Life Insurance Underwriting Guide

Transcription

1 Life Insurance Underwriting Guide National Life Insurance Company Life Insurance Company of the Southwest 30 % Last Updated March MK2312(0412) TC66287(0312)

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3 Table of Contents Quick Tips for fficient Processing Paramedical Facilities/Laboratory Testing Services Medical Testing Life Underwriting Requirements Provider Harbor and Foundation Horizon, Advantage 79, IncomeBuilder, FlexLife, and LSW LifeCycle LSW Term National Life Insurance Company Term and Permanent Products Rate Classes/Table Ratings lite Preferred and Preferred Risk Guidelines Table of Height and Weight Financial Underwriting Guidelines Juvenile Applications Business Insurance Insurable Interest Section 79 Plans Tentative Quotes Tentative Rating Request Trial Application Informal Inquiry Field Underwriting isability Income Rider IR Ineligible Occupation Listing Foreign National Guidelines Medical Questionnaires - Help avoid APS! iabetes Tentative Rating Charts APS Guidelines Uninsurable Risks and xtremely Problematic Risks Life Coverage/isability Income Rider Probable Action After Issue Contract Changes Sample Application LSW Sample Application NLIC Sample Paramedical xam

4 Quick Tips for fficient Processing Submitting an Application Before submitting an application for processing, be sure to complete the application in its entirety with answers to all questions and details to all questions answered yes. Use black or blue ink only. o not use white-out or make changes after the client has signed the application form. Be sure to use the most current version of the application kit and include all required forms. This can include illustrations, sales certificates, strategy allocation forms, replacement forms, 1035 exchange forms, HIPAA, HIV consent form etc. If COM is elected, attach a voided check to the checklist. The Preferred method for submitting completed applications is: mail: [email protected] or Fax: To send by US Mail: LSW/NLIC Attn: New Business M300 One National Life rive Montpelier, VT Originals: In most cases, there is no need to send originals to the Home Office. However, incoming 1035 transfer paperwork, lost policy forms, surrender forms, absolute assignment forms and policies from other companies must be sent via mail with an original signature. Transferring companies will require the original signatures and forms. Underwriting Requirements Once your application has been processed, you will be notified by of any outstanding underwriting requirements. As the writing agent, you are responsible for ordering and following up on requirements. The Home Office will order medical records (APSs) unless otherwise noted (MSI is available for agency ordered APSs; see page six). Please note that requirements vary by product, issue age and the rate class, see product specific charts in this guide. The company may request additional requirements as deemed necessary. Common Underwriting Requirements Oral Swab Kit (Agent Administered) Your Field Underwriting Guide can help you determine if an Oral Fluid Swab will be required for the underwriting process. If required, it must be completed at the time the application is taken; agent administered. Include a copy of the lab slip with the application. o not obtain this test if a paramedical exam and blood/urine are otherwise required. Follow the instructions on the kit and mail immediately to the address indicated. Additional kits can be ordered from Clinical Reference Lab, Customer Service at or via at [email protected] Status Once submitted, application status and outstanding requirements are available to view via the website. Go to to access this information 24 hours a day. Please refrain from calling the Home Office for status. The website also allows you to download current application kits, check state approvals, research new products and more. We re here to help! If you have questions, call the Sales Team at , Option 2, Option 1. 4

5 Paramedical xamination (Agent Ordered) Full testing (paramedical exam, blood/urine, KG etc) may be needed depending on the product, issue age, rate class, face amount applied for and medical history (i.e. diabetes or obesity). Please review the Life Underwriting Requirements in this guide. If full testing is needed, one of the following companies must be utilized: APPS/American ParaProfessional Systems xam One Portamedic MSI/xamination Management Service The paramed company will contact the prospective client to set up an appointment. Reference LSW/ National Life when contacting the paramed company Laboratory Testing Services Clinical Reference Lab is the approved testing service for oral fluid/saliva, blood profiles and urinalyses. Use of our approved lab assures the timely transmission of test results. Blood Profiles/Urinalysis/Oral Fluid OF Agent administered oral fluid testing is available for certain rate classes and certain products. A full blood profile and urinalysis is always required for Preferred and lite Preferred consideration. A urinalysis is required whenever blood testing is needed. Please refer to the product-specific charts in this guide for additional information. HIV consent forms must be submitted in those states where required, for all proposed insureds that require laboratory testing. Completion of these forms is the agent s responsibility. Medical Testing by Other Companies We will consider a paramedical exam*, KG, treadmill and/or labs that have been completed within the last twelve months for another carrier if copies are made available to us. We reserve the right to request current testing. Medical Testing Please refer to the product specific charts for certain products, face amounts, ages and rate classes that may be considered without medical testing. The company reserves the right to require additional requirements as deemed necessary. Questionnaires Medical Questionnaires are available to help avoid the need for medical records and also assist in gathering detailed medical information from a client. Available on web site and in this guide. Form Catalog# Alcohol Use/UI Arthritis Avocation, Aviation & Foreign Travel Back Pain Blood Pressure/Hypertension Business Insurance Cardiac/Chest Pain Criminal History epression/anxiety/psych iabetes rug Use Financial Foreign National Gastro-Intestinal Genitourinary Military Personnel Migraines Mountain Climbing Respiratory/Asthma/Sleep Apnea Seizures Stroke/TIA Tumors * The health questions on the application must be completed. 5

6 Quick Tips for fficient Processing (cont d) APS (Attending Physician Statement) The Home Office will order medical records unless otherwise noted. We offer the service of ordering medical records through our vendor MSI/xamination Management Service. Contact your New Business Case Manager if you wish to use this service. An APS (copy of the client s medical records) may be required by the underwriter in order to complete the underwriting process. Obtaining these records can take 2-6 weeks, depending on the physician. Its important to provide complete physician information on the application (full name, address, phone number) for the personal physician as well as all other physicians and specialists seen. The Underwriter will advise of options for requirements for certain impairments. If available, you will be notified via from the Underwriter. Inspection Reports/Personal History Interview (Ordered by Home Office) Please provide the proposed insured s phone numbers on every application regardless of the amount applied for and inform the applicant of the possibility of contact. Routine Inspection $5,000,001 and over: Inspection Required Foreign Nationals: Inspection Required Routine PHI (Phone Interview) Through $2,000,000: Underwriter iscretion $2,000,001 - $5,000,000 (all ages): Required PHI Ages 70 & over for $500,000 and over: Required PHI PHI may also be required for certain riders applied for Illustrations Contact the Sales esk for assistance with running illustrations at , Option 2, Option 1. In states that have adopted the NAIC Illustration Regulation, a signed illustration or valid sales certification is required with submission of the application. If a state hasn t adopted the NAIC Model Regulation and the state s regulations do not require a signed illustration one does not need to be submitted. Agents are required to familiarize themselves with their state s regulations. LifeBuilder applications also require an illustration to be submitted with the application. Policy Issue and elivery Policies are sent directly to the agent for delivery to the policyowner unless otherwise directed. The policy should be delivered in person as soon as possible. A policy transmittal accompanies the policy which outlines all delivery requirements and receipts needed to complete the sale. A self-addressed envelope is also enclosed for your convenience in returning of these items or they may be faxed to the Home Office at or ed to [email protected]. Agent Commissions and Contracting LSW commissions are generated weekly and National Life commissions are generated twice a month. Please see the website for a Life commission cutoff schedule. Motor Vehicle Report (Ordered by Home Office) Ages 14 30: All applications Ages 31 40: Requested for $250,000 and over Ages 41 69: Requested for $500,000 and over Ages 70+: Requested for $100,000 and over Please note that Pennsylvania and Louisiana require us to appoint you in their State prior to solicitation. Contact the Life Agent Services Support Center at (x6765) for commission, contracting, website or forms related questions. An MVR may also be requested at the underwriter s discretion, based on the application and history. 6

7 Life Underwriting Requirements Provider Underwriting Amount Issue Age Through $50,000 A A A A A A OF $50,001 - $100,000 A A A A A A $100,001 - $150,000 A A A A A A $150,001 - $200,000 A A A A A A $200,001 - $250,000 A A A A A A $250,001 - $300,000 A C $300,001 - $500,000 A $500,001 - $1,000,000 A $1,000,001 - $3,000,000 A $3,000,001 - $5,000,000 A F F F F F $5,000,001 - $10,000,000 A F F F F F F F F $10,000,001 and up A F F F F F F F F Category OF A C F Medical Requirements Application and Oral Fluid (for VSNT, SNT or Std Tobacco) Application (for VSNT, SNT or Std Tobacco) Application, Blood Profile and Urine Application, Paramedical, Blood Profile, Urine Application, Paramedical, Blood Profile, Urine and KG Application, M xam, Blood Profile, Urine and KG (Ages need Stress Test in lieu of KG for $10,000,001+) Rate Classes Please note that preferred rates are not available at ages 0 to 65 for face amounts through $250,000. Available Ages/Face Amounts Verified Standard 3 Ages 0-85; All Face Amounts xpress Standard 4 Ages 0-85; All Face Amounts Standard Tobacco 5 Ages 15-85; All Face Amounts Preferred NT Ages 15-65; $250,001 and Over Ages 66-75; $25,000 and Over Preferred Tobacco Ages 15-65; $250,001 and Over Ages 66-75; $25,000 and Over 2 Issue age last birthday 3 Verified Standard NT used at ages xpress standard class not available in PA/NJ 5 200% rating added to Standard NT rates for tobacco users up to age 19 (NA in PA) 7

8 Life Underwriting Requirements Harbor and Foundation Issue Age Underwriting Amount 0-14 Through $50,000 $50,001 - $100,000 $100,001 - $150,000 $150,001 - $200,000 $200,001 - $250,000 $250,001 - $300,000 $300,001 - $500,000 $500,001 - $1,000,000 $1,000,001 - $3,000,000 $3,000,001 - $5,000,000 $5,000,001 - $10,000,000 $10,000,001 and up A A A A A A A A A A A A OF OF OF OF C C F F C C C C C OF C OF C OF F F OF C OF OF OF F F OF OF F F F OF OF Category OF Medical Requirements Application and Oral Fluid (for VSNT, SNT or Std Tobacco) A C F Application Application, Blood Profile and Urine Application, Paramedical, Blood Profile, Urine Application, Paramedical, Blood Profile, Urine and KG Application, M xam, Blood Profile, Urine and KG (Ages need Stress Test in lieu of KG for $10,000,001+) F F F F F F OF F F F F F F Rate Classes Harbor1 lite Preferred NT Preferred NT ages Foundation2 ages ages ages 0-85 ages 0-85 xpress Standard NT4 ages 0-85 ages 0-85 Preferred Tobacco ages ages Standard Tobacco ages ages Verified Standard NT 5 1 Issue age nearest birthday 2 Issue age last birthday 3 Verified Standard NT used at ages xpress standard class not available in PA/NJ 5 200% rating added to Standard NT rates for tobacco users up to age 19 (NA in PA) 8 8

