C PR. Comprehensive PLUS Financial Network Policy Review

Size: px
Start display at page:

Download "C PR. Comprehensive PLUS Financial Network Policy Review"

Transcription

1 C PR Comprehensive PLUS Financial Network Policy Review A GUIDE AND UTILITIES TO ASSIST YOUR CLIENTS IN MAINTAINING LIFE INSURANCE COVERAGE TO MEET THEIR EVOLVING NEEDS

2 C PR Comprehensive PLUS Financial Network Policy Review A GUIDE TO REVIEWING YOUR CLIENTS UNIQUE INSURANCE NEEDS WHAT IS C PR? As an advisor, you can provide a valuable service for your clients by making sure that their life insurance coverage is adequate to help them meet their current financial goals. Although clients regularly review financial goals and investments, they often forget to review their life insurance coverage to meet their changing needs and concerns. When you perform a Comprehensive PLUS Financial Network Policy Review, you provide a service that demonstrates a commitment to your client s interests. Basically, you will be reviewing your client s current coverage, and assessing any life changes that have taken place since the policy or policies were issued. PLUS Financial Network helps you illustrate the value of periodic life insurance reviews for your clients. Done periodically, a Comprehensive PLUS Financial Network Policy Review can help your clients develop savings, insurance and estate planning strategies. WHY PERFORM C PR? Many clients may not realize their life insurance needs may have changed since they first purchased this important asset. Life insurance policies are often left unattended, they don t perform as expected, or they may be in danger of lapsing due to loans, excessive withdrawals or non-payment of premiums. As a part of financial goal setting, it is critical to revive your clients life insurance coverage to keep pace with their changing lives. The following list of life changes and events can signal the need to perform a Comprehensive PLUS Financial Network Policy Review. Marriage or Divorce Childbirth or Adoption New Job or Career Change Significant Salary Increase Home Purchase Starting or Owning a Business Nearing Retirement Financial Support of Elderly Parents HOW DOES IT WORK? When administering C PR, you will review your client s current needs and purposes for life insurance. Gather as much documentation as possible on their current life insurance policies. Complete a Comprehensive PLUS Financial Network Policy Review Underwriting Fact Finder* to assess your client s objective and medical history. Have your client sign an In-Force Policy Illustration Form* so that we may obtain policy information from their current carrier, and PLUS Financial Network will ensure that your client s life insurance coverage meets their current protection needs. PLUS Financial Network does all the work and provides an unbiased 3rd party analysis. * Forms are available at or by contacting our Marketing Team at or

3 C PR Comprehensive PLUS Financial Network Policy Review HOW TO GET STARTED You can give your clients assurance and grow your business by offering a complimentary Comprehensive PLUS Financial Network Policy Review. Contact the PLUS Financial Network team today to get started. We support you with knowledgeable service and timely information. Our goal is to make it easier for you to help your client protect what matters most. Our C PR kit offers ideas about identifying prospects and starting the life insurance checkup conversation. IDENTIFY OPPORTUNITIES Use the information below to help target and track clients who are good prospects for a Comprehensive PLUS Financial Network Policy Review. The following criteria are some of the signs that a client is a good candidate: Years Old Owns a Policy That is at Least 3 Years Old In Good Health Has Estate Planning Issues or Concerns Owns a Small Business Has Experienced a Recent Life or Financial Change In addition, your prospects may fall into all or none of these categories: Do existing policies coincide with current goals? Have financial objectives changed since the client bought the life insurance policy(ies)? Are term policy premiums about to increase? Do the client s long-term goals require a permanent policy? PLUS FINANCIAL NETWORK WANTS TO HELP YOU, THE ADVISOR, TO HELP YOUR CLIENTS ACHIEVE FINANCIAL SECURITY. Managing client relationships goes beyond the initial sale, a Comprehensive PLUS Financial Network Policy Review is a great way to demonstrate your commitment to personalized service, and show concern for the financial well-being of your clients and their families.

4 ADVISOR S GUIDE TO LEARNING C PR Comprehensive PLUS Financial Network Policy Review IDENTIFY PROSPECTS The first step in conducting C+PR is to identify the right prospects, and the easiest place to start is your list of existing clients. CONTACT PROSPECTS Contact your clients and prospects to offer a complimentary PLUS Financial Network Policy Review. We can even provide sample letters to get you started. IDENTIFY YOUR CLIENT S NEEDS AND OBJECTIVES Collect copies of current policy (ies). Complete the Underwriting Fact Finder and a Request for In-Force Policy Information. Define your client s life changes, goals and needs. IDENTIFY SOLUTIONS Product and planning tactics are reviewed by PLUS Financial Network professionals to determine if they are aligned with the client s goals and objectives. Recommendations are either to maintain the current policy (ies) or consider other options that could optimize coverage. PLUS Financial Network will develop a proposal that fits your client s needs. PRESENT CLIENT SOLUTIONS Present your analysis, proposals and marketing materials to your client. CLOSE THE SALE Identify the forms needed to complete the transaction and provide your client the necessary assistance in completing them. Walk through what your client will need to do next to complete the application. Be sure to ask for referrals once the sale is completed.

