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Minnesota Insurance Division Consumer Complaint Form
A copy of this form and any or all information you provide may be sent to the party complained against. 1. Complainant. Your name: Street address: 2. Insured.
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State Consumer Protection Agency Contacts/
State Consumer Protection Agency Contacts/Consumer Complaint Process Address: 1450 Energy Park Drive, Suite 350. St. Paul, MN 55108-5227 Phone: 651-642-0567
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FW1960-0514 Page 1 of 9 v2-0614
The following is added to the ARBITRATION provision: RESOLUTION. OF DISPUTES: If We are unable to resolve any disputes with You regarding this Service Plan, You
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