9 Life Underwriting Requirements Horizon, Advantage 79, IncomeBuilder, LSW FlexLife, and LSW LifeCycle 6 Underwriting Amount Issue Age Through $50,000 A C C C $50,001 - $100,000 A C C $100,001 - $150,000 A C C $150,001 - $200,000 A C $200,001 - $250,000 A C $250,001 - $300,000 A C $300,001 - $500,000 A $500,001 - $1,000,000 A $1,000,001 - $3,000,000 A $3,000,001 - $5,000,000 A F F F F F $5,000,001 - $10,000,000 A F F F F F F F F $10,000,001 and up A F F F F F F F F Category Medical Requirements A Application C Application, Blood Profile and Urine Application, Paramedical, Blood Profile, Urine Application, Paramedical, Blood Profile, Urine and KG F Application, M xam, Blood Profile, Urine and KG (Ages need stress test in lieu of KG for $10,000,001+) te: Oral Fluid testing is not available with the products listed on this page. Rate Classes Horizon 1 Advantage 79 1 IncomeBuilder 1 LSW FLexLife 1 LSW LifeCycle 1,6 lite Preferred NT ages ages ages ages ages Preferred NT ages ages ages ages ages Standard/Verified Standard NT 2 ages 0-85 ages ages 0-85 ages 0-85 ages 0-90 Preferred Tobacco ages ages ages ages ages Standard Tobacco 2 ages ages ages ages ages Issue age nearest birthday 2 200% rating added to Standard NT rates for tobacco users up to age 19(NA in PA) 6 The underwriting amount for LifeCycle (2nd to die) will be equal to the Base Face Amount and APB Amount. If SPR is requested the Underwriting amount will be the greater of the Base and APB or Base and SPR lump sum equivalent amount. 9

10 Life Underwriting Requirements LSW Term Issue Age Underwriting Amount Through $50,000 $50,001 - $100,000 $100,001 - $150,000 $150,001 - $200,000 $200,001 - $250,000 $250,001 - $300,000 $300,001 - $500,000 $500,001 - $1,000,000 $1,000,001 - $3,000,000 $3,000,001 - $5,000,000 $5,000,001 - $10,000,000 $10,000,001 and up A A A A A A A A A A A A C OF C OF C OF C C C F F OF C OF C OF C OF F F OF C OF OF OF F F OF OF OF OF OF F F F F F F F F F F F F Category Medical Requirements OF Application and Oral Fluid (for VSNT, SNT or Std Tobacco) A C F Application Application, Blood Profile and Urine Application, Paramedical, Blood Profile, Urine Application, Paramedical, Blood Profile, Urine and KG Application, M xam, Blood Profile, Urine and KG (Ages need stress test in lieu of KG for $10,000,001+) Issue Ages1 Rate Classes Available Level Term 10-G (ages 18-75) lite Preferred NT Level Term 15-G & 15-NG (ages 18-70) Preferred NT Level Term 20-G & 20-NG (ages 18-65) Verified Standard NT Level Term 30-G & 30-NG (ages 18-50) xpress Standard NT2 (for face amounts up to $249,999 only) Preferred Tobacco Standard Tobacco 1 Issue age last birthday 2 xpress Standard class not available in PA/NJ 10 10

11 Underwriting Requirements National Life Term and Permanent Products Underwriting Amount Issue Age Through $50,000 A C C C $50,001 - $150,000 A C C $150,001 - $300,000 A C $300,001 - $500,000 A $500,001 - $1,000,000 A $1,000,001 - $3,000,000 A $3,000,001 - $5,000,000 A F F F $5,000,001 - $10,000,000 A F F F F F F $10,000,001 and up F F F F F F F Category A C F Medical Requirements n-medical (Ages 15-17, urinalysis required) nmedical, Blood Profile, Urine Paramedical, Blood Profile, Urine Paramedical, Blood Profile, Urine, KG M xam, Blood Profile, Urine, KG ( Ages 0-14, M xam + KG only Ages 15-17, M xam, Urine, KG only Ages Need Stress Test in lieu of KG for $10,000,001+) 1 Issue age nearest birthday. Proposed insureds with cardiovascular conditions should check with their physician before performing a Stress Test. 11

12 LSW Underwriting Classes 1 lite Preferred n-tobacco See guidelines on next page. Preferred n-tobacco See guidelines on next page. OF Verified Standard/Standard NT Offers competitive rates for applicants who are fully underwritten, who are standard risks and who do not use tobacco. OF xpress Standard 2 NT Available to applicants who do not use products containing tobacco or nicotine who qualify as standard under quick underwriting and to those with ratings of four tables or less who would otherwise be substandard. Preferred Tobacco Available to applicants who use products containing tobacco or nicotine who meet all preferred guidelines (see next page). A blood profile and urinalysis are required for all Preferred Tobacco applicants. OF Standard Tobacco Applicants who use tobacco and who do not otherwise meet the preferred guidelines will fall into this rate class. Table Ratings converted to Percent Ratings Table 2...Table B...150% Table 3...Table C...175% Table 4...Table...200% Table 5...Table...225% Table 6...Table F...250% Table 8...Table H...300% Table 10...Table J...350% Table 12...Table L...400% Table 16...Table P...500% Ratings are illustrated using Standard or Verified Standard class as the platform for n-smoker clients or using Standard Tobacco class as the platform for tobacco users See product-specific tables on pages 7-9 for rate classes available. 2 Please refer to the product-specific charts for class

13 lite Preferred n-tobacco and Preferred Criteria 1 lite Preferred n-tobacco Preferred Citizenship U.S. Resident. U.S. Resident. Tobacco or Nicotine Products 2,3 use of tobacco or nicotine - containing products of any kind within the last 24 months. Current lab testing negative for nicotine. use of tobacco or nicotine - containing products 4 of any kind within the past 12 months. Current lab testing negative for nicotine. Health Alcohol/rugs Aviation/Avocation Family History Standard risks with no current borderline medical problems. medical history which would have been ratable in the past. drug or alcohol abuse or treatment within the last 10 years. aviation, hazardous avocation or occupation. This does not include major commercial airline pilots or holiday scuba diving. parental family history of death from cardiovascular disease or cancer prior to age 60. Standard risk with no current borderline medical problems. medical history which would have been ratable in the past. drug or alcohol abuse or treatment within the last 10 years. aviation, hazardous avocation or occupation. This does not include major commercial airline pilots or holiday scuba diving. parental family history of death from cardiovascular disease or cancer prior to age 60. Build Blood Pressure Cholesterol riving History See Height and Weight Chart on next page. Current untreated blood pressure with a 12-month average reading of 135/85 or better. Current untreated cholesterol of 200mg/dl or less and a Chol/HL ratio of 4.0 or less. alcohol related moving violations within five years and no more than two moving violations within the last two years. See Height and Weight Chart on next page. Current blood pressure with a 12-month average reading of 140/90 or better. Cholesterol of 240mg with ratio of 8.0 or less; or total cholesterol of with a ratio of 6.0 or less. alcohol related moving violations within five years. ratable driving record. 1 Please refer to the National Life and LSW product-specific charts for classes available. 2 t applicable for Preferred Tobacco class. 3 Products such as cigarettes, cigars, chewing tobacco, pipe, nicotine gum products, nicotine patch, etc. 4 Individual consideration will be given for infrequent cigar use. 13

14 Table of Height and Weight (LSW Products) This chart is used as a guideline to identify the weights that are usually acceptable for standard premium rates within the rate classes shown, and to show the acceptable weight to qualify for the disability income rider. Other factors, including age or disproportion in body measurements (girth of chest and abdomen), may impact the final decision. Feet Inches xpress Standard NT Verified Standard NT & Standard Tobacco Preferred NT & Preferred Tobacco lite Preferred NT IR 14

15 Financial Underwriting Guidelines Cover Letter The writing producer is an important source of information. Through a cover letter, he/she can provide an explanation of the purpose, need, and method used to establish the requested face amount and total line of coverage as well as any unusual aspects of the case, and competitive situations. Copies of the needs analysis and financial statement should accompany applications with large face amounts. Personal Insurance While each application is underwritten based on its own merits, the following are general guidelines for personal insurance to cover income replacement and survivorship. Coverage for non-working spouses would be considered for reasonable amounts based on the working spouse s income as well as net worth and purpose of the coverage. We welcome discussions on individual situations. Issue Ages Will Consider Up To: 0-17 See juvenile insurance guidelines x annual earned income x annual earned income x annual earned income x annual earned income x annual earned income 66+ 5x annual earned income Bankruptcy We will not offer coverage to an individual with a history of Chapter 7 bankruptcy until the bankruptcy proceedings have been discharged, the client is currently working full-time, and demonstrates a financial need for a reasonable amount of coverage. We will consider coverage for applicants currently in Chapter 11 or 13 once the applicant is making regular debt payments and they are not subject to any court imposed restrictions. All applicants will be underwritten on their own merit, taking into consideration stable employment, annual income, net worth, purpose and need for coverage, as well as any emotional, anxiety and other medical concerns. Juvenile Applications Face Amount up to $1,000,000 Generally, we will consider insurance on juveniles up to the face amount on the lesser insured parent (or legal guardian); unless state insurance law dictates otherwise. All children should be similarly insured and the purpose of the coverage clearly defined. In order to sustain long term premium payments, households with modest annual income should not exceed 10% of income for life insurance premiums. If multiple applications are submitted for the same family, a cover letter (include a copy with each application) or note on the Agent s Report with details on the sale will help to provide more efficient processing. Please include the amount of coverage in force and applied for on the parents and any siblings on the application. Face Amounts over $1,000,000 Larger face amounts applied for on children are considered on an individual basis. It is the agent s responsibility to provide supporting financial details and the background of the sale to justify the coverage applied for. Ownership Acceptable ownership and premium payers for minors include parents/legal guardians or grandparents only. 15

16 Juvenile Applications (cont d) Forms/Signatures A HIPAA form is needed for each child. The child s signature is required at age 15 and over. A HIV consent form is also required whenever laboratory testing is needed. A parent s signature is required on the application if the grandparents are applying for the coverage. Medical Testing Please refer to the product-specific requirements for medical testing needed. Please contact your Underwriting Team with special situations prior to completing an application. Business Insurance Insurance is frequently used to protect against financial loss in a business relationship. The most common are Key Person, Buy/Sell, and eferred Compensation. The amount of death benefit must be suitable for the given business financial situation. ach business sale should include a detailed cover letter and Business Insurance Questionnaire, Form The letter should clearly explain the purpose, how the amount was arrived at, and how others in the business are equitably treated. Reference to and/or copies of tax returns [both personal and business] along with business income statements and balance sheets will often be requested to support the amount applied for. 16

