Fla. Admin. Code R. 69O-124.024 (2026)

The following disclosure form shall be utilized:

IMPORTANT NOTICE TO APPLICANTS REGARDING STUDENT LOANS OBTAINED THROUGH: ___________ Name of Insurance Company

PLEASE READ THE FOLLOWING STATEMENTS CAREFULLY:

1. IF YOU APPLY FOR A STUDENT LOAN FROM AN INSURANCE COMPANY, THE INSURANCE LAWS OF THIS STATE PROVIDE THAT YOU CANNOT BE REQUIRED TO PURCHASE INSURANCE FROM THE INSURANCE COMPANY IN ORDER TO QUALIFY FOR THE LOAN.

2. THE STANDARDS FOR QUALIFYING FOR A FEDERAL OR STATE GUARANTEED STUDENT LOAN AS WELL AS THE REQUIREMENTS FOR REPAYING EACH LOAN ARE ESTABLISHED BY FEDERAL AND STATE LAW AND YOU MUST MEET THESE STANDARDS REGARDLESS OF WHETHER YOU ALSO DECIDE TO PURCHASE INSURANCE.

I certify that I have read the above statements and that I understand my rights and privileges relative to the purchase of any insurance in connection with my student loan application.

____________________________

Signature of Insurance Applicant

____________________________

Date

Rulemaking Authority 624.308(1) FS. Law Implemented 624.307(1), 626.9541(1)(a), 626.9551(1)(a) FS. History–New 11-24-85, Formerly 4-64.04, 4-64.004, 4-124.024.

Effective: 11/24/1985.