5 POLICY REVIEW UNDERWRITING FACT FINDER DATE: ADVISOR NAME: PHONE: FAX: RETURN QUOTE BY: o o FAX o MAIL o AGENT PICK UP NEEDED BY: / / CLIENT INFORMATION: CLIENT NAME: DATE OF BIRTH: / / o MALE o FEMALE HEIGHT: WEIGHT: lbs. STATE OF SALE: NICOTINE USE: o YES o NO o QUIT WHEN FORM: o CIGARETTES o CIGARS o CHEWING TOBACCO o OTHER: POLICY GOALS & PRODUCT DESIGN (PLEASE RANK 1-5 IN ORDER OF IMPORTANCE): DEATH BENEFIT REDUCE PREMIUM INCREASE BENEFIT CASH VALUE ACCUMULATION EXTENDED COVERAGE DURATION HOW LONG: YEARS OTHER MEDICAL HISTORY: GENERAL HEALTH DETAILS: _ TREATMENTS (WITHIN LAST 5 YEARS): _ MEDICATION(S) (NAME AND DOSAGE): HAS THE CLIENT BEEN TREATED FOR ANY OF THE FOLLOWING? o ALCOHOL/DRUGS o CANCER o CARDIAC o DIABETES o HYPERTENSION o DEPRESSION o LUNG DISORDERS o SLEEP APNEA o OTHER BLOOD PRESSURE AND CHOLESTEROL (IF NOT NORMAL): LATEST BP READING: / LATEST TOTAL CHOLESTEROL mg RATIO: HDL: LDL: FAMILY HISTORY: (PARENTS AND SIBLINGS) DIAGNOSIS OF HEART DISEASE OR CANCER PRIOR TO AGE 60? o YES o NO IF YES, DETAILS: IF DECEASED, INDICATE CAUSE AND AGE: AVIATION/AVOCATION: IN THE PAST 5 YEARS HAS THE CLIENT PARTICIPATED IN, OR DOES THE CLIENT INTEND TO PARTICIPATE IN ANY OF THE FOLLOWING? o AVIATION o RACING o SKY DIVING o SCUBA DIVING o OTHER o NONE DETAILS: CITIZENSHIP/RESIDENCY/TRAVEL: U.S. CITIZEN: o YES o NO GREEN CARD: o YES o NO PLANS TO LIVE OR TRAVEL OUTSIDE THE U.S.? DETAILS: DRIVING HISTORY: IN THE PAST 10 YEARS, HAS THE CLIENT HAD ANY OF THE FOLLOWING MOTOR VEHICLE RELATED INCIDENTS? o MOVING VIOLATION o RECKLESS DRIVING o DUI o LICENSE SUSPENDED OR REVOKED DETAILS: Visit our website at for additional sales tools.

6 POLICY INFORMATION AUTHORIZATION AND REQUEST CARRIER NAME: INSURED S NAME: POLICY #: PRODUCT: FACE AMOUNT: $_ PLEASE SUPPLY THE FOLLOWING INFORMATION: Policy Type: Term UL WL VUL Length of Term (if applicable): Issue Date: Current Premium: Mode: Paid To Date:_ Gross Death Benefit: Issue Class: Riders Type: State of Issue: Maturity Date:_ Owner (if Trust, full name and date): Beneficiary: Assignee: Products Available for Conversion: Conversion Expiration Date: (Applicable for Term Policies) To Whom It May Concern: I hereby authorize you to release any information on the above captioned policy with your company, to PLUS Financial Network. A photocopy or faxed copy of this authorization shall be as valid as the original. Thank you for your attention to this request. Sincerely, Owner/Trustee Signature: Date: / / Owner/Trustee Name (Printed): Owner/Trustee SSN: - - Owner/Trustee Signature: Date: / / Owner/Trustee Name (Printed): Owner/Trustee SSN: - - Insured s Name (Please Print): Date of Birth: / / I AUTHORIZE YOU TO FORWARD THIS INFORMATION TO: o PLUS Financial Network 2155 Butterfield, Suite 102 South Troy, MI fax: o Other: PREFERRED METHOD OF DELIVERY: FAX MAIL

7 IN-FORCE POLICY ILLUSTRATION AUTHORIZATION AND REQUEST CARRIER NAME: INSURED S NAME: POLICY #: PRODUCT: FACE AMOUNT: $_ PLEASE PROVIDE A SEPARATE IN-FORCE ILLUSTRATION ON EACH OF THE FOLLOWING PARAMETERS: PREMIUM REQUEST (check one or more) o Pay current scheduled premium o Solve for level premium o Pay no further premium o Specified premium of $ o Solve for premium to age 100 TARGETING (if solving for premium or distributions)* o Endow at Maturity o Target Cash Value $ Target Year/Age *No-Lapse UL products will default to solving for Lapse Protection Guarantee. SPECIAL INSTRUCTIONS: PREMIUM DURATION (check one or more) o Pay all years o Pay until policy year OR to age SPECIFIED AMOUNT (optional, check one or more) o Change Death Benefit to $ o Change Death Benefit option to Option 1 RATE OF RETURN (IF VUL) % POLICY LOAN/WITHDRAWLS (check one or more)** o Solve for distribution o Specified distribution of $ o From Year/Age Through Year/Age **Specify if withdrawal, loan, or combination of both in the special instructions section. Certain restrictions may apply. PLEASE SUPPLY THE FOLLOWING INFORMATION: Paid To Date/Next Due Date: Total Premiums Paid: Policy Loan: Loan Interest Rate:_ Cash Value: Surrender Value:_ Cost Basis: Owner: Beneficiary: Issue Class: To Whom It May Concern: I hereby authorize you to release any information on the above captioned policy with your company, to PLUS Financial Network. This includes, but is not exclusive to, any cash value information as well as in-force ledgers. A photocopy or faxed copy of this authorization shall be as valid as the original. Thank you for your attention to this request. Sincerely, Owner/Trustee Signature: Date: / / Owner/Trustee Name (Printed): Owner/Trustee SSN: - - Owner/Trustee Signature: Date: / / Owner/Trustee Name (Printed): Owner/Trustee SSN: - - Insured s Name (Please Print): Date of Birth: / / I AUTHORIZE YOU TO FORWARD THIS INFORMATION TO: o PLUS Financial Network 2155 Butterfield, Suite 102 South Troy, MI fax: o Other: PREFERRED METHOD OF DELIVERY: FAX MAIL

