¶ Judgment affirmed, with costs.
¶ On July 31, 1982, plaintiff, while driving an automobile owned by him and insured by defendant, was involved in an automobile accident. On August 2, 1982, plaintiff applied to defendant for no-fault insurance benefits using a form prescribed by the Department of Insurance (11 NYCRR Appendix 13-A). The prescribed form contains the following provisions:
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