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Question 1 of 2
1. Question
ATTESTATION
I do hereby solemnly attest that I am the student enrolled for this course and I am the same individual who completed this examination. I accept and agree that by entering my name below shall serve as my electronic signature for this purpose. I understand that this affidavit is provided under oath or affirmation, and that false information shall be grounds for possible penalties under California Insurance Code or Rule.
* By typing my name below, I am electronically signing this form
Signature of Student (*Required)
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Question 2 of 2
2. Question
Date (*Required)
