Old Republic National Title Insurance Company

Final Approved Attorney Certificate

Fax To (610) 687-6056

 

 

NOTICE

AND

WAIVER

 

Policy Number:
Premises
Address:
City:
State:
Zip/Postal Code:
Pursuant to the requirement of the Pennsylvania Insurance Department, notice is hereby given that a mortgagee's title insurance policy is to be issued to your mortgage lender and that such policy does not afford title insurance protection to you in the event of a defect in the title to the real estate which you are acquiring (including, but not limited to, unpaid bills for labor and material, forgeries, missing heirs, unpaid taxes, etc.).  You are hereby advised of your right and opportunity to obtain an owner's title insurance policy in your favor for the amount of your purchase price (or the amount of your purchase price, plus the cost of any improvements which you anticipate making).

The additional cost to you for an owner's policy of title insurance in the amount of  $ is $ if requested at this time.

The said requirement directs that you sign the statement below if you do not wish to purchase this protection.

 

Old Republic National Title Insurance Company

By

Authorized Officer or Agent

This is to certify that the foregoing notice of right to purchase an owner's title insurance policy for the protection of the undersigned purchaser has been received and the undersigned purchaser hereby waives such right.  It is understood and agreed that OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY shall have no responsibility to the undersigned purchaser for the status of the title to the real estate being acquired or for any loss by reason of a complete or partial failure of title.

Signature of Mortgagor/Purchaser

 

Signature of Mortgagor/Purchaser

 

Dated