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 The non-binding indication terms and conditions can be changed, modified or withdrawn at the underwriters' sole discretion without any obligation or liability to offer coverage.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.
Name
This field is for validation purposes and should be left unchanged.