I declare to have acquainted with the General Conditions of the contract being worth note of information and accept the terms.
I recognize to be informed that any omission, false statement (declaration) or inaccuracy in the present statement(declaration) can pull(entail) the nullity of the contract or the reduction of the amount of the compensations(allowances) and are subjected as the case may be, in the penalties planned to articles L 113-8 and L 113-9 of the code of the insurances