8 AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION HIPAA COMPLIANT Mailing Address: 2155 Butterfield Dr., Ste. 102 South Troy, MI Phone: (248) Fax: (248) I understand that PLUS Financial Network, and its staff, the insurers PLUS Financial Network represents and their reinsurers, any insurance support organization and their authorized representatives may need to collect information about me in regard to obtaining insurance coverage. Therefore, I authorize any physician, medical practitioner, medical examination company, hospital, clinic or other medical facility or medical-related facility, insurance or reinsuring company, the Medical Information Bureau, Inc. (MIB), Motor Vehicle Report (MVR), Prescription Drug Report (PDR), consumer reporting agency (CRA), or employer having information available as to the diagnosis, treatment or prognosis with respect to any physical or mental condition and/or treatment of me to give the insurers listed below, their reinsurers and authorized representatives all such information. This information may include, but is not limited to, documents relating to my mental and physical health, office notes, laboratory studies, pathology reports, test results, mental health records, psychotherapy notes, drug/alcohol abuse, treatment records, pharmacy prescriptions, HIV testing and treatment, STD testing and treatment, any other communicable disease records, genetic testing, general reputation, mode of living, finances, occupation, driving records and other personal traits ( information ). To facilitate rapid submission of such information, I authorize all said sources to give information and records to PLUS Financial Network, its staff and its authorized representatives. I understand and agree that the information obtained by use of this Authorization will be used by PLUS Financial Network and/or insurers listed below and their authorized representatives to determine eligibility for insurance, and eligibility for benefits under existing policies. Any information obtained will not be released by PLUS Financial Network EXCEPT to one or more of the insurers listed below, their reinsurers, the MIB, my insurance agent or other persons or organizations performing business or legal services in connection with my application, or as may be otherwise lawfully required or as I may further authorize. I understand that the recipient of information disclosed pursuant to this Authorization may re-disclose the information and that, once disclosed, the information may no longer be protected by state or federal law. I agree this Authorization shall be valid for two (2) years from the date shown below, unless I revoke it sooner, or in the event of a claim for benefits, for the duration of such claim. I understand that I have the right to revoke this Authorization in writing, mailed via certified mail, return receipt requested, to PLUS Financial Network at the mailing address provided above. I understand that a revocation is not effective to the extent that PLUS Financial Network or others have relied on the protected health information disclosed pursuant to this Authorization prior to its revocation. I understand the execution of this Authorization is voluntary and that I can refuse to sign this Authorization. I understand that my refusal to sign this Authorization will not affect my ability to obtain treatment or payment or my eligibility for health care benefits. However, I understand that my refusal to sign this Authorization may prevent me from obtaining insurance products or services from one or more of the insurers listed below. I acknowledge that I have read and understand the above and agree that this Authorization was completed prior to my signature. I further agree that a copy of this Authorization, whether a photocopy, carbon copy, or otherwise, shall have equal standing as if it were the original and can be relied upon by PLUS Financial Network and/or any third party designated herein. PLUS Financial Network represents the following insurers: American General/AIG Companies, American National, Ameritas, Assurity Life Insurance, AVIVA, AXA/Equitable, Banner Life, Chesapeake Life, Cincinnati Life, Employee Pooling, LLC, Fidelity Life, Fidelity Security Life, Genworth Life Insurance Company, Genworth Life & Annuity, Great American Life, Guarantee Trust Life, Hartford, ING Companies, John Hancock Life, LifeSecure, Lincoln Benefit Life, Lincoln National Life, Mass Mutual, MetLife Investors, Metropolitan Life, Minnesota Life, Mutual of Omaha, National Life Group, National Western Life Insurance, Nationwide, North American Company for Life and Health, Presidential, Principal, Principal National Life Insurance, Principal Life Insurance Company, Protective Life, Prudential Life, SBLI, State Life, Sun Life of Canada, Transamerica Occidental Life, Union Central Life, United of Omaha, and Zurich. Signed this day of, 20 Signature of Proposed Insured/Parent or Guardian Date of Birth Proposed Insured/Parent or Guardian (Please Print) Agent/Witness PLUS FINANCIAL NETWORK HIPAA AUTHORIZATION 09/03/14

Completion of a fact finder will accelerate the underwriting process

Completion of a fact finder will accelerate the underwriting process QUICK FACT-FINDER TOOLS All personal information protected by HIPPA regulations (see HIPPA form attached with supplemental forms) Completion of a fact finder will accelerate the underwriting process Name:

More information

Informal Inquiry Not an Application for Life Insurance

Informal Inquiry Not an Application for Life Insurance Print Form Informal Inquiry Not an Application for Life Insurance Date: Producer: Face Amount: Product Type: PERSONAL INFORMATION Applicant: Male Female DOB: SS#: Driver s License #: Place of Birth: Street

More information

AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION INFORMAL INQUIRY NAME DOB SEX TOBACCO USE

AUTHORIZATION TO OBTAIN AND DISCLOSE INFORMATION INFORMAL INQUIRY NAME DOB SEX TOBACCO USE INFORMAL INQUIRY NAME DOB SEX TOBACCO USE ADDRESS CITY, STATE, ZIP HEIGHT WEIGHT SS# PLACE OF BIRTH DL# INSURANCE AMT $ PLAN OF INSURANCE (UL/SUL/TERM) INSURANCE IN-FORCE $/ INSURANCE CARRIERS REPLACEMENT/1035?

More information

MEMBER OFFICE INFORMATION. Agent Name: Phone: Email: PLAN INFORMATION. Type of Insurance: o TERM o UL Face Amount Desired:

MEMBER OFFICE INFORMATION. Agent Name: Phone: Email: PLAN INFORMATION. Type of Insurance: o TERM o UL Face Amount Desired: I n f o r m a l I n q u i r y PLEASE SEND THE COMPLETED INQUIRY VIA EMAIL TO: CPEPE@TOLIGROUP.COM VIA FAX TO: 866.240.7557 OR VIA MAIL TO: ATTENTION UNDERWRITING DEPARTMENT 2035 CROCKER RD. STE. 105 WESTLAKE,

More information

Life Insurance Review

Life Insurance Review Life Insurance Review As a financial professional, you understand the importance of preparing for the unexpected... as well as for the inevitable. Your clients insurance portfolio should be reviewed periodically

More information

Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) APPLICATION for Group Term Life Insurance

Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) APPLICATION for Group Term Life Insurance Gynecologists Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) APPLICATION for Group Term Life Insurance The American College of Obstetricians

More information

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY Simsbury, Connecticut 06089 Section 1

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY Simsbury, Connecticut 06089 Section 1 GROUP LIFE INSURANCE APPLICATION HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY Simsbury, Connecticut 06089 Section 1 Policyholder: American College of Emergency Physicians Policy No.: AGL-1905 Certificate

More information

Informal Inquiry. Name Soc. Sec. # BISYS Agent ID Phone No. Address City State Zip Fax No. Email Address

Informal Inquiry. Name Soc. Sec. # BISYS Agent ID Phone No. Address City State Zip Fax No. Email Address page 1 of 5 Preliminary Inquiry Not an application for life insurance. This Informal Inquiry form is used exclusively to gather specific information on a proposed insured s medical history and other factors

More information

Member s Name Social Security # First Middle Last. Member s Address Number Street City State Zip Code. Name and Address of Member s Physician

Member s Name Social Security # First Middle Last. Member s Address Number Street City State Zip Code. Name and Address of Member s Physician Please print or type all information requested Member s Name Social Security # First Middle Last Member s Address Number Street City State Zip Code ASRT Member ID # Home Phone No. Work Phone No. Name and

