I am (one of) the ____________________s in this matter; the statements in the foregoing document are true of my knowledge, except as to matters which are therein stated on information and belief, and as to those matters, I believe them to be true.
I declare under penalty of perjury under California law that the foregoing is true and correct.
Executed on ____________________ (date) ____________________ at ____________________ (name of city), California.
DATED:
Respectfully Submitted,
____________________
Signature
Cal. Code Regs. Tit. 10, § 2623.8
Note: Authority cited: Sections 1861.10, 12921 and 12926, Insurance Code. Reference: Sections 1861.05(b) and (c), 1861.08 and 1861.10(a) and (b), Insurance Code; and CalFarm Insurance Company, et al. v. George Deukmejian, et al., 48 Cal.3d 805 (1989).