When the payment instructions include disbursement of funds to joint or multiple recipients ("Joint Recipients"), I agree with the insurer and/or its affiliates (the "Companies") and other Joint Recipients that:

1. The funds are and shall be jointly owned by Joint Recipients;
2. The funds are subject to the withdrawal or receipt by any of the Joint Recipients;
3. All funds, whenever disbursed to any of the Joint Recipients will be applied to the credit of all the Joint Recipients; and
4. Payment to any of the Joint Recipients shall be valid and discharge Companies from any liability for such payment.

I authorize Companies to recognize the signatures of any of the Joint Recipients as providing valid instructions for payment. I further agree that all Joint Recipients are liable to Companies for any over-distribution that may occur, regardless of whether or not a benefit occurred to a particular Joint Recipient. I understand and agree that it is my responsibility to determine any legal effects of a claim of ownership of the funds between Joint Recipients. Companies disclaim all liability, and I hereby agree to hold Companies harmless, from any claim arising from or related to disbursement made to Joint Recipients. The right or authority of the Companies under this agreement shall not be changed or terminated by me or any other Joint Recipients.

If I choose to receive claim payment(s) to my designated deposit account, I authorize the insurer and/or its affiliates (the "Companies") to make electronic fund transfer deposits into my designated deposit account as an optional method of payment of my eligible claim payments. I understand that any deposit made to an inactive account will be returned and reissued to me as a prepaid debit card. In addition, if any overpayment of claim benefits are credited to my account in error, I authorize withdrawal of any payments necessary in order to assure the accuracy of my eligible claim payments. I can cancel this authorization at any time by giving written notice. Any notice hereunder will not be deemed effective until the Companies have received my written notice.

If I choose to receive claim payment(s) by a prepaid card, I authorize the use of a preloaded Claim Card Mastercard Prepaid Card ("Claim Card") by the insurer and/or its affiliates as an optional method of payment for my eligible claim payments. I agree that additional claim payments may also be loaded onto the Claim Card. I understand that there may be restrictions that prevent the use of the Claim Card in certain circumstances and that some payments may involve combinations of the Claim Card and payment by check. I understand there are specific terms and conditions and fees associated with the use of the Claim Card. I understand the Cardholder Agreement which I will receive with the Claim Card will set forth the terms and conditions of use and any applicable fees.