More information

The United States Life Insurance Company in the City of New York Home Office: One World Financial Center, 200 Liberty Street, New York, New York 10281

The United States Life Insurance Company in the City of New York Home Office: One World Financial Center, 200 Liberty Street, New York, New York 10281 The United States Life Insurance Company in the City of New York Home Office: One World Financial Center, 200 Liberty Street, New York, New York 10281 (Herein called the Company) Application For Group

More information

Life Settlement application and Checklist

Life Settlement application and Checklist and Checklist Page 1 of 7 Life Settlement Checklist Please make sure to complete each section in its entirety. Missing information will delay our ability to market your case and ultimately secure a settlement

More information

TimeSaver. A proven solution for your impaired risk cases

TimeSaver. A proven solution for your impaired risk cases TimeSaver TM A proven solution for your impaired risk cases The Crump TimeSaverTM is the most widely accepted preliminary inquiry in the industry. This powerful tool helps identify the right solution for

More information

Check Life Insurance plan(s) desired Life Insurance for Member: $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000

Check Life Insurance plan(s) desired Life Insurance for Member: $25,000 $50,000 $75,000 $100,000 $125,000 $150,000 $175,000 $200,000 The United States Life Insurance Company in the City of New York APPLICATION FOR GROUP TERM LIFE INSURANCE Home Office: One World Financial Center, 200 Liberty Street, New York, NY 10281 (Herein called

More information

ACCIDENTAL DEATH -NEW BUSINESS MEMO WHOLE LIFE PROTECTOR APPLICATION

ACCIDENTAL DEATH -NEW BUSINESS MEMO WHOLE LIFE PROTECTOR APPLICATION Telephone: 800-428-3001 ACCIDENTAL DEATH -NEW BUSINESS MEMO WHOLE LIFE PROTECTOR APPLICATION Regular Mail: Overnight Mail: P.O. Box 7192 225 South East St Indianapolis, IN 46207-7192 Indianapolis, IN 46202

More information

The United States Life Insurance Company in the City of New York

The United States Life Insurance Company in the City of New York Are you a: Member Spouse of a Member Member/Applicant information Please print or type Name (First, Middle, Last) Address The United States Life Insurance Company in the City of New York Application For

More information

The United States Life Insurance Company in the City of New York

The United States Life Insurance Company in the City of New York Applicant information (Please print or type) The United States Life Insurance Company in the City of New York APPLICATION FOR GROUP LEVEL TERM LIFE INSURANCE Home Office: One World Financial Center, 200

More information

Personal History (Please Use A Separate Form For Each Person)

Personal History (Please Use A Separate Form For Each Person) TexIns Solutions, Ltd. 7435 Hollister Road, Houston Texas 77040 *Preliminary Inquiry & Authorization* NOT AN APPLICATION FOR LIFE INSURANCE (Use Reverse Side If Additional Space Is Needed) Personal History

More information

The United States Life Insurance Company in the City of New York

The United States Life Insurance Company in the City of New York Member information (Please print or type) The United States Life Insurance Company in the City of New York APPLICATION FOR GROUP TERM LIFE INSURANCE Home Office: One World Financial Center, 200 Liberty

More information

JLTexpress APP. How it Works. Carriers Available. Toll Free 800.222.4090

JLTexpress APP. How it Works. Carriers Available. Toll Free 800.222.4090 JLTexpress APP The easiest way to sell term life insurance. How it Works The broker completes the JLTexpress APP and submits via email or fax. Depending on the carrier you may have to complete to complete

More information

You may apply for up to $2,000,000. Your spouse may apply for up to $1,000,000

You may apply for up to $2,000,000. Your spouse may apply for up to $1,000,000 ASSOCIATION LIFE INSURANCE THROUGH THE ISBA INSURANCE AGENCY Thank you for your interest in the ISBA s Group Term Life Insurance product. Per your request, please find enclosed the following: A product

More information

Client Information Name Male Female SSN - - Address (City, State, Zip Code)

Client Information Name Male Female SSN - - Address (City, State, Zip Code) Quick Quoter Informal Inquiry t an application for Life or Disability insurance This Quick Quoter from is used exclusively to gather specific information on a proposed insured s medical history and other

More information

Name Firm/Agency. Phone Fax Email. Check one; Single Life case Survivorship (complete 2 apps) 1st to Die (complete 2 apps)

Name Firm/Agency. Phone Fax Email. Check one; Single Life case Survivorship (complete 2 apps) 1st to Die (complete 2 apps) Insurance Designers, LLC and it s Partner and Affiliate offices comprise a full service brokerage organization committed to comprehensive insurance analysis for clients. Our on-site underwriting program

More information

AIS CARFAGNO INSURANCE SERVICES - Trial Submission Datasheet Instructions on how to get the most out of your Informal Inquiries:

AIS CARFAGNO INSURANCE SERVICES - Trial Submission Datasheet Instructions on how to get the most out of your Informal Inquiries: AIS Instructions on how to get the most out of your Informal Inquiries: 1.) 2.) 3.) 4.) In addition to the completed datasheet, all inquiries and cases that are to be shopped Informally by Carfagno Insurance

More information

Welcome to Credit Union-Approved 50-Plus Term Life Insurance

Welcome to Credit Union-Approved 50-Plus Term Life Insurance Welcome to Credit Union-Approved 50-Plus Term Life Insurance Print out this kit for everything you need to decide if this coverage is right for you: 50-Plus Term Life Insurance introduction and highlights

More information

Robert Stark Life Settlement Data Request Form Connecticut

Robert Stark Life Settlement Data Request Form Connecticut Robert Stark CT Life Settlement Data Request Form Life Settlement Data Request Form Connecticut Life Settlement Data Request Form LIFE INSURANCE POLICY INFORMATION Name of Insurance Company Face Amount

More information

PRELIMINARY INSURANCE EVALUATION

PRELIMINARY INSURANCE EVALUATION THIS PRELIMINARY INSURANCE EVALUATION is a request to the various Insurance Companies and organizations listed on the enclosed authorization to obtain and disclose information. By completing the questions

More information

Robert Stark Life Settlement Application Utah

Robert Stark Life Settlement Application Utah Robert Stark Utah Life Settlement Application Life Settlement Application Utah LIFE SETTLEMENT APPLICATION LIFE INSURANCE POLICY INFORMATION Name of Insurance Company Face Amount Policy Number Account

