KRS 304.47-030: Required statements for applications and claims forms.

(1) All applications shall contain a statement in a form approved by the Department of

Insurance that clearly states in substance the following: "Any person who

knowingly and with intent to defraud any insurance company or other person files

an application for insurance containing any materially false information or conceals,

for the purpose of misleading, information concerning any fact material thereto

commits a fraudulent insurance act, which is a crime."

(2) All claim forms shall contain a statement in a fo rm approved by the Department of

Insurance that clearly states in substance the following: "Any person who

knowingly and with intent to defraud any insurance company or other person files a

statement of claim containing any materially false information or conceals, for the

purpose of misleading, information concerning any fact material thereto commits a

fraudulent insurance act, which is a crime."

(3) Fraud warning statements shall not be required on applications or claim forms used

by reinsurers.