17 Insurable Interest Owner/Beneficiary Insurance law and public policy in the various states require that we establish that an insurable interest between the Proposed Insured and the Owner/ Beneficiary exists at the time we issue a life insurance policy. The strictest definition of insurable interest suggests that the Owner/Beneficiary must suffer a quantifiable financial loss at the Insured s death. In other words, the Owner/Beneficiary must be better off if the Insured lives rather than dies. xcept when spouses insure each other or when parents insure minor children; it is the Agent s responsibility to carefully describe the insurable interest supporting any application where the Owner is someone other than the Proposed Insured and if the relationship of the Owner to the Beneficiary is questionable. It s important that the explanation include the financial loss incurred at the Proposed Insured s death. Because the Owner controls several aspects of the policy such as the right to change the beneficiary, change the face amount or riders or cancel the policy; the insurance company is charged with assuring there is insurable interest of the owner for any policy issued. Generally accepted Ownership Arrangements include Insured, Spouse, Parent of Minor Child, Grandparent, Business Partner, Business/Corporation Owned by the Insured, and Trusts. The simplest, most common relationship we insure is that between spouses. Survivor income, debt repayment, tuition costs and final expenses are all quantifiable needs that become readily apparent at death in this situation and are perfectly appropriate purposes for life insurance. Loan repayment in debtor relationships, key-person and buy-sell agreements in business relationships and estate protection are other fairly quantifiable needs that can be supported by life insurance. The law also makes allowance for the bonds of love and affection which exist between spouses (or significant others ), when parents insure minor children and grandparents insuring grandchildren (with parent s approval). The relationships between cousins, nieces/nephews and aunts/uncles are more difficult to insure because the financial and emotional ties are hard to identify and quantify; therefore not generally accepted and the insurance company may ask for additional clarification or justification. 17

18 Section 79 Plans The National Life Group supports its distribution partners with permanent life insurance products designed to provide a competitive edge in the Section 79 arena. The following guidelines and procedures are designed for efficient processing in New Business and Underwriting. Visit our Company website ( com) for detailed product, sales and marketing materials available. Section 79 sales require the services of a National Life approved Third Party Administrator. General Guidelines Product Availability: Refer to website for current information. Although employee participants may elect the minimum $50,000 term coverage defined in the IRS Code Section 79, National Life Group will consider only applicants electing permanent insurance coverage. Groups of Nine and Less Participants Historic Treasury Regulations dictate limits on evidence of insurability for groups of nine or less participants. The determination of potential standard classification is based on limited evidence. medical testing should be completed. 1. Fully completed application 2. MIB (Medical Information Bureau) inquiry. 3. PHI (Personal History Interview). Maximum Age: 65 Maximum Face Amount: $2,000,000 or our available retention, if less, due to NL/LSW coverage already in-force. Rate Class: Standard Underwriting Classification Only The proposed insured must qualify for Table B or better, in which case we will offer standard. Those failing to qualify as such will be declined. Insureds who are issued standard under this process will not be permitted to apply for enhanced underwriting classification for the policy in the future. Flat xtra Rating A flat extra cost of insurance (COI) per $1,000 of face amount will be imposed for the first five policy years. An illustration is required for each application showing the appropriate plan, face amount and flat extra temporary rating. Insured s Age at Issue Male n- Tobacco Male Tobacco Female n- Tobacco Female Tobacco ages ages ages ages ages ages

19 Section 79 Plans (cont d) Agent Responsibility 1. Fully completed application and related forms; with details to all answers. 2. The Agent s Report must note the commission percentage for the TPA. 3. Completed Hold Harmless Forms (LSW Form 8638 & Form 8639 or NL Form 8770 & Form 8771). 4. Provide census completed by employer at the point of sale. An mployer Certification Form will be required by Home Office if the completed census is not provided with the application (Form see sample form on the following pages; available on company website). Groups of Ten or More Participants Refer to the General Guidelines noted above. Groups of ten or more participants follow normal underwriting review with regard to evidence of insurability including medical testing based on face amount and age, prescription drug review, MVR, physician reports, etc. The proposed insured may be considered for any rate class available as the product allows. See Agent and TPA Responsibilities. 5. Submit requirements above to a company-approved TPA for review and approval. 6. A copy of the application papers should be submitted through usual channels. TPA Responsibility 1. Review application papers for suitability. 2. Review Census/mployer Certification. 3. Verify commission percentage on Agent s Report; approval stamp. 4. Complete Third Party Administrator Cover Letter Form 8642, approval stamp. 5. Run illustration with appropriate flat extra premium; approval stamp. 6. Forward all items above to NLG New Business, Montpelier, VT. 19

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21 Tentative Quotes Introduction Requirements Submission to Home Office Certain medical or non-medical impairments may require pre-qualifying a proposed client for insurance coverage. The Tentative Quote process is designed to provide detailed information to the underwriter to determine possible insurability before an application is taken. The listing of Uninsurable and Problematic Risks provided in this guide should be reviewed prior to submitting a request. All quotes are tentative, non-binding and subject to change after a full underwriting work up and company retention limits. Requirements needed for a Tentative Quote: Tentative Rating Request (sample on following pages or available on website) or message with details to include: age, sex, height/weight, amount of insurance to be considered, riders requested, medical diagnosis, date diagnosed, treatment and medications, restrictions, prognosis and all other pertinent information for each medical impairment. Requests can be faxed or ed to National Life Group as follows or obtained via phone directly to your underwriting team: Fax forms to mail [email protected] with completed form attached. Please allow 48 hours for reply and send a copy of quote obtained if an application is submitted. 21

22 Tentative Rating Request Fax to or -mail Agent: Appt.ate: Client Last Name: Client Age (OB): Sex: M F Height: Weight: Smoker: N Y Plan: Amt. of Insurance: Riders Requested: iagnosis: ate iagnosed: Treatments Received and Medications: Restrictions: Prognosis: Comments: Please allow 48 hours for a reply. 22

23 Trial Application Introduction Requirements Submission A Trial Application may be submitted for an abbreviated review of a proposed insured s health, financial, or other pertinent history to determine potential underwriting action prior to the formal application process. Any application received will be assigned a policy number and an MIB record is ordered. After initial review we will advise the agent/agency of any requirements such as an attending physicians statement (APS).. Upon completion of the underwriting process, the agent/agency will be notified of a tentative offer which will be subject to any necessary requirements needed for age and amount. Any tentative offer other than standard will require an adverse action letter to be sent when required by statute. Requirements needed for a Trial Application are: New Business Checklist with Trial Application clearly indicated, Fully completed Form 8121 Application for Life Insurance, and Form 8164 HIPPA Complaint Authorization. Important: medical testing should be ordered or money collected. Forms can be faxed or ed to National Life Group as follows: Fax forms to mail forms to [email protected] Important: Forms must be password protected if ing. 23

24 Informal Inquiry Introduction An informal inquiry will provide a preliminary review for insurability. A policy number will be assigned. We will advise the agent/agency of any requirements such as attending physicians statement (APS). Upon completion of the underwriting process, the agent/agency will be notified of a tentative offer which will be subject to a formal application and any necessary requirements needed for age and amount. Requirements Identifying Information Submission All quotes are tentative, non-binding and subject to change after a full underwriting work up and company retention limits. Requirements needed for an Informal Inquiry are: Form 1386 Informal Inquiry and Authorization Pursuant to Life Insurance, or a cover letter including identifying information. And Form 8164 HIPPA Complaint Authorization, or a blanket authorization form approved by National Life. Important: Authorization must be dated within last 6 months. When using a cover letter instead of Form 1386 the following identifying information should be included: Agent Name & Number Client s Name & Address Social Security Number ate of Birth Sex Smoker Status Face Amount Policy Funding Total Life Insurance currently in force Identify Companies ates and details of medical conditions of concern esired Premium Class Are there any competitive offers pending? Forms can be faxed or ed to National Life Group as follows: Fax forms to mail forms: [email protected] Important: Forms must be password protected if ing. 24

25 tice: ate: Full Name: Informal Inquiry and Authorization Pursuant to Life Insurance A signed 8164 HIPAA Compliant Authorization must accompany this Informal Inquiry and Authorization form. In addition, your agent will supply you with a separate Prenotification form to help you understand the underwriting process. Age: Soc. Security : Address: (Street, City, State, Zip Code) ate of Birth: Place of Birth: Occupation: Insurance esired: Kind? Amount: WP? AB? $ Has any type of product containing nicotine been used by the Proposed Insured within the last 24 months? $ Total Life Insurance currently in force: Name of Soliciting Agent: $ Agent Number: Companies: Company regularly represented? Reason for preliminary inquiry? Proposed Insured's medical and personal history responsible for the presentation of the inquiry: (Please include name and addresses of physicians/medical facilities consulted, along with dates and details of any medical problems. Use reverse side of this form for Additional Remarks. If you would like you can submit a non med Part B with this form to provide more details.) I, the Proposed Insured, authorize any: Physician; Medical practitioner; Hospital; Clinic or other medically related facility; Insurer or reinsurer; MIB, Inc.; Consumer reporting agency; or mployer having information as to: iagnosis, treatment and prognosis of any physical or mental condition of me or any of my minor children on whose life I have applied for insurance; and Any non-medical information of me or such minor children; to give to the Company, or its authorized representative, any and all such information. This information may be used to determine eligibility for life or health insurance or claims for benefits, and I authorize the Company to release any of this information to: MIB, Inc.; Reinsurers; and Other life insurance companies in which I have insurance or seek insurance or benefits from. 1386(0911)A Cat National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Centralized Mailing Address: One National Life rive, Montpelier, VT Copies to the Company, the Customer, and the Agent Page 1 of 2 25

26 Informal Inquiry and Authorization Pursuant to Life Insurance - Continued I authorize the Company to redisclose the information to: Any person performing a business or legal function for its benefit; An attending physician for diagnostic or treatment purposes; Government authorities to prevent insurance related illegal activities; Persons conducting medical or statistical studies for the Company; Persons having an authorization specifically permitting the redisclosure; and when required by law. This authorization shall remain valid for 30 months from the date shown below. I authorize the Company to obtain an investigative consumer report. I understand that I am entitled to be interviewed by the consumer reporting agency that prepares any such report, as long as I can reasonably be contacted during normal business hours. I wish to be interviewed if an investigative consumer report is prepared. I understand I have a right to receive a copy of this authorization. I acknowledge receipt of copies of the prenotifications relating to investigative consumer reports and MIB, Inc. A copy of this authorization shall be as valid as the original. Signature of Proposed Insured: ate: (mm/dd/yyyy) 1386(0911)A Page 2 of 2 26