More information

Attention: Life Quotes Fax Number: (913) 492-9994

Attention: Life Quotes Fax Number: (913) 492-9994 Preliminary Underwriting Questionnaire and Authorization Information and Instructions Thank you for taking the time to complete the following pages. It is our goal to get the best possible offer for your

More information

Life Insurance Policy Information. Policyowner(s) (please print clearly) insurance company policy number issue date (00/00/0000)

Life Insurance Policy Information. Policyowner(s) (please print clearly) insurance company policy number issue date (00/00/0000) L I F E S E T T L E M E N T Q U E S T I O N N A I R E (please print clearly) Life Insurance Policy Information insurance company policy number issue date (00/00/0000) face amount total policy loan cash

More information

Life Insurance Policy Information. Policyowner(s)

Life Insurance Policy Information. Policyowner(s) L I F E S E T T L E M E N T A P P L I C A T I O N Life Insurance Policy Information insurance policy number issue face amount total policy loan cash surrender value annual premium payment next premium

More information

The Lincoln National Life Insurance Company

The Lincoln National Life Insurance Company The Lincoln National Life Insurance Company A Stock Company Home Office Location: Fort Wayne, Indiana Group Insurance Service Office: P.O. Box 2616, Omaha, NE 68103-2616 Phone: (800) 423-2765 Fax: (877)

More information

EVIDENCE OF INSURABILITY COVERAGE DETAIL

EVIDENCE OF INSURABILITY COVERAGE DETAIL EVIDENCE OF INSURABILITY COVERAGE DETAIL This application consists of two parts: The Evidence of Insurability Coverage Detail form and Medical & Lifestyle Questionnaire. INSTRUCTIONS Plan Administrator:

More information

APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company)

APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) Member information (Please print or type) Name APTA

More information

ADA-Sponsored Disability Income Protection Plan Application for Insurance

ADA-Sponsored Disability Income Protection Plan Application for Insurance Members Insurance Plans ADA-Sponsored Disability Income Protection Plan Application for Insurance IPWS15 Read all forms Complete sections 1 thru 9 Mail or Fax ALL completed forms Questions? 866.607.5334

More information

insurance company policy number issue date (00/00/0000) face amount total policy loan cash surrender value amount paid

insurance company policy number issue date (00/00/0000) face amount total policy loan cash surrender value amount paid LIFE SETTLEMENT QUESTIONNAIRE (please print clearly) Life Insurance Policy Information policy number issue date (00/00/0000) face amount total policy loan cash surrender value annual premium payment next

More information

Limited to term cases with face amounts of $750,000 or greater, or permanent cases with face amounts of $500,000 or greater

Limited to term cases with face amounts of $750,000 or greater, or permanent cases with face amounts of $500,000 or greater TimeSaverTM A proven solution for your impaired risk cases The Crump TimeSaver TM is the most widely accepted preliminary inquiry in the industry. This powerful tool helps identify the right solution for

More information

Application for Life Insurance

Application for Life Insurance National Slovak Society Of the United States of America A Fraternal Benefit Society 351 Valley Brook Road McMurray, PA 15317-3337 Phone (724) 731-0094 Fax (724) 731-0146 www.nsslife.org Application for

More information

VOLUNTARY GROUP TERM LIFE INSURANCE Application to: American Family Life Assurance Company of Columbus (AFLAC) Worldwide Headquarters

VOLUNTARY GROUP TERM LIFE INSURANCE Application to: American Family Life Assurance Company of Columbus (AFLAC) Worldwide Headquarters VOLUNTARY GROUP TERM LIFE INSURANCE Application to: American Family Life Assurance Company of Columbus (AFLAC) Worldwide Headquarters Policy Number Columbus, Georgia 31999 Please Print In Black Ink - To

More information

Does Your Client s Current Life Portfolio Make the Cut?

Does Your Client s Current Life Portfolio Make the Cut? Does Your Client s Current Life Portfolio Make the Cut? First American Insurance Underwriters Introduces PAR: Policy Annual Review. Agents and advisors know the value of building credibility. Whether it

More information

APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company)

APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) Member information (Please print or type) Name APTA

More information

Standard or Better TOP. Available Maximum Face Amount per Lifetime

Standard or Better TOP. Available Maximum Face Amount per Lifetime S E R I E S Top & Top Plus program details Two Programs with Accelerated Underwriting Transamerica Life Insurance Company offers two accelerated underwriting programs that enable qualifying applicants

More information

Preferred or Similar Standard or Similar

Preferred or Similar Standard or Similar TOP & TOP PLUS program details Two Programs with Accelerated Underwriting Transamerica Life Insurance Company offers two accelerated underwriting programs that enable qualifying applicants to receive up

More information

U.S. FINANCIAL LIFE INSURANCE COMPANY REQUEST FOR POLICY REINSTATEMENT FOR POLICY #

U.S. FINANCIAL LIFE INSURANCE COMPANY REQUEST FOR POLICY REINSTATEMENT FOR POLICY # U.S. FINANCIAL LIFE INSURANCE COMPANY REQUEST FOR POLICY REINSTATEMENT FOR POLICY # POLICY OWNER HOME PHONE INSURED HEIGHT WEIGHT DATE OF BIRTH SOCIAL SECURITY NO. WORK PHONE PLEASE NOTE ANY CHANGE OF

More information

TOP and TOP Plus Programs 1

TOP and TOP Plus Programs 1 TOP and TOP Plus Programs If clients have been sold a term policy within the past 5 years and have been fully underwritten by an eligible carrier CLICK on the buttons below to view TOP and TOP Plus eligibility.

