QUICK Indication Request - Sportify Insurance

DISCLAIMER & NOTICE: All information contained herein is subject to change at any time. This indication request form, representations and other information herein; in no way represents or warrants a guarantee of coverage. The indication is provided on a NON-binding basis. A confirmed rate insurance quote will only be provided until the full online application is received, reviewed and accepted by underwriters. The non-binding indication terms and conditions can be changed, modified or withdrawn at the underwriters' sole discretion without any obligation or liability to offer coverage. The Risko Strategies, LLC/SPORTIFY or its Affiliate Brokers will not be held liable to anyone in connection to the misuse or misrepresentation of the contents herein. Indication request MUST be made by a person 18 years of age or older.

Sportify Scholarship Insurance Estimate

NON-BINDING INDICATION REQUEST FORM

APPLICABLE ONLY IN THE STATES OF: CA;CO;CT;FL;GA;NJ;NY;NV;OH;OK;PA;TX;VA Complete these 6 questions in order to receive a non-binding, rough estimate cost of insurance. The indication is NOT an offer an insurance.

1) Covered Sport (Male or Female)*
Select the Sport for which athlete seeks scholarship insurance (offer/commit/award) protection. Dual sport athletes MUST complete an indication form for each covered sport.
2) Student Athlete Insurance Eligibility (select one or more)
- Received written (print/email/social media) recruitment communication from one or more college(s) indicating interest in evaluating you as scholar athlete for their specific sports program.oice
- Listed in a city, regional, or nationally recognized media outlet or national college sports recruitment web site as a ranked scholar athlete.
- Made a verbal commitment to a college which is indicated in the aforementioned media outlets/recruitment web site
- Signed a National Letter of Intent (NLI)
Select the description that bests describes your current recruitment status
3) Target (Recruit) or Current College of attendance*
Type the name(s) of the college(s) for which the student athlete is considered a scholarship recruit (received offer/ commitment or signed NLI) or college, which the athlete currently attends under athletic scholarship.
4) Describe your athlete status for College(s) listed above*
- Target College(s) of a high school athlete
- Current College of a scholarship athlete
Specify if target college(s) is for a student athlete who is currently in high school or if college is the current institution of a college scholarship athlete.
5) Student Athlete or Parent Domicile*
City State ZIP Code

Enter only City; State & Zip code
6) Name of the Insurance Applicant (MUST be 18 years old-otherwise the parent is the applicant)*
Preferred Method of Contact for Indication (we do NOT spam and do NOT sell or share ANY contact information)
- Phone: enter in next field below
- Email: enter in next field below
Applicant Preferred Contact Email or Telephone for indication delivery*
(we do NOT spam and do NOT sell or share ANY contact information)
7) How did you learn about us?*
We value your interest and wish to assess effective ways to raise the product concept awareness. Please select your response from choices herein.
Comments
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