27 Field Underwriting LSW s isability Income Rider The primary concerns in underwriting IR include qualification for: Build Medical History Maximum Amount ligible based on income/face amount of life coverage Occupation Build Refer to the Height and Weight chart in this guide. There is no flexibility in the maximum weight listed. Medical History Certain medical impairments will prohibit approval of IR. A general listing of medical conditions is listed in the section on probable action relating to IR. Basically, any medical impairment that may generate a substandard premium rate would not be eligible for IR. Whenever possible, the Underwriter will consider excluding an impairment or body part from the IR rather than denying the rider. Any injury or impairment within two years of the application will likely be excluded from the IR depending on severity. If a prospect is currently disabled for any reason, we are unable to consider for IR. All in force isability coverage with all companies will be taken into consideration when calculating the total amount eligible based on income (the 66% or 40% whichever applies). Short-term or long-term disability coverage is included in these calculations based on the scale below: Less than six months won t count towards maximum available; Six months up to but not including one year count at 50% One year or more count at 100% Occupations Part-time employees (less than 30 hours per week) and certain occupations are not eligible for IR coverage. See listing on next page. Ineligible occupations may be due to hazards, persistency of business, seasonal/ migrant work, or based on claims experience within the industry or company. This list is periodically updated. Self employed persons are considered on an individual basis by the underwriter. oes the client work from his/her own home? If so, what is the percent of time spent out of the home office? oes he/she travel to meet with clients? Could they do the job without leaving the home at all? It is crucial that the agent obtain accurate and detailed medical information when IR is being requested so that the Underwriter may make a fair assessment. If few details are provided, additional requirements will be requested that will delay approval. Whenever possible, an Underwriter will use a questionnaire in lieu of an Attending Physician Statement (APS). Maximum Amount Available The maximum monthly benefit available from LSW is $2,000/month, subject to underwriting and state limitations. The monthly amount cannot exceed 66% of gross monthly income (40% in California; except for 1099 employees); or $20 per $1,000 of the LSW face amount life insurance applied. (For example, a $2,000 IR must be attached to a base policy of at least $100,000.) Is their occupation otherwise eligible for IR if not for self employment? Self employed consultants, graphic designers, (and other occupations who don t need to leave their home office to do their work) and working from their own home are not eligible for IR. Federal and Municipal employees are eligible for IR, but only up to the amount of their home mortgage payments or $2,000/month, whichever is less. We would require a copy of their mortgage statement to consider. Please feel free to contact your underwriter with questions. 27

28 isability Income Riders (IR) 1 Two different IRs are available on LSW Term, UL and IUL policies, providing coverage for disabilities due to either sickness or accident. Please see the Agent Guides for detailed information on the IR. These riders are not approved in all states of for all products; see the Naitional Life website for availability. Part-time employees (less than 30 hours per week) and certain occupations shown below are not eligible for IR coverage: Actor/Actress Air Traffic Controller Amusement Park mployee Armed Forces or Coast Guard Artist/Musician Asbestos Worker Athletic Coach or Instructor Auto Body Repair Blaster Bowling Alley mployee Bridge or am Worker Bus Boy Bus river Cab river Carpet/Floor Installer Casino mployee Chauffeur/Limo river Circus mployee elivery Person ishwasher iver omestic Servant (Maid, Butler, etc.) rivers (local delivery or long-distance) xotic ancer FBI Agent Federal or Municipal mployee 7 Fire Fighter Fisherman/Seaman Flight Attendant Forest Ranger Game Warden Golf Pro Housewife Immigration Officer Life Guard Logging mployee Longshoreman Migrant Worker Mine Worker Movie Industry mployee Nature/Adventure Guide Nurse Peddler Piano Mover/Safe Mover Pilot Police Officer Prison/Corrections mployee Professional Athlete Racing mployee (dog or horse) Rodeo Rider or Clown Roofer School Teacher 8 (public or private) Security Guard (armed) Self-mployed (call with specific info) Skating Rink mployee Steeplejack (Billboard Worker) Structural Iron Worker Subway or Tunnel Construction Worker Theater Industry mployee Truck river Vending Machine Worker 28 6 In South Carolina, isability is defined as the insured s inability to perform the duties of his or her own occupation during the first year of disability and has the inability to perform the duties of any occupation for which he or she is suited thereafter. 7 May purchase IR up to monthly home mortgage amount. 8 Only IR5 available.

29 Foreign National Guidelines Contents: Section 1. efinition of Foreign Nationals Section 2. Foreign Nationals Living Inside of the United States Section 2.1: Green Card Holders Section 2.2: Visa s Section 3. Foreign Nationals Living Outside of the United States Basis for Underwriting ecisions: Country of Origin Refer to the U.S. epartment of State travel warnings list for problematic countries (available via internet) Reason in the U.S. Future plans mployment Section 1: efinition For purposes of an insurance application with National Life (NL) & Life Insurance Company of the Southwest (LSW), a foreign national is a citizen of a foreign country. A foreign national may travel to the U.S. as a non immigrant or reside in the U.S. on a permanent basis as an immigrant. Section 2: Foreign Nationals Living Inside of the United States Section 2-1: Green Card Holders: If an alien holds a Green Card permanent residency and is, therefore, able to provide an Alien Registration number on the application, we will treat the same as if they are a U.S. Citizen for insurance purposes. Please provide the Green Card/Alien Registration number on the application. Section 2-2: Visa s: If an alien does not have a Green Card and therefore cannot provide an alien registration number, we must obtain a copy of their Visa. A foreign national questionnaire (form 8327, catalog #50038) is required. Any offer will depend upon the country of origin, the connection to the U.S., and the need for insurance. An H1 Visa is typically the only accepted Visa, and that is on a case-by-case basis. Property ownership/verifiable business interests Connection to the state of execution is required Company Guidelines: Face amount limit $1,000,000 per life Minimum face amount $100,000 Permanent plan of insurance only (no term) riders (all riders are unavailable, including ABR, unemployment, etc) Standard class, at best. preferred or elite available Minimum age is 18 (no children under age 18 will be considered) mployed full-time Residents of Colombia, Cuba or Haiti are not insurable on any basis Foreign travel guidelines will apply. Underwriting requirements: Copy of visa Foreign national questionnaire (Form 8327) Proof of property ownership (example: copy of mortgage statement or deed) Any medical testing required must be completed in the U.S. Important: If an alien is in the U.S. Illegally, no offer can be made. 29

30 Section 3: Foreign Nationals Living Outside of the United States Marketing Objectives: An agent must sell insurance primarily to individuals who are citizens or permanent residents of the U.S. Applications on clients who live outside of the U.S. should be a small ratio of the agent s total business. An agent cannot solicit business outside of the U.S. An agent must have a primary residence in the U.S. The client must be affluent, wealthy individuals (not blue collar workers). The client must meet category I or II criteria for Foreign Nationals. Categories of Foreign National Business: Category I: The Company will consider applications on Foreign Nationals if the proposed insured demonstrates (and it is verifiable by the Company) that the proposed insured: 1. Owns a U.S. residence, substantial other properties or verifiable substantial business interests in the U.S.; 2. Is a key person in a U.S. Corporation and is frequently in the U.S. on business; or; 3. Is a key person in a foreign domiciled corporation that is admitted to do business and has offices in the U.S. and who is frequently in the U.S. on business (four or more times per year). Requirements for Category I: ssentially treated as U.S. Nationals All transactions and interactions with NL & LSW must be in nglish U.S. Trust required U.S. address required for billing/administration purposes at time of issue Premiums must be paid in U.S. dollars. Category II: If not in Category I, the Company will consider applications on Foreign Nationals if the proposed insured is a professional or business person who can demonstrate (and it is verifiable by the Company) that he/she conducts business (i.e. banking) in the U.S. and/ or travels to the U.S. on a frequent and regular basis (four or more times per year). Basis for Underwriting ecisions: Country of origin refer to the U.S. epartment of State travel warnings list for problematic countries (available via internet) Reason in the U.S. Future plans mployment Property ownership/verifiable business interests Connection to the state of execution is required Requirements for Category II: All transactions and interactions with NL & LSW must be in nglish oes require a U.S. Institutional Trust (bank or trust company) with a U.S. sitused trustee (via an endorsement) An irrevocable trust is not necessary, however, as U.S. sitused trust must remain in existence for the life of the policy for purposes of: stablishing jurisdiction in the U.S. for policy issuance and any potential future litigation; Maintaining a U.S. address for purposes of billing/ administration; and Having a U.S. Trustee for collection of death proceeds. Foreign address or ownership changes will not be permitted Trust must meet requirements of state where established Premiums paid in U.S. dollars. 30

31 Foreign National Guidelines (cont d) Company Guidelines: Face amount limit $1,000,000 per life. Minimum face amount is $100,000 Permanent plan of insurance only (no term) riders (all riders are unavailable, including ABR, unemployment, etc) Best class available is standard. preferred or elite available. Minimum age is 18 (no children under age 18 will be considered) Category II Foreign Nationals require a special endorsement Foreign travel guidelines will apply Residents of Colombia, Cuba or Haiti are not insurable on any basis. Underwriting Requirements: Foreign national questionnaire (form 8327) Proof of property ownership (example: copy of mortgage statement or deed) Full medical testing is required and must be completed in the U.S. Request for exceptions for testing to be completed outside of the U.S. must be approved by the underwriter and must be completed by a U.S. Consulate physician. International inspection report required for all face amounts applied for Medical records will be requested. The proposed insured, beneficiary or countries of residence/citizenship must not be on the restricted list published by the U.S. epartment of Treasury, Office of Foreign Assets Control (see: Company Reservation: The Company reserves the right to reject or restrict any application submitted on any foreign national. Please contact your underwriter with any questions. Category III: The Company will not consider applications on all other Foreign Nationals (i.e. those with no contact with the U.S. or infrequent contact). * Category II ndorsement (will be part of every policy issued in this category): For as long as this policy remains in force, ownership of the policy must be maintained by an institutional trust located in the United States. An institutional trust is a recognized financial institution or trust company. The trustee shall be the United States financial institution or trust company. ealings on behalf of the trust must be executed by an officer of the financial institution or trust company as trustee. All policy premiums are to be paid by the trustee/trust in United States dollars and all billing and administration for this policy will be through the trustee/trust. Any and all benefits or other distributions payable pursuant to this policy shall be paid to the institutional trust/trustee. 31

