 1, 2020 or the expiration of the moratorium period set by the State of Delaware.

To that end, I certify and affirm under the penalties of perjury that:

  • The Named Insured is a resident of the State of Delaware;
  • The Named Insured is independently owned and operated;
  • The Named Insured is currently experiencing financial hardship(s) due to the novel coronavirus (COVID-19) pandemic.

CERTIFICATION / AFFIRMATION