By submitting this referral, I confirm that the information provided is accurate to the best of my knowledge and that I am authorized to provide it. When I provide another person’s contact information, I confirm that I have permission to share it with Sokar Group so that Sokar Group or an appropriately licensed representative may contact that person regarding the requested insurance or related services.
Submission does not bind or modify insurance coverage, guarantee eligibility or issuance, constitute an insurance application, or create an insurance contract. A referral does not authorize anyone to solicit, negotiate, recommend, quote, sell, or otherwise transact insurance unless appropriately licensed and authorized.
Products and services are subject to licensing, carrier appointments, underwriting, availability, policy terms, conditions, and applicable law. Referral recognition, credit, compensation, or other consideration, if applicable, is governed by Sokar Group policies and applicable law and is not guaranteed by submission.
Do not include Social Security numbers, Medicare numbers, payment information, medical records, or other sensitive information.