32 32 Medical Questionnaires Obtaining detailed medical information is critical for an underwriter s assessment of the mortality and/or morbidity risk. The following questionnaires are available to assist in gathering detailed information from the client and may be accessed via the Forms Section on the web site. Questionnaire: Catalog # When needed: Alcohol Use Arthritis OF Avocation, Aviation & Foreign Travel OF Back Pain OF Blood Pressure OF Business Insurance Cardiac (Chest Pain) Criminal History epression/anxiety/psychiatric OF iabetes rug Use Financial Foreign National Gastro-Intestinal OF Genitourinary OF Military Personnel Migraine OF Mountain Climbing Respiratory/Asthma/Sleep Apnea OF Seizure OF Stroke/TIA OF Tumor OF Catalog # Form # 9270 Catalog # Form # 9275 Catalog # Form # 1480 Catalog # Form # 9277 Catalog # Form # 8625 Catalog # Form # Catalog # Form # 9274 Catalog # Form # Catalog # Form # 9437 Catalog # Form # 9594 Catalog # Form # 9269 Catalog # Form # 1392 Catalog # Form # 8327 Catalog # Form # 9276 Catalog # Form # 9267 Catalog # Form # Catalog # Form # 9271 Catalog # Form # Catalog # Form # 9268 Catalog # Form # 9272 Catalog # Form # 8624 Catalog # Form # 9279 Any UI (driving while intoxicated) history History of alcohol treatment within ten years History of abnormal liver function testing or current abnormal lab testing n-rheumatoid, non-steroid treated arthritis (i.e., osteoarthritis, gout) Any participation in racing, parachuting, sky diving, underwater diving, aviation or foreign travel History of, or current treatment for, musculoskeletal back pain when requesting Waiver of Premium or isability Income Rider History of, or current treatment for high blood pressure Applications covering business needs or relationships History of cardiac chest pain and other cardiac impairments History of felony or misdemeanor conviction History of, or current treatment for, depression, anxiety or other psychiatric issues. History of, or current treatment for diabetes History of drug treatment or drug use within the past ten years As needed to provide client or business finances Must be submitted with all foreign national applications History of, or current treatment for, acid reflux, gastritis, gastric or duodenal ulcers History of, or current treatment for urethritis, prostatitis, BPH (hypertrophy of the prostate), kidney stones or other benign kidney disorders Current affiliation with military organization History of, or current treatment for, stress, migraine, or cluster headaches Any participation within the past three years or planned mountain climbing History of, or current treatment for, non-steroid asthma, bronchitis, emphysema, pneumonia, tuberculosis or sleep apnea History of, or current treatment for seizures. History of stroke or transient ischemic attack within ten years. History of benign (non-cancerous) tumors or cysts (I.e., fibroid, basal cell)

33 Alcohol Usage Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: o you presently use alcoholic beverages? (If NO, state when usage ceased.) (If YS, record usage below.) Amount: Beer aily Weekly Monthly Why did you change your usage habits? id you ever drink substantially more than outlined above? (If, complete below) Amount: Beer Wine Liquor ate Started Number of Years aily Weekly Monthly Wine Liquor ate of Last rink Have you ever consulted a doctor or counselor or received treatment because of your alcohol use? (If yes, indicate names and addresses of any doctors, counselors, hospital or treatment center below.) Have you ever been charged with impaired driving, lost your job, or been arrested due to the influence of alcohol? (If yes, give details below.) Are you now a member of A.A.? Please add any additional information which you feel is important: 9270(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

34 Arthritis Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: What kind of arthritis did the doctor say you have? (Rheumatoid, degenerative; osteo-arthritis, gouty, arthritis of the spine, Ankylosing Spondylitis, Marie-Strumpell's disease, muscular rheumatism, Reiter's syndrome, Lupus rythematosis, Polymyalgia Rheumatica) How long ago was it diagnosed? Who is treating it now? What joints or parts of the body does it affect? How? What kinds of treatment/medication have you received in the past 10 years? By whom? What kinds of treatment/medication have you received currently? By whom? When was the last flare-up? How often do they occur? id you have to stay home from work? How long? When did you last see your doctor for this? Has your arthritis caused any stiffness, limitations, or deformities? 9275(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

35 Avocation, Aviation & Foreign Travel Supplemental Application National Life Insurance Company Home / Administrative Office: One National Life rive, Montpelier, VT Life Insurance Company of the Southwest Administrative Office: One National Life rive, Montpelier, VT Home Office: 1300 West Mockingbird Lane, allas, TX Full Name of Proposed Insured: All questions refer to Proposed Insured Part A - Aviation Questionnaire (For pilots and crew members.) 1. What type of Pilot Certificate do you hold? Student Private Commercial Airline Transport Rating (ATR) Instrument Flight Rating (IFGR) 2. Are you a member of a Military Reserve or National Guard unit on flying status? If "", check one? Active Inactive 3. What type of aircraft do you fly? Crew position 4. Was your certificate granted subject to physical waiver? 5. Have you ever been grounded or restricted for violation of Civil Air Regulations? (If "", give details in Remarks) 6. Has your Federal Pilot Certificate ever been cancelled? (If "", give details in Remarks) 7. ate of last flight as a Pilot: 8. Is it your intention to fly in the future as a: Pilot Crew member: Crew member 9. Total flying hours (Give details in Remarks.) Student Pilot in Command Other capacity escribe your annual flying activity in the chart below. Type of Flying Next 12 mos. hours Past 12 mos. hours 1 to 2 years ago hours mployer-owned Charter flying or instructing n-commercial pilot or student Military Other (Give details in Remarks) 10. o you fly only within the United States? (If "", give details in Remarks) 11. If full coverage at standard rates is not available, do you desire: Full coverage with extra premium, if available? Restricted aviation coverage without extra premium, if available? Part B - Foreign Travel Questionnaire 1. To what foreign country (or countries) do you intend to travel? 2. How long do you plan to remain? 3. For what purpose is the trip made? 4. Will you be located in one or more of the larger cities, or will you travel about the country? 5. Have you traveled abroad before? 6. If so, when and to what countries? 1480(1109) National Life Group is a trade name of National Life Insurance Company, Life Insurance Company of the Southwest and their affiliates. ach company is solely responsible for its own financial condition and contractual obligations. Page 1 of 3 Cat

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38 Back Pain Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: When was it diagnosed and what is the location, intensity and duration of your back pain? How does the pain affect your functional abilities (including mobility, occupation, social activities)? How often do you have pain / what amount of time has been lost from work / is it disabling in any way? o you have any associated medical or psychiatric impairments / narcotic pain medications used / drug or alcohol misuse? What is the current treatment / any walking devices used / list all physicians seen and dates? Physician's Name Address/Telephone Number ate Last Seen/Frequency Area of Specialty (i.e. family physician, specialist, etc.) 9277(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

39 Blood Pressure Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: ate of diagnosis: What medication(s) are you currently taking and dosage(s)? Has there been any change in your medication in the past 12 months? (If, please provide details) Have you ever required hospitalization or emergency room treatment for this condition? (If, please provide details) o you have any blood pressure related health problems such as: kidney disease, enlarged heart or history of a stroke, other? (If, please provide details) o you self monitor your blood pressure? If yes, please provide most recent reading: ate of last blood pressure checkup by your doctor and reading: Physician's Name Address/Telephone Number ate Last Seen/Frequency Area of Specialty (i.e. family physician, cardiologist, other) 8625(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

40 Name (please print): ate of Birth: Business lnsurance Worksheet Policy #: ate Completed: 1. Title / uties: 2. Percentage of Ownership / Years with Company: 3. Type of Business: Sole Prop. Partnership S-Corp C-Corp 4. Purpose of insurance: Keyman Buy/Sell eferred Comp Creditor (provide amount & term of loan) Other 5. escribe how face amount was determined: (Please include a cover letter with any special situations to consider.) 6. Are other members of the company insured in favor of the business, or currently applying for coverage? If, provide the following details: Name and Title Insurance In Force Insurance Applied For Business Ownership (Percentage) 7. If other members are not insured or not applying, please explain. 8. Has the business been involved in bankruptcy proceedings in the past seven years? If, provide type filed, date, reason and date of discharge: 9. Business Financial Information: Current Assets Fixed Land Assets Fixed Building Assets Other Assets Total Assets NT WORTH 10. What is the market value of the business? 11. How was the market value of the assets determined? 12. When was the last appraisal of the assets? 13. Compensation: Current Year Proposed Insured's Salary Bonus or Commission Proposed Insured's K1 Other (describe) TOTAL Gross Business Revenue xpenses Net Income Before Taxes For total face amounts over 5 million for all insureds, please provide: Last 2 years business tax returns Last 2 years business income statements and balance sheets 20098(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT Current Liabilities Long Term Liabilities Other Liabilities Total Liabilities Last Year 2 Years Ago 40

41 Cardiac Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: 1. Have you ever had? Chest pain? Palpitations? Fluttering or skipping of the heart? Shortness of Breath? Heart murmur? Heart attack or heart failure? Coronary artery bypass graft (CABG)? Angioplasty or balloon angioplasty? Stent placement? Heart Catherization? Heart studies due to symptoms or family history? 2. When did the above event occur and was there only one event? 3. Please give the name and address of the physician you see for this condition. 4. When was the last time you saw your physician for this condition and how often do you see your physician for this condition? 5. What type of tests are completed at your follow-ups and what were the results? (KG, stress test, echocardiogram, angiogram, holter monitor). 6. What medications do you currently take for this condition? 7. o you have any other significant medical history? (diabetes, emphysema, chronic obstructive pulmonary disease, stroke, cancer, carotid disease, kidney disease, vascular disease) * 8. o you use tobacco in any form? (cigarettes, cigars, chew, nicotine gum)* *if question 7 or 8 is answered yes please contact your home office underwriter 9274(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

42 Criminal History Questionnaire Applicants with a felony or misdemeanor history are considered on an individual basis for life insurance. The National Life Group requires full and truthful disclosure in order to make an informed decision on insurability. A Criminal Records Check may be obtained at the discretion of the Company. Name (please print): ate of Birth: Policy #: ate Completed: Please list all felony or misdemeanor convictions and any pending charges: ate of Offense(s) State & County of Offense(s) Felony / Misdemeanor / Class Criminal Offense Charge(s) Sentence (Fine and/or Term Served) Probation: ate Completed or ate of Anticipated Completion Please provide additional information which you would like us to consider: 20087(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

43 epression / Anxiety / Psychiatric Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: Specific diagnosis: (i.e. depression, anxiety, bipolar, schizophrenia, other) ate of diagnosis: What medication(s) are you currently taking and dosage(s)? Have you been treated for this condition in the past? (If yes, give dates, duration and treatment) Have you ever been referred for or received outpatient psychotherapy or counseling? (If yes, provide name, address and telephone number of doctor and dates of treatment) Have you lost time from work due to your condition? (If yes, give frequency, duration and dates) Have you ever been hospitalized, attempted suicide or have you had suicidal thoughts? (If yes, give details) Physician's Name Address/Telephone Number ate Last Seen/Frequency Area of Specialty (i.e. family physician, psychologist, other) 9437(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

