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| Date: ____________________ |
| OWNER POLICY REJECTION FORM |
| Pursuant to requirement of Sections 2704.051 and 2704.052, Texas Insurance Code, as amended, the undersigned hereby acknowledges that a Loan Policy to be issued in file No. _________________ in consideration of $ _______________ premium is to be issued to the lender and that such policy does not afford title insurance coverage to the undersigned in the event of a defect in the title to the real estate which is being acquired. An Owner’s Policy of Title Insurance in the amount of $ _______________ shall be issued for an additional premium cost of $ _______________ unless rejected hereby. |
| The undersigned hereby reject the issuance of said Owner’s Policy. |
| ______________________________ |
| ______________________________ |
| [ACKNOWLEDGMENT] |