Figure: 28 TAC §3.3832(b)

(Company Name)
(Address-City & State)
(Telephone Number)
Long-Term Care Insurance
Outline of Coverage
(Policy Number or Group Master Policy and Certificate Number)
(Except for policies or certificates which are guaranteed issue, the
following caution statement, or language substantially similar, must
appear as follows in the outline of coverage.)

Caution: The issuance of this long-term care insurance (policy) (certificate) is based upon your responses to the questions on your application. A copy of your (application) (enrollment form) (is enclosed) (was retained by you when you applied). If your answers are incorrect or untrue, the company may have the right to deny benefits or rescind your policy. The best time to clear up any questions is now, before a claim arises! If, for any reason, any of your answers are incorrect, contact the company at this address: (insert address)