I hereby certify to the best of my knowledge, that the information contained in this application is true, correct and complete, and that I am requesting assistance only for amounts that are not reimbursable from insurance or any other source. I agree to provide further proof of the information I have provided on this application if requested to do so.
Qualified events: Accident, expenses related to any illness or death or travel and other expenses required to care for the critically ill Real Estate Professional (REP), spouse/domestic partner or immediate family member

Sponsors Information