More information

Standard or Better TOP. Available Maximum Face Amount per Lifetime

Standard or Better TOP. Available Maximum Face Amount per Lifetime Top & Top Plus program details Two Programs with Accelerated Underwriting Transamerica Life Insurance Company offers two accelerated underwriting programs that enable qualifying applicants to receive up

More information

Prospect for New Sales, Without

Prospect for New Sales, Without Prospect for New Sales, Without Requiring Medical Exams! Product TransTerm SM Transamerica Opportunity Program (TOP) is now available on TransTerm SM 10, 15, 20, 25 or 30-year policies. Present clients

More information

Greek Catholic Union of the U.S.A. 5400 Tuscarawas Road, Beaver, PA 15009 Phone: 724-495-3400 FAX: 724-495-3421. Authorization

Greek Catholic Union of the U.S.A. 5400 Tuscarawas Road, Beaver, PA 15009 Phone: 724-495-3400 FAX: 724-495-3421. Authorization Greek Catholic Union of the U.S.A. A Fraternal Benefit Society 5400 Tuscarawas Road, Beaver, PA 15009 Phone: 724-495-3400 FAX: 724-495-3421 Authorization For Blood Testing and Disclosure of Results I do

More information

Civil Service Employees Benefit Association 67182-7. Address City State Zip. Place of Birth Home/Cell Phone # Work Phone # E-mail Address

Civil Service Employees Benefit Association 67182-7. Address City State Zip. Place of Birth Home/Cell Phone # Work Phone # E-mail Address Group Term Life Application for 10-Year or 20-Year Level Term Rate Please complete the entire application. If completing this application in paper format, please print clearly in dark ink and mail to WrightUSA

More information

Lincoln Special Exchange Program

Lincoln Special Exchange Program Lincoln Special Exchange Program External term to perm Make the switch to affordable guaranteed protection If your clients want more than what their term policies offer, now s a great time to step up to

More information

CRITICAL ILLNESS CLAIM FORM

CRITICAL ILLNESS CLAIM FORM Send all claims to: Continental American Insurance Company Critical Illness Claims Processing Unit Post Office Box 427 Columbia, South Carolina 29202 Phone: (800)-433-3036 Fax: (866)-849-2970 CRITICAL

More information

Greek Catholic Union of the U.S.A. 5400 Tuscarawas Road, Beaver, PA 15009 Phone: 724-495-3400 FAX: 724-495-3421. Authorization

Greek Catholic Union of the U.S.A. 5400 Tuscarawas Road, Beaver, PA 15009 Phone: 724-495-3400 FAX: 724-495-3421. Authorization Greek Catholic Union of the U.S.A. A Fraternal Benefit Society 5400 Tuscarawas Road, Beaver, PA 15009 Phone: 724-495-3400 FAX: 724-495-3421 Authorization For Blood Testing and Disclosure of Results I do

More information

U.S. FINANCIAL LIFE INSURANCE COMPANY REQUEST FOR POLICY REINSTATEMENT FOR POLICY #

U.S. FINANCIAL LIFE INSURANCE COMPANY REQUEST FOR POLICY REINSTATEMENT FOR POLICY # U.S. FINANCIAL LIFE INSURANCE COMPANY REQUEST FOR POLICY REINSTATEMENT FOR POLICY # POLICY OWNER HOME PHONE INSURED HEIGHT WEIGHT DATE OF BIRTH SOCIAL SECURITY NO. WORK PHONE PLEASE NOTE ANY CHANGE OF

More information

Senior Whole Life Transmittal

Senior Whole Life Transmittal Senior Whole Life Transmittal Applicant Information: Insured Name: underwriting process. Please advise the best time and place to contact the applicant: We may need to contact the applicant for more information

More information

Group Term Life Insurance Application

Group Term Life Insurance Application Group Term Life Insurance Application Hartford Life and Accident Insurance Company Simsbury, Connecticut 06089 Policyholder American College of Emergency Physicians Policy No. AGL-1752 Certificate No.

More information

Term Life Insurance Plan

Term Life Insurance Plan Term Life Insurance Plan Your association is pleased to endorse Term Life Insurance available to you and your spouse. You can choose the coverage amount to fit your needs. Term Life is an affordable way

More information

Zoom through Underwriting with TOP 15 and TOP 25

Zoom through Underwriting with TOP 15 and TOP 25 Zoom through Underwriting with TOP 15 and TOP 25 Now you can help your clients steer clear of a lengthy underwriting process and accelerate placement of a new term policy with the Transamerica Opportunity

More information

GROUP DISABILITY INCOME INSURANCE FOR PHYSICIANS PLAN DETAILS

GROUP DISABILITY INCOME INSURANCE FOR PHYSICIANS PLAN DETAILS GROUP DISABILITY INCOME INSURANCE FOR PHYSICIANS PLAN DETAILS Underwritten by New York Life Insurance Company Administered by: THE HILB GROUP OF NEW YORK, LLC PO Box 5671, Bay Shore, NY 11706 (800)-556-1700

More information

APPLICATION FOR FINAL EXPENSE WHOLE LIFE

APPLICATION FOR FINAL EXPENSE WHOLE LIFE APPLICATION FOR FINAL EXPENSE WHOLE LIFE SBLI USA Life Insurance Company, Inc. Toll Free: 1-877-SBLI-USA / 1-877-725-4872 460 W. 34th Street, Suite 800, New York, NY 10001-2320 website: www.sbliusa.com

More information

HELP PROVIDE SECURITY AT AFFORDABLE RATES

HELP PROVIDE SECURITY AT AFFORDABLE RATES US Airways Pilots Association (USAPA) Group Term Life Insurance 10-Year Level Premium Administered by: For Association Members and Their Families Issued by ReliaStar Life Insurance Company, a member of

More information

Address City State ZIP Code. 2) Date of Birth: - -

Address City State ZIP Code. 2) Date of Birth: - - Use this form to start the term insurance application process. Understand that completion of this form does not constitute an offer of insurance. Insurance will not take effect until the policy is delivered

More information

application for survivorship joint life insurance Part 1

application for survivorship joint life insurance Part 1 AMERITAS LIFE INSURANCE CORP. (ALIC) LINCOLN, NEBRASKA 68501 INFORMATION REGARDING INSURED A 1.A. Name: Last First Middle application for survivorship joint life insurance Part 1 Male Female INFORMATION

More information

USLIFE Group Voluntary Term Life Insurance Coversheet

USLIFE Group Voluntary Term Life Insurance Coversheet USLIFE Group Voluntary Term Life Insurance Coversheet Applicant Name: (If applicable see next section below) NYSBG Company Name: NYSBG Dues Level: Corporate $60 Current Check attached Corporate Employee

More information

AGENT S INSTRUCTIONS. Auto-Owners Life Insurance Company

AGENT S INSTRUCTIONS. Auto-Owners Life Insurance Company The process is simple and the application consists of only a few questions. Once completed, the agent faxes three pages to ExamOne. The process When is ExamOne simple and receives the application the application,

More information

Personal Information Page

Personal Information Page PLEASE USE BLACK INK ONLY Personal Information Page Please complete this form in its entirety. Missing information may delay the establishment of your policy. Personal Information Birthplace: Sex: Male

More information

CHOLESTEROL. Super Pref 0-70 4.5 220 Treated or untreated

CHOLESTEROL. Super Pref 0-70 4.5 220 Treated or untreated Best Risk Classification John Hancock Super Pref 71+ n/a 280; HDL>40 (All products) Super Pref 71+ n/a 150-250; HDL>45 ING (Males Only) Super Pref 61+ 6.0 300 ING (Females Only) Super Pref 61+ 5.5 300

More information

Tennessee Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance.

