AUTHORIZATION, CLIENT ATTESTATION & CONSENT

Health Insurance Marketplace & HealthSherpa

I hereby appoint 9ja Insurance as my authorized representative for all matters related to my health insurance enrollment and coverage.

By executing this agreement, I certify and acknowledge:

1. 1. Explicit Consent
   I authorize 9ja Insurance to complete, submit, update, and maintain my Marketplace application, select plans, and manage renewals on my behalf.
2. 2. HealthSherpa Authorization
   I consent to 9ja Insurance’s access to HealthSherpa and CMS systems using my personal information strictly for enrollment, renewal, and servicing purposes.
3. 3. Renewal Authority
   I authorize automatic renewal or reassignment to a comparable plan if necessary to prevent coverage gaps.
4. 4. Client-Initiated Engagement
   • I initiated this relationship with 9ja Insurance without solicitation.
   • I independently sought the services of 9ja Insurance.
   • I knowingly declined continued representation from any prior agent or agency.
5. 5. Waiver of Prior Agent Affiliation
   I affirm that I no longer desire representation by any previous agent or agency and hereby elect 9ja Insurance as my sole agent of record.
6. 6. Non-Compete & Solicitation Disclaimer
   I understand that 9ja Insurance did not induce or solicit me in violation of any agreement. Any prior contractual limitations are my responsibility, and I agree that 9ja Insurance bears no liability related to such agreements.
7. 7. Change Reporting & Accuracy
   I agree to report all material changes and confirm that the information provided is complete and accurate.

This authorization remains effective until revoked in writing.

Written Revocation Address:
9ja Insurance
5900 Balcones Drive Suite 100
Austin, TX 78731