44 iabetes Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: ate of diagnosis: How is your diabetes treated? (i.e. diet, oral medication, insulin, other) Has your treatment ever changed? (If yes, provide details.) What medication(s) are you currently taking and dosage(s)? o you check your own blood sugars? If yes, how often do you test and what are your average readings? What was the date & result of your last hemoglobin A1C test? Have you ever been hospitalized for this condition? (If yes, provide details.) Have you had any complications as a result of your diabetes? (i.e. hypoglycemic episodes, heart disease, circulatory problems, skin infections, eye problems, stroke, kidney problems, etc.) Have you ever lost time from work due to your diabetes history? Physician's Name Address/Telephone Number ate Last Seen/Frequency Area of Specialty (i.e. family physician, endocrinologist, etc.) 9594(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

45 rug Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: Are you now using or have you, within the past 10 years, used any of the following, other than for treatment of a medical condition under proper medical supervision? Amphetamines: (Benzedrine, exedrine, 'cstasy', 'Ice', 'Speed', 'Uppers', etc.) Barbiturates: (Amytal, 'owners', Phenobarbital, Tuinal, etc.) Cannabis: ('Hashish', Marijuana, 'Pot', 'Weed', etc.) Cocaine: (Belladonna, 'Coke', 'Crack', 'Snow', etc.) Hallucinogens: ('Acid', 'Angel ust', LS, 'Microdots', Peyote, Psilocin, etc.) Opiates: (Codeine, Heroin, Methadone, Morphine, Opium, 'Smack', etc.) Sedatives: ('owners', Valium, 'Tranks', etc.) Solvents: (Aerosols, Glue, etc.) (If YS to any of the above, provide full details including name of drug and dates when usage commenced and ceased.) Have you ever sought medical treatment due to drug usage or detoxification? (If YS, provide full details including date(s) of attendance and name/address of doctor(s).) Have you suffered from any impairments associated with drug usage? (Hepatitis B, mental problems, etc.) (If YS, provide full details.) Are you now drug-free? (If YS, state when usage ceased.) 9269(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

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47 Foreign National Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: Policy Information Type of Policy: Face Amount: Rate: Purpose of Insurance: Owner: Beneficiary: Client Personal Information Name: Approximate Net Worth: ate of Birth: (mm/dd/yyyy) How long have you know them? Address: (Street, City, State & Zip Code) How well do you know this person? How and where did you meet? Who else do you know who knows this person? Category 1 US Residence Address: (Street, City, State & Zip Code) Substantial US Property List Substantial US Business Interests List Home's Value: Check one: Key Person in a US Company OR Key Person in a Foreign Company Position in Company: Travels to the US on business See tes for Additional Property Listings Company Name: Company Name: Income: times per year and stays approximately See tes for Additional Business Listings per visit. 8327(0112) Cat National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Centralized Mailing Address: One National Life rive, Montpelier, VT Page 1 of 2 47

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49 Gastro-Intestinal Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: Generally describe the symptoms: How did the doctor define the problem? (low or excess acid, gastritis, gastric or duodenal ulcer, etc) How often does the discomfort / pain / problem occur? (Give dates & duration) Has there ever been bleeding? (If "yes", what kind of treatment have you received? (etails / dates) Are you now taking medication? (Give details and name of prescribing doctor) Are you still having symptoms? (If "no", date of last symptoms.) Give full names/addresses of physicians seen for these symptoms/treatments, as well as date of last visit. 9276(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

50 Genitourinary Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: Give full names/addresses of physicians seen for this problem: How often did these incidences occur? (Give dates and duration.) How did your doctor define the cause? (xamples: urethritis, nephritis, kidney stones, prostatitis, tumor, hypertrophy of the prostate (BPH)) If a kidney stone, was the stone passed? (Naturally or with surgical assistance) Have you ever had an IVP (kidney x-ray), an x-ray other than an IVP for this problem, cystoscopy, or biopsy? (Give results) What kind of treatment have you received? (Give details & dates) Are you fully recovered? (If no, state symptoms and give details.) Has the doctor suggested further tests or surgery? 9267(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

51 Name (please print): ate of Birth: Military Personnel Questionnaire Policy #: ate Completed: 1. nlisted Warrant Officer Officer Branch: Airforce Army Marines Navy Coast Guard Merchant Marines Status: Active uty Inactive Reservist National Guard 2. Rank: 3a. Occupation: 3b. Special Forces: 4. Military Occupation Specialty (MOS): 5. ate of next enlistment: 6. What is your current or anticipated orders for military deployment: 7. o you receive special pay for any of the following? (Check all that apply & provide details) Hazard uty Scuba iving Parachuting xplosive Ordinance isposal Travel Pay Flight Pay Other etails: a. If you selected Parachuting: Static Line number of jumps: Halo number of jumps: b. If you selected Scuba iving: SCUBA diving total number of dives: Number of dives per year: eepest dive depth: Length of time under: Average dive depth: Length of time under: o you or have you used mixed gases? ate of last use: 8. Aviation - Are you actively involved or trained in any of the following? Pilot Co-Pilot Navigator Staff on Aircraft Other a. If you answered '' to Question 8, please provide: Type of aircraft: Total flying hours experience: Annual flying hours: 9. Mission Type(s) Fighter Cargo Special Ops or Back Ops Airlift AWACs Search & Rescue Recon Other Med-vac 10. o you intend to get out of the military in the next three years and work for a contracting company? If, what company? What is anticipated occupation? 11. Have you ever been placed on medical leave? If, provide details: 12. Have you ever been treated for Post Traumatic Stress isorder (PTS)? If, provide details: 20086(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

52 Migraine Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: What type of headache? (stress, migraine, cluster headache, etc.) o you have just headaches, or do you have other symptoms? (nausea, vomiting) When did the symptoms first occur? When did the symptoms last occur? Any change? How often do the headaches occur? How long do they last? (duration of headaches) Treatment? Hospitalized? (When / Where) Any tests done? (Results) Give full names/addresses of physicians seen for this problem: When last seen? Current medications: 9271(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

53 Mountain Climbing Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: 1. Indicate the Class of climbing in which you participate: Class 1 Hiking/Trails Walking without the use of hands or special equipment. Class 2 Scrambling Climbing over rocks or boulders with the use of hands and wearing proper shoes. Class 3 Class 4 Class 5 Class 6 2. o you ice climb? asy Climbing Moderate Climbing ifficult Climbing o you climb glaciers? o you climb solo? 3. How long have you been climbing? 4. Where do you climb? 5. What seasons do you climb? 6. Are you a member of a club? 7. List the equipment you use: Artificial - Aid Climbing Spring 8. o you, or do you intend to Alpine Climb? Altitudes: Steeper than Class 2, using hand and footholds and sometimes ropes. Number of easy climbs per year: Climbers are roped together and only one climber moves at a time. The stationary climber protects the others by bracing with the rope. Number of moderate climbs per year: Free climbing with the use of special equipment to protect the climber. Class and number of difficult climbs per year: 5.0 to 5.7: 5.8 to 5.11: 5.12 up: The use of special equipment to climb otherwise inaccessible or impassable routes. Number of aided climbs per year: Number ice climbs per year: Number glacier climbs per year: Number solo climbs per year: Summer, name of club: Fall Winter Number of alpine climbs per year: 20088(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

54 Respiratory Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: 1. What is your specific diagnosis? ( i.e. asthma, emphysema, COP, sleep apnea, other) 2. ate of diagnosis: 3. Have you used tobacco products in the past five years? 4. What type of symptoms do you experience with this condition? (i.e. shortness of breath, wheezing, coughing, etc.) 5. Frequency of symptoms/episodes? 6. What treatment is taken at the time of the episodes? 7. ate of last symptoms/episode? 8. o you require any kind of medication/treatment between episodes? (If, please provide details) 9. Have you had any special respiratory testing such as pulmonary function tests or sleep studies? (If, give your doctor s name, address and telephone number and the date testing was done and results) 10. Have you ever been hospitalized or treated at the mergency Room for respiratory symptoms? (If, give the date and reason for your hospitalization or treatment and the name, address and telephone number of the hospital) 11. Have you had any lost time from work due to your condition? (If, give frequency, duration and dates) 12. Have you ever used oxygen or a breathing machine? (If, please provide details) 13. If a c-pap is prescribed, how often is it used? Physician's Name Address/Telephone Number ate Last Seen/Frequency Area of Specialty (i.e. family physician, pulmonologist, etc.) 9268(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

55 Seizure/pilepsy Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: 1. When was seizures or epilepsy first diagnosed? 2. Has it been described as any particular type? (i.e. grand mal, petit mal, etc.) (If "", please provide details.) 3. Have you had any scans or other investigations? (If "", please provide details including dates of investigations and results.) 4. Regarding the frequency and severity of your attacks: a.) Please describe the nature of your attacks. b.) Are you aware of any specific provoking cause for your attacks? (If "", please provide details.) c.) How long does each attack last? d.) How frequently do attacks occur? (i.e. how often in the last 12 months) e.) When was your last attack? 5. Are you prevented from holding a driving license or are your activities restricted in any other way due to epilepsy? (If "", please provide details.) 6. Please provide details of your treatment. Include names of medication (i.e. ilantin, Tegretol, etc.), dosage and how often taken. a.) Currently: b.) In the past: 7. Regarding the monitoring of your condition: a.) Who is in charge of your follow-up? b.) How often are you seen for follow-up? c.) When was your last consultation? 8. Have you lost significant time (i.e. weeks) off work with this condition? (If "", please provide details including dates and duration of time off work.) 9. Please provide any additional information on your condition which you feel will be helpful in processing your application. 9272(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

56 Stroke / Transient Ischemic Attack (TIA) Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: What was cause of the stroke / TIA? ate of all episodes: [please indicate if these were transient ischemic attacks (TIAs) or strokes] What were your symptoms?: (i.e. coma, paralysis, seizure, difficulty speaking, headache, dizziness, etc.) What parts of the body were affected? o you have any residual paralysis, disabilities or restrictions? (If yes, please provide details) Have you had any further symptoms since your stroke or transient ischemic attack (TIA)? What medication(s) are you currently taking and the dosage(s)? Was any surgery, testing or other treatment needed? (If yes, please provide details) Physician's Name Address/Telephone Number ate Last Seen/Frequency Area of Specialty (i.e. family physician, neurologist, other) 8624(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

57 Tumor Questionnaire Name (please print): ate of Birth: Policy #: ate Completed: Where was the growth located? Was the growth removed? (When, where, and who removed the growth) Was it tested? o you know the results? (Give etails) Were you told the growth was removed completely? id you receive other treatment such as x-ray, radiation, cobalt, etc.? (If yes, please give the date of the last treatment.) Have you had any previous tumors? Any since? 9279(0112) National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. ach company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York. Cat Centralized Mailing Address: One National Life rive, Montpelier, VT

