Acknowledgement FormI, *, certify that: My device was fully functional (free of any defects and damages) at the time I purchased my protection plan I am filing a claim on the device covered by my protection plan (not on a non covered device) I have not used my device for commercial/public purposes I have not misrepresented any information during this claim process I understand that filing misrepresented claims may lead to civil or criminal prosecution By entering my Full Name below, I declare that the foregoing is true and correctYou must acknowledge all statements to proceed.Signed by: (Please enter your first and last name) *Required.Email Address: *Please enter a valid email address.Note that if you would like a copy of this form, you must print this page before submitting.Claim Number: Acknowledgement_Form_v1.0Last updated 12th October, 2017© 2017 SquareTrade. All Rights Reserved