Tennessee Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance. Toll Free: 1-800-276-7619, Ext. 4264 AssureLINK Address: http://assurelink.assurity.com Tennessee Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance.

More information

Section A: Applicant Information

Section A: Applicant Information United National Life Insurance Company of America 1275 Milwaukee Avenue - Glenview - Illinois 60025-800-207-8050 Combined Application for Hospital Confinement (U9910) / Hospital Confinement & Home Care

More information

Columbia Alumni Association (CAA) Group Term Life Insurance Application

Columbia Alumni Association (CAA) Group Term Life Insurance Application Columbia Alumni Association (CAA) Group Term Life Insurance Application Please complete and return this form to: CAA Plan Administrator NEBCO P.O. Box 152501 Irving, TX 75015-2501 1-800-223-1147 Request

More information

Helpful Hints Regarding Your Claim

Helpful Hints Regarding Your Claim Short-term Disability Claim Form Instructions EPIC s Short Term Disability Claim Form has three sections you (the employee), your employer, and your attending physician(s) must each complete your corresponding

More information

ING Life Underwriting

ING Life Underwriting ING Life Underwriting Requirements Guide June 2011 1 General Information 2 Medical, Inspection & APS Requirements 3-4 Preferred Criteria 5-6 Financial Requirements/Underwriting Guide LIFE INSURANCE Your

More information

California Life Settlement Qualification Form

California Life Settlement Qualification Form PERSONAL INFORMATION California Life Settlement Qualification Form First Insured Name: SS # Current Address: City: State: Zip: Date of Birth: Driver s License Number: State: Expiration: Second Insured

More information

Montana Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance.

Montana Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance. Toll Free: 1-800-276-7619, Ext. 4264 AssureLINK Address: http://assurelink.assurity.com Montana Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance.

More information

Tips for Submitting a Complete and Compliant Replacement

Tips for Submitting a Complete and Compliant Replacement Tips for Submitting a Complete and Compliant Replacement If the application being submitted includes existing coverage, the following tips will assist in completing the replacement form and application.

More information

TOP and TOP Plus. Standard or Better

TOP and TOP Plus. Standard or Better TOP and TOP Plus Program Details PRODUCT TransTerm SM Two Programs with Accelerated Underwriting Transamerica Life Insurance Company now offers two accelerated underwriting programs that enable qualifying

More information

term life 10, 15, 20, 30

term life 10, 15, 20, 30 Companion Life Insurance Company A Mutual of Omaha Company term life 10, 15, 20, 30 product and underwriting guide Y6754_1208 For producer use only. Not for use with the general public. Term Life 10, 15,

More information

Producer Guide. External Term Conversion Program LIFE INSURANCE UPDATED DECEMBER 2012

Producer Guide. External Term Conversion Program LIFE INSURANCE UPDATED DECEMBER 2012 External Term Conversion Program LIFE INSURANCE Producer Guide UPDATED DECEMBER 2012 External Term Conversion Overview Through the External Term Conversion program, MetLife 1 will allow a conversion from

More information

Life Changes, So Does Life Insurance

Life Changes, So Does Life Insurance Marketing Letter for Business Clients [DATE] [CLIENT NAME] [ADDRESS] [CITY], [STATE] [ZIP) Dear [Mr./Ms.] [LAST NAME]: Are you one of 62% of life insurance policyholders that don t know what they own or

More information

ProTec Insurance Company

ProTec Insurance Company INSTRUCTIONS FOR LIFE INSURANCE, AD&D AND LIVING/ACCELERATED BENEFIT CLAIMS Section 1 General Information This section is to be completed by the employer s authorized representative. Section 2 Circumstances

More information

NEW BUSINESS MEMO WHOLE LIFE

NEW BUSINESS MEMO WHOLE LIFE NEW BUSINESS MEMO WHOLE LIFE Regular Mail: P.O. Box 7192 Indianapolis, IN 46207-7192 FAX Number: 317-692-7711 Telephone: 800-428-3001 Overnight Mail: 225 South East St Indianapolis, IN 46202 # pages including

More information

Final Expense Whole Life Insurance

Final Expense Whole Life Insurance Final Expense Whole Life Insurance FE 300 1/05 BC Life & Health Insurance Company An important part of your financial strategy Final Expense Whole Life Insurance Rates are Guaranteed and fixed for life

More information

NEW BUSINESS MEMO GUARANTEED ISSUE WHOLE LIFE

NEW BUSINESS MEMO GUARANTEED ISSUE WHOLE LIFE NEW BUSINESS MEMO GUARANTEED ISSUE WHOLE LIFE Regular Mail: United Home Life Insurance Company P.O. Box 7192 Indianapolis, IN 46207-7192 FAX Number: 317-692-7711 Telephone: 800-428-3001 Overnight Mail:

More information

Arizona Life Settlement Qualification Form

Arizona Life Settlement Qualification Form PERSONAL INFORMATION Arizona Life Settlement Qualification Form First Insured Name: SS # Current Address: City: State: Zip: Date of Birth: Driver s License Number: State: Expiration: Second Insured Name:

More information

Toll Free: 1-800-276-7619, Ext. 4264 AssureLINK Address: http://assurelink.assurity.com

Toll Free: 1-800-276-7619, Ext. 4264 AssureLINK Address: http://assurelink.assurity.com Toll Free: 1-800-276-7619, Ext. 4264 AssureLINK Address: http://assurelink.assurity.com Ohio Application for Simplified Critical Illness Insurance This application includes all forms needed to apply for

More information

MAIL TO: AIG Benefit Solutions P.O. Box M, Beattyville, KY 41311 FAX: (888) 598-0575