58 iabetes Tentative Rating Charts Which diabetes tentative rating chart to use: Chart 1 - Oral Medication/iet Controlled; n-tobacco Users Chart 2 - Insulin ependent; n-tobacco Users (next page) Chart 3 - Oral Medication/iet Controlled Tobacco Users (next page) Chart 4 - Insulin-ependent; Tobacco Users (next page) The following tables are based on an applicant who has good control (glycohemoglobin A1C of 8.0% or less) of his/her diabetes and has no other impairments or complications. Add % for diabetes under fair control. If poor control or non-compliant with diet/ medication - decline. Chart 1: Oral Medication/iet Controlled iabetics; n-tobacco Users Years on Medication/iet Onset Under 20 ecline ecline ecline ecline % 300% 300% 350% % 225% 250% 300% % 200% 225% 225% % 175% 200% 200% Standard 150% 175% 175% Standard Standard 175% 150% 80 + Standard Standard Standard Standard 150% = Table 2 175% = Table 3 200% = Table 4 Through 200% Table 4 may be LSW xpress Standard (non-tobacco users) 9 225% = Table 5 250% = Table 6 300% = Table 8 9 When product allows. 58

59 Chart 2: Insulin-ependent iabetics; n-tobacco Users Onset Years on Insulin Under 20 ecline ecline ecline ecline % 325% 350% 350% % 300% 300% 325% % 250% 300% 300% % 225% 250% 300% % 175% 200% 225% % 150% 175% 175% 80 + Standard 150% 150% 150% Chart 3: Oral Medication/iet Controlled iabetics; Tobacco/Nicotine Users Onset Years on Medication/iet Under 20 ecline ecline ecline ecline % 350% 350% 350% % 300% 300% 300% % 250% 300% 300% % 225% 250% 250% % 200% 225% 225% % 150% 200% 200% % 150% 150% 150% 150% = Table 2 175% = Table 3 200% = Table 4 Through 200% Table 4 may be LSW xpress Standard (non-tobacco users) 9 225% = Table 5 250% = Table 6 300% = Table 8 350% = Table 10 Chart 4: Insulin-ependent iabetics; Tobacco Users Onset Years on Medication/iet Under 20 ecline ecline ecline ecline % 350% 400% 400% % 350% 350% 350% % 300% 350% 350% % 300% 300% 300% % 225% 250% 300% % 200% 225% 225% % 200% 200% 200% 9 When products allows. 59

60 Attending Physician Statement (APS) Guidelines * The following guidelines are not meant to be all-inclusive. Requests for medical records may also be at the Underwriter s discretion due to MIB information, abnormal laboratory results, etc as well as at larger face amounts and/or older ages. We will always require medical records for applicants age 70 and above. An APS is required, regardless of the amount, if the proposed insured has consulted a physician or has had any history of the following: Within the past 10 years: Alcohol/rug abuse and/or treatment Cardiovascular or Coronary Artery isease such as bypass, angioplasty, heart attack, myocardial infarct, angina, arrhythmias, abnormal KGs, valve replacement or repair, septal defects, carotid artery disease or surgery, aneurysm Cancer (except for basal cell skin cancers) iabetes treated by insulin, with tobacco use, or any face amounts over $100,000 mphysema, COP, Chronic Bronchitis Heart Murmur Hepatitis Kidney/Renal isease Lupus Within the past 3 years: Asthma requiring oral steroid use isabled for non-musculoskeletal impairment or if taking certain pain medications Falls and injuries, over age 65 Gastric Bypass Mental disorders requiring multiple or psychotrophic medications Rheumatoid Arthritis if disabling, requiring steroid or immunosuppresent use (prednisone, methotrexate, etc) or multiple medications Seizures, epilepsy, convulsions Sleep apnea Ulcerative Colitis or Crohn s isease Multiple Sclerosis, not disabling (if disabling; no offer) Parkinson s isease, not disabling (if disabling; no offer) Peripheral Vascular isease Stroke, TIA, CVA, Cerebral Hemorrhage Routine (APS) Guidelines Ages 0-15 $500,000 and over Underwriter discretion Underwriter discretion through $1,000,000; required over $1, 000, Underwriter discretion through $500,000; required over $500, All applicants * See page six for details on ordering. 60

61 Uninsurable and Problematic Risks Applications should not be written on persons with the following impairments/issues. This list is not intended to be all-inclusive. If your applicant has a serious condition not listed here, please contact your Underwriting Team for a tentative quote. Age 70 and over must have routine physical within 24 months. If declined by another carrier within the last year, contact your Underwriting Team for a tentative quote. Abdominal Aortic Aneurysm, present or surgically corrected within the past six months Alcohol treatment within the last two years Angioplasty/Bypass or MI/heart attack in the last six months; or in combination with history of diabetes, stroke and/or continued tobacco use Alzheimer s disease, ementia or Cognitive Impairment Bankruptcy, Chapter 7, that has not been discharged Cancer treatment, current; or certain internal organ cancer diagnosed within the past three to five years contact underwriter with specific details Cirrhosis of Liver COP/mphysema, severe (on oxygen or disabling) or with current tobacco use CVA (stroke) within one year; or with history of diabetes or cardiac history iabetes if uncontrolled (glycohemoglobin A1C 10.0 and above) or if complications present (amputation, retinopathy, kidney or vascular disease) or in combination with cardiac, stroke or morbid obesity. Juvenile onset diabetes (diagnosed prior to age 20) isabled for most non-musculoskeletal related impairments (i.e. on SSI or I due to depression, PTS or other medical issues.) rug use within the last three years or daily marijuana use UI within last year or two or more within the past five years pilepsy/seizures diagnosed within one year Felony or Misdemeanor, not released from probation or parole for at least one year or charge pending; all felony convictions are otherwise individual consideration Gastric Bypass within six months Heart Surgery within six months or in combination with iabetes or Stroke history Heart Valve Surgery within one year HIV positive/ais IOLI / SOLI Investor Owned or Stranger Owned Life Insurance Kidney ialysis or Chronic Renal Failure Mental isorder/pts requiring hospitalization or disability in last year Multiple Sclerosis, if disabling or progressive Organ Transplant, awaiting or recipient Parkinson s isease if disabling Parole or Probation (see Felony or Misdemeanor above) Pregnancy with current gestational diabetes, toxemia, eclampsia, pre-eclampsia. Would reconsider at six weeks post partum. Surgery (major) pending Suicide attempt in last year; or more than one attempt within two years Valve replacement within last year 61

62 Medical Condition Probable Action Abscess... rating...standard AIS... ecline...ecline Alcoholism (total abstinence - >2 years)... Moderate rating to Standard...ecline Allergies/Allergic Reaction... rating...standard ALS (Lou Gehrig s isease)... ecline...ecline Alzheimer s disease... ecline...ecline Amputations, if not due to peripheral vascular disease... Rate for cause...ecline Anemia... Rate for cause...ecline Aneurysm, abdominal... Table 4 to ecline...ecline Aneurysm, cerebral, stable after full recovery... rating to moderate rating...ecline Angina pectoris (current; stable)... Table 6 to ecline...ecline Anxiety, mild... rating...standard or R Aortic insufficiency murmur (depends on age)... Standard to ecline...ecline Appendectomy/Appendicitis... rating...standard Atrial fibrillation (depends on frequency and cause)... rating to moderate rating...ecline Arthritis, osteo... rating...r or ecline Arthritis, rheumatoid (depends on severity)... rating to ecline...ecline Arthoscopic knee surgery (within 1 year)... rating...xclusion Rider after one year - full recovery... rating...standard or R Asthma (depends on age, attacks, medications)... rating to ecline...r or ecline Back disorder... rating...r or ecline Bartholin cyst... rating...standard Bell s palsy (fully recovered; after three months)... rating...standard Blindness (depends on cause)... rating...xclusion Rider Bone or joint disorder... Rate for cause...r or ecline Bone spur present... rating...xclusion Rider surgically corrected... rating...standard Breast cancer, (after 3 years; depends on pathology)... Possible flat extra to ecline...ecline Breast disorders, not cancer... rating...standard Broken bone fully recovered... rating...standard or R not recovered or pins/plates inserted... rating...r or ecline LIF IR 62 R = xclusion Rider This listing is not meant to be all-inclusive. Please contact your Underwriter with questions. The Probable Action guidelines are provided as a courtesy for general information purposes and should not be interpreted as tentative quotes or binding in any way.

63 Medical Condition Probable Action Bronchiectesis (depends on severity)... rating to ecline...r or ecline Bronchitis (acute)... rating...standard Bronchitis (chronic)... rating to ecline...r or ecline Bundle branch block, right/incomplete... rating...standard Bundle branch block, right/complete... rating to Table 4...Standard or ecline Bundle branch block, left/complete with cardiac evaluation... Table 4 to ecline...ecline with no cardiac evaluation... ecline...ecline Bursitis... rating...r or ecline Cancer, internal... Call for quote...call for quote Cancer, skin, basal cell (removed)... Usually Standard...xclusion Rider or ecline Cancer, skin, squamous cell (removed)... Possible Standard...ecline Cancer, skin, melanoma... Possible Standard...ecline Cardiomyopathy present or chronic... ecline...ecline resolved >3 years... Table 4 to ecline...ecline Cartilage - torn present... rating...xclusion Rider fully recovered... rating...standard or R Cataracts (recovered 3 months)... rating...standard or R Cerebral palsy... Table 4 to ecline...ecline Chronic fatigue syndrome (fully recovered)... rating...ecline Chronic obstructive lung disease (COP)... Table 2 to ecline...ecline (depends on severity) Cirrhosis of the liver... ecline...ecline Colitis, spastic... rating...standard or R Colitis, ulcerative... rating to ecline...r or ecline Concussion, cerebral within six months... Postpone...Postpone after six months - no residuals... rating...standard or R Congestive heart failure... Table 6 to ecline...ecline Convulsions... rating to Table 6...ecline Coronary artery disease... rating to ecline...ecline LIF IR R = xclusion Rider This listing is not meant to be all-inclusive. Please contact your Underwriter with questions. The Probable Action guidelines are provided as a courtesy for general information purposes and should not be interpreted as tentative quotes or binding in any way. 63

64 Medical Condition Probable Action Crohn s disease... Table 2 to ecline...ecline Cyst - sebaceous, Bartholin... rating...standard Cystic fibrosis... ecline...ecline Cystitis... rating...standard Cystocele, rectocele surgically corrected... rating...standard present... rating...xclusion Rider & C (dilatation and curettage) - benign results first year... rating...r or ecline after one year - no recurrence... rating...standard efibrillator/ventricular Tachycardia... ecline...ecline epression... rating to ecline...ecline ermatitis - atopic... rating...standard iabetes mellitus (depends on age of onset, control)... rating to ecline...ecline islocation - one occurrence; fully recovered... rating...standard iverticulitis and diverticulosis... rating to Moderate Rating...R or ecline rug abuse (total abstinence 5 years)... rating to ecline...ecline mphysema... Table 4 to ecline...ecline ndocarditis... Rate for cause...ecline pilepsy, petit mal - no attack in one year... rating...ecline pilepsy, grand mal/others - no attack in one year... rating to moderate rating...ecline sophageal stricture... Rate for cause...r or ecline Fibrositis, myositis... rating...r or ecline Fibromyalgia... rating to moderate rating...ecline Fractured skull (no residuals)... rating...standard or R Fracture (other than skull) full recovery... rating...standard or R not recovered or pins/plates inserted... rating...xclusion Rider or ecline Gall bladder disorder - present... rating...r or ecline Gastroenteritis... rating...standard or R Genitourinary disorder (rate for cause)... rating to moderate rating...standard or R Glaucoma... rating...r or ecline LIF IR 64 R = xclusion Rider This listing is not meant to be all-inclusive. Please contact your Underwriter with questions. The Probable Action guidelines are provided as a courtesy for general information purposes and should not be interpreted as tentative quotes or binding in any way.

