CELL PHONE PROTECTION CLAIMS FORM

1. Your wireless service (cell phone) provider billing statement that corresponds with your checking account statement in Section 5(a). Your payment amount will be shown as 'payment received'.
2. Replacement cellular wireless telephone purchase receipt from a cellular service provider's retail or internet store. Receipt must indicate it is for a phone and show the subtotal before taxes (if applicable). Insurance deductible on receipt or statement also permitted.
3. If the claim is due to damage you must try to get it repaired first. If it is not able to be repaired please submit signed documentation from a certified repair facility that their recommendation is to replace the phone.
4. If the claim is due to theft or criminal action, a copy of the police report filed within 48 hours of the occurrence. Required on all theft claims.
5. Documentation (if available) of any other settlement of the claim.
6. A document from the cellular wireless telephone provider or other sufficient proof, as determined by the Cardinal Credit Union, that the telephone you are claiming is currently linked to your cellular wireless telephone account.

Please read the following prior to submitting your claim

• Cardinal Credit Union reserves the right to repair or replace the stolen/damaged item or to substitute a cash payment to repair or replace (not exceed the total purchase price of the item and benefit limit). If you receive a replacement or a cash payment the damaged item becomes the property of Cardinal Credit Union.
• The benefit covers cellular telephones in the event of theft, or damage when the proceeding month's cellular telephone bill was charged to an eligible account and your loss must be reported within 60 days of the incident. You must return this claim form within 90 days of the incident.
• Cellular Telephone Protection is subject to a fifty-dollar ($50) co-payment per claim and a maximum of two (2) claims per twelve (12) month period.

Exclusions under this benefit include but are not limited to the following:

• Cellular wireless telephone accessories other then standard battery and/or standard antenna provided by the manufacturer.
• Cellular wireless telephone purchased for resale, professional, or commercial use.
• Cellular wireless telephones that are lost or "mysteriously disappear" means the vanishing of an item in an unexplained manner where there is absence of evidence of wrongful act by a person or persons.
• Cellular wireless telephone under the care and control of a common carrier (including, but not limited to, U.S. Postal Service, airplanes, or delivery service).
• Cellular wireless telephones stolen from baggage unless hand-carried and under your personal supervision, or under the supervision of your traveling companion who is previously known to you.
• Cellular wireless telephone stolen from a construction site.
• Cellular wireless telephone which has been rented, leased, borrowed or cellular wireless telephones that are received as part of a pre-paid plan.
• Cosmetic damage to the cellular wireless telephone or damage that does not impact the cellular wireless telephone's ability to make or receive phone calls.
• Damage or theft resulting from abuse, intentional acts, fraud, hostilities of any kind (including, but not limited to, war, invasion, rebellion, or insurrection), confiscation by theauthorities, risks or contraband, illegal activities, normal wear and tear, flood, earthquake, radioactive contamination, or damage from inherent product defects or vermin.
• Damage or theft resulting from misdelivery or voluntary parting with the cellular wireless telephone.
• Replacement cellular wireless telephone not purchased from a cellular service provider's retail or internet store.
• Taxes, delivery and transportation charges and any fees associated with the service provider.

Coverage under Cellular Telephone Protection is in excess of any other reimbursement you have available. You must file with your primary insurance carrier, or verify lack of coverage, BEFORE any settlement can be issued. If you have no insurance policies, you will be advised if additional information is needed.

• If your claim is less than your deductible, please send a copy of your Declarations Page to confirm your deductible amount.
• If your claim is greater than your deductible, please send a copy of the claim and settlement verification from your primary insurance carrier.
• If you claim is not covered by your primary insurance carrier, please attach letter of denial from them.

I agree that any compensation I receive from the Cardinal Credit Union for the Cellular Telephone Protection, for the property loss occurring with relation to the claim I have filed is subject to the following conditions:

• My rights of recovery or remedies from any party for my property loss or damage are transferred to Cardinal Credit Union to the extent of the cost of Cardinal Credit Union's payment to you. Cardinal Credit Union shall then be entitled to enforce my rights in an attempt to obtain the recovery on that property. The Cellular Telephone Protection Benefit is entitled to receive any benefits obtained from such recovery attempt up to the amount for which I have been compensated for any loss plus any reasonable amount expended in obtaining such recovery; and
• If I recover any compensation for or regain possession of the property for which a claim was submitted to the Cellular Telephone Protection Benefit within two (2) yearsof the date on which I received compensation, I shall immediately inform The Cellular Telephone Protection Benefit of such recovery and shall reimburse the CellularTelephone Protection Benefit up to the amount which I received from the Benefit Administrator in compensation for such property.

I understand that my failure to comply with these conditions and/or my failure to notify the Cellular Telephone Protection Benefit of my recovery for possession of my property is an action constituting fraud and breach of contract and subjects me to legal action. I waive the right to interpose any defense in any litigation arising out of the claim I have filed in my recovery of insurer. The claim information stated above is true and correct to the best of my knowledge and belief. I understand that any materiel misrepresentation of fact on this claim form automatically voids my claim. I understand that the claim form must be completed and that all required insurace claims, police reports, etc., must be filed and submitted before any claim under the plan can be processed and paid. In addition, I hereby agree to cooperate with any designated representative of Cardinal Credit Union benefit in the investigation of my claim and provide statements when requested to do so.