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CUNA Mutual Insurance Agency, Inc. l P.O. Box ****; Madison, WI 53705-0010 l Phone: 800-***-**** l Fax: 855-***-**** lendingclaim.trustage.com l E-Mail:*******.******@********.*** l Voice/TTD 800-***-**** DCFEOBLPL

November 23, 2023

SUSAN HOUSE

901 ROY AVENUE

GREEN BAY WI 54303 3952

Claimant: Susan House

Claim No.: 223-***-****

Benefit No.(s): 223*********

Loan No.(s): 193*******

Benefit No. Contract Number/

Credit Union Name

Loan No. Waived Period Waived

Amount

223********* 04801344

Capital Credit Union

19391428

06

11/01/23 through 11/30/23 $584.64

Information received indicates you qualify for the Hospitalization benefit. Therefore, loan payments will be waived, subject to the terms and conditions of protection as set forth in your contract. If there is any change in your loan status, please notify us as soon as possible in order to prevent additional loan payment from being waived.

You can check your benefit status and history any time by either: Go to lendingclaim.trustage.com

Enter your claim number

Calling 800-***-****

Enter your claim number and date of birth into the automated system CUNA Mutual Insurance Agency, Inc. l P.O. Box 5010; Madison, WI 53705-0010 l Phone: 800-***-**** l Fax: 855-***-**** lendingclaim.trustage.com l E-Mail:*******.******@********.*** l Voice/TTD 800-***-**** DCFEOBLPL

FRAUD WARNING: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit, or knowingly presents false information in an application for insurance may be guilty of a crime and subject to fines and confinement in prison, and denial of insurance benefits, depending on state law.

Alabama and Maryland Residents: Any person who knowingly or willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly or willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Arkansas: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison. California Residents: For your protection California law requires the following to appear on this form. Any person who knowingly presents false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. Colorado Residents: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance within the department of regulatory agencies.

District of Columbia Residents: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits, if false information materially related to a claim was provided by the applicant. Florida Residents: Any person who knowingly and with intent to injure, defraud or deceive any insurer files a statement of claim or an application containing any false, incomplete or misleading information is guilty of a felony of the third degree. New Jersey Residents: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. New York Residents: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or 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, and shall also be subject to civil penalty not to exceed $5,000 and the stated value of the claim for each such violation.

Ohio Residents: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Pennsylvania Residents: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or 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 and subjects such person to criminal and civil penalties. Puerto Rico Residents: Any person who knowingly includes false information in an application for insurance, or presents a fraudulent claim for payment of a loss or benefit, or files more than one claim for the same loss commits a felony. If found guilty such person is subject to fines ($5,000 to $10,000) or confinement in prison (2-5 years) or both for each violation.

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