MAIL TO: AIG Benefit Solutions P.O. Box M, Beattyville, KY 41311 FAX: (888) 598-0575 Application for Disability Benefits PLEASE ANSWER ALL QUESTIONS FULLY AS THIS WILL HELP EXPEDITE THE EVALUATION OF YOUR CLAIM. INSTRUCTIONS: INSURED: COMPLETE PART I, SIGN AND THE AUTHORIZATION FOR RELEASE

More information

INSURANCE RESOURCES GROUP LIFE SETTLEMENT APPLICATION

INSURANCE RESOURCES GROUP LIFE SETTLEMENT APPLICATION The information herein will be held in the strictest confidence. INSURANCE RESOURCES GROUP LIFE SETTLEMENT APPLICATION INSURED S INFORMATION Insured s Name: Social Security #: - - Street Address: (No PO

More information

MEMBER S FULL NAME CERTIFICATE # SOCIAL SECURITY NO. MM / DD / YYYY r FEMALE WORK PHONE #

MEMBER S FULL NAME CERTIFICATE # SOCIAL SECURITY NO. MM / DD / YYYY r FEMALE WORK PHONE # NADA Dealer Life Insurance Program and Accidental Death & Dismemberment Insurance (DLIP) Request Form Please print in ink or type all answers initial and date any changes you make Request for Group Insurance

More information

A Guide for Successfully Completing the Group Life Insurance Evidence of Insurability Form

A Guide for Successfully Completing the Group Life Insurance Evidence of Insurability Form A Guide for Successfully Completing the Group Life Insurance Evidence of Insurability Form Mutual of Omaha appreciates the opportunity to provide you with valuable life insurance protection for yourself

More information

NEXT PAGE. Applicant information (Please print or type) Name. Are you a: Member Spouse Domestic Partner* If Spouse/Domestic Partner, Name of Member

NEXT PAGE. Applicant information (Please print or type) Name. Are you a: Member Spouse Domestic Partner* If Spouse/Domestic Partner, Name of Member APPLICATION FOR GROUP LEVEL TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) Applicant information (Please print or type)

More information

Hartford Term 10, 15, 20, 30

Hartford Term 10, 15, 20, 30 INDIVIDUAL LIFE INSURANCE Hartford Term 10, 15, 20, 30 Product Details, Underwriting Classifications, Sample Rates and Height/ Charts INSURANCE PRODUCTS: NOT INSURED BY FDIC OR ANY MAY LOSE NOT A DEPOSIT

More information

Idaho Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance.

Idaho Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance. Toll Free: 1-800-276-7619, Ext. 4264 AssureLINK Address: http://assurelink.assurity.com Idaho Application for Acci-Flex Insurance This application includes all forms needed to apply for Acci-Flex Insurance.

More information

TOP 15 & TOP 25 Program Details

TOP 15 & TOP 25 Program Details TERM TOP 15 & TOP 25 Program Details The Transamerica Opportunity Program (TOP) from Transamerica Financial Life Insurance Company offers qualifying clients an easier way to increase or extend their existing

More information

Disability Insurance Claim Packet Instructions. Your Disability Benefit Claim. How To Apply For Benefits

Disability Insurance Claim Packet Instructions. Your Disability Benefit Claim. How To Apply For Benefits Claim Packet Instructions Your Disability Benefit Claim This packet contains the forms necessary to apply for disability benefits. It also addresses common questions about Disability claims. Please save

More information

GROUP LIFE / ACCIDENTAL DEATH NOTICE OF CLAIM

GROUP LIFE / ACCIDENTAL DEATH NOTICE OF CLAIM GROUP LIFE / ACCIDENTAL DEATH NOTICE OF CLAIM EMPLOYER INSTRUCTIONS Send the Claimant s Statement to the beneficiary for completion and have it returned to you. Complete the Employer s Statement. These

More information

EVIDENCE OF INSURABILITY COVERAGE DETAIL

EVIDENCE OF INSURABILITY COVERAGE DETAIL EVIDENCE OF INSURABILITY COVERAGE DETAIL This application consists of two parts: The Evidence of Insurability Coverage Detail form and Medical & Lifestyle Questionnaire. INSTRUCTIONS Plan Administrator:

More information

Must have been fully underwritten, with blood work, to qualify. If it was issued without blood work/analysis, it is not eligible.

Must have been fully underwritten, with blood work, to qualify. If it was issued without blood work/analysis, it is not eligible. UL TOP Program Details The Transamerica Opportunity Program (TOP) from Transamerica Life Insurance Company offers qualifying clients an easier way to increase or extend their existing term life coverage

More information

REQUEST FOR THE ONTARIO MEDICAL ASSOCIATION GROUP TERM LIFE PLUS 75 INSURANCE PLAN

REQUEST FOR THE ONTARIO MEDICAL ASSOCIATION GROUP TERM LIFE PLUS 75 INSURANCE PLAN NEW YORK LIFE INSURANCE COMPANY REQUEST FOR THE ONTARIO MEDICAL ASSOCIATION GROUP TERM LIFE PLUS 75 INSURANCE PLAN SECTION A: MEMBER INFORMATION I wish coverage for (Check One) Myself Myself and Eligible

More information

Automatic Bank Draft--Starting day of each month (not available on the 29th, 30th and 31st) Automatic Premium Loan (APL) is active unless checked

Automatic Bank Draft--Starting day of each month (not available on the 29th, 30th and 31st) Automatic Premium Loan (APL) is active unless checked POLICY NUMBER PACIFIC GUARDIAN LIFE INSURANCE COMPANY, LIMITED Pacific Guardian Tower 1440 Kapiolani Boulevard, Suite 1700 Honolulu, Hawaii 96814-3698 (808) 955-2236 PROPOSED INSURED S INFORMATION Full

More information

Making it easier for you to do business

Making it easier for you to do business Making it easier for you to do business Nationwide Life Underwriting Desk Reference For insurance professional use only not for distribution with the public EasyMed or regular underwriting? Determine which

More information

PREFERRED UNDERWRITING

PREFERRED UNDERWRITING PREFERRED UNDERWRITING For Solution 10 & Solution 20 Criteria Guide 2015 FOR ADVISOR USE ONLY Contents About this guide...1 Preferred underwriting...1 Availability...1 Risk classifications...1 Standard

More information

APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company)

APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) APPLICATION FOR GROUP TERM LIFE INSURANCE Underwritten by The United States Life Insurance Company in the City of New York (Herein called the Company) Member information (Please print or type) Name APTA

More information