Sample Acknowledgment
I certify that I displayed a computer screen illustration for _______________________ that complies with state requirements and for which no hard copy was furnished. The illustration was based on the following personal and policy information:
DATE: ___________________________
I acknowledge that I viewed a computer screen illustration based on the information as stated above. No hard copy of the illustration was furnished. I understand that an illustration conforming to the policy as issued will be provided to me no later than at the time the policy is delivered.
APPLICANT _____________________________
DATE: ___________________________
An illustration conforming to the requirements of the model must be prepared and delivered by the producer at or prior to delivery of the policy.
02-031 C.M.R. ch. 910, § 9