65 Medical Condition Probable Action Gout... rating...xclusion Rider Headache, migraine... rating...standard or R Hearing impaired... rating...xclusion Rider Heart attack (depends on age/severity)... rating to ecline...ecline Heart bypass surgery (depends on age/severity)... rating to ecline...ecline Heart valve replacement... Table 4 to ecline...ecline Hepatitis, chronic Hep. B (treated and resolved)... Table 4 to ecline...ecline Hep. C (treated and resolved)... Table 4 to ecline...ecline Other... Call for quote...ecline Hernia... rating...r or decline Herniated disc... rating...xclusion Rider High blood pressure (well controlled)... rating...standard Hip disorder... Rate for cause...r or ecline Histoplasmosis, nonsystemic, six months after recovery... Table 2 to ecline...ecline Hodgkin s disease... Call for quote...ecline Hydronephrosis (fully recovered/depends on cause)... Table 2 to decline...r or ecline Hysterectomy benign... rating...standard malignant... Flat extra to ecline...ecline Ileitis, regional... Table 4 to ecline...ecline Kidney failure, dialysis... ecline...ecline Kidney infection/pyelonephritis (if no recurrence in 2+ years; depends on cause)... rating...standard or R Kidney removal (depends on cause)... Call for quote...ecline Leukemia (in remission 5+ years)... Flat extra to ecline...ecline Ligament injury - full recovery... rating...standard or R Lou Gehrig s isease - ALS... ecline...ecline Lupus, systemic... Table 4 to ecline...ecline Lupus, discoid (skin only; in remission, no steroid use)... rating...ecline Malaria - single attack... rating...standard Meniere s disease... rating...xclusion Rider Meningitis (full recovery)... rating...standard LIF IR R = xclusion Rider This listing is not meant to be all-inclusive. Please contact your Underwriter with questions. The Probable Action guidelines are provided as a courtesy for general information purposes and should not be interpreted as tentative quotes or binding in any way. 65

66 Medical Condition Probable Action Mental retardation (depends on severity)... Moderate rating to ecline...ecline Murmur (mitral)... Moderate rating to ecline...r or ecline Mitral valve prolapse... rating to ecline...standard to ecline Mononucleosis (infectious; uncomplicated recovery)... rating...standard Multiple sclerosis (not progressive or disabling)... Table 2 to ecline...ecline Myasthenia gravis... Call for quote...ecline Myocarditis... Call for quote...ecline Muscular dystrophy... ecline...ecline Nephritis single episode and no complications... rating...standard or R others... Mod. rating/ecline...ecline nhodgkins lymphoma... Call for quote...ecline Osteomyelitis... rating/moderate rating...ecline Pacemaker... Table 3 to ecline...ecline Pancreatitis... Rate for cause...ecline Paraplegic... Table 6 to ecline...ecline Parkinson s disease... Table 3 to ecline...ecline Pericarditis(present)... Rate for cause...ecline recovered... rating...standard or R Peripheral vascular disease (not severe)... Table 2 at best...ecline Phlebitis full recovery... rating...xclusion Rider multiple episodes (depends on cause)... Table 2 to ecline...ecline Pleurisy single episode and recovered... rating...standard others... Rate for cause...ecline Pneumonia full recovery, no further work up needed... rating...standard Pregnancy - current no current or past complications... rating...postpone with history of complications... Rate for cause...r or ecline Prostate; prostatitis; TURP (no malignancy) acute episode - no recurrence for 3 years... rating...standard recurrent/chronic... rating...r or ecline LIF IR 66 R = xclusion Rider This listing is not meant to be all-inclusive. Please contact your Underwriter with questions. The Probable Action guidelines are provided as a courtesy for general information purposes and should not be interpreted as tentative quotes or binding in any way.

67 Medical Condition Probable Action Psychosis (schizophrenia)... Table 6 to ecline...ecline Quadriplegic... Highly rated to ecline...ecline Raynaud s disease (full recovery)... rating...xclusion Rider Raynaud s phenomenon (depends on cause)... rating to ecline...r or ecline Rheumatic fever, no heart damage... rating...standard Sarcoidosis (depends on organs involved)... Moderate rating to ecline...ecline Sebaceous cyst - removed... rating...standard Sciatica... rating...r or ecline Sleep Apnea (consistent cpap use)... Possible Standard...ecline Stroke (after one year; full recovery)... Table 4 at best...ecline Suicide attempt (after 2 years)... Flat extra to ecline...ecline Tennis elbow... rating...standard or R Thyroid disorder hyperthyroid - if medically stable... rating...standard or R hypothyroid - controlled with medication... rating...standard Transient ischemic attack (TIA) (no residuals)... rating to moderate rating...ecline Tuberculosis (full recovery; no residuals)... rating...standard to ecline Tumors... Call for quote...call for quote Ulcer (depends on type)... rating to moderate rating...xclusion Rider Varicose veins... rating...standard or R LIF IR R = xclusion Rider This listing is not meant to be all-inclusive. Please contact your Underwriter with questions. The Probable Action guidelines are provided as a courtesy for general information purposes and should not be interpreted as tentative quotes or binding in any way. 67

68 After Issue Contract Change Quick Reference Guide LSW Products 2 Contract changes (after the rewrite period of 120 days from the application date) are considered after issue changes. These changes are processed in Customer Services. Please note that additional underwriting requirements may be needed at the underwriter s discretion. Please indicate submitting Agency Name/Number as well as Policy Number on All changes should be submitted with a completed Customer Services Agency Transmittal (catalog #45208) via to: [email protected]; or Fax to Change: Form(s): * Complete F8121 Questions: Underwriting Requirements: tes: (Indicate Policy # on top of form) Available within the first year: Available on or after first policy anniversary: Lost Policy , 4, 5 Reinstatement ated at on / /, plus signatures Contact Contract Change at Home Office Add or Increase Benefits/Riders Please check Agent's Guides for rider availability by product. Accelerated Benefits Rider Terminal (ABR1) Complete bottom section of pg 2, include statement: Add ABR Terminal Illness to Policy LSxxxxxx Accelerated Benefits Rider Chronic (ABR2) HIPAA Part A: 1a Part B: 8 Part, H, J, L Part J: Include statement Add ABR - Chronic Illness Accelerated Benefits Rider Critical (ABR3) HIPAA Part A: 1a Part B: 8 Part, H, J, L Part J: Include statement Add ABR - Critical Illness Accidental eath Benefit (AB) 8121, 8121G, HIPAA Part A: 1a, 7a, 8a, 11a 12a, 13a, 14a Part B: 6b, 8; Part, Part F, Part H, Part J, Part L Part J: Include statement Add AB Additional Protection Benefit (APB) 8121, 8121G, HIPAA Part A: 1a, 7a, 8a, 11a 12a, 13a, 14a Part B: 6b, 8; Part, Part F, Part H, Part J, Part L Part J: Include statement Add APB Children s Term Rider (CTR) 8121, 8121G, HIPAA Part A: 1a, 7a, 8a Part B: 6b, 8; Part : 1,2, Part F, Part H, Part J, Part L Part J: Include statement Add CTR * May vary with state special forms. See sample application (0911 version) on the following pages for reference. 2 Refer to Form 1441 for National Life Products After Issue Change Requirements. 3 Accelerated Benefit Riders are not available in all states or on every product. Riders may also be subject to reinsurance approval. 68

69 Change Form(s): * Complete F8121 Questions: Underwriting Requirements: tes: (Indicate Policy # on top of form) Available within the first year: Available on or after first policy anniversary: Add or Increase Benefits/Riders isability Income Rider (IR) 8121, 8121G, HIPAA Part A: 1a, 7a, 8a, 11a, 12a, 13a, 14a Part B: 6b, 8; Part, Part F, Part H, Part J, Part L Part J: Include statement Add IR (2 or 5)_ Guaranteed Insurability Rider (GIR) 8121, 8121G, HIPAA Part A: 1a, 7a, 8a, 11a, 13a Part B: 6b, 8 Part, F, J, L Part J: Include statement Add GIR Other Insured Rider (OIR) 8121, 8121G, HIPAA, 8083, HIV Consent Form 8121: Part A: 1a, 7a, Part B: 6b, 8 Part J, Part L, All questions for Second Proposed Insured Age/Amount requirements for OIR coverage applied for Part J: Include statement Add OIR, Required signatures: owner, primary insured and primary other insured Overloan Protection Rider 8121 Part A: 1a, 7a, Part B: 6b, 8. Part J, Part L Part J: Include statement Add OPR Unemployment Rider (UR) 8121, 8121G Part A: 1a, 7a, 8a, 11a, 12a, 13a, 14a Part B: 8 Part J, Part L Part J: Include statement Add UR Waiver of Premium (WP) 8121, 8121G, HIPAA Part A: 1a, 7a, 8a, 10a thru 14a Part B: 6b, 8. Part, H, J, L Part J: Include statement Add WP Change in Class: Change to preferred nontobacco class from Preferred Tobacco (nonsmoker change only) 8121, 8121G, HIPAA, HIV consent form Part A: 1a, 7a, 8a, 10a, Part B: 6b. Part : 1, Part J, L Oral Fluid or Urinalysis 1 for first 3 policy years - thereafter need Part H on 8121 aslo Part J: add Change to preferred NT class Change to nontobacco class (non-preferred) 8121, 8121G, HIV consent form, HIPAA Part A: 1a, 7a, 8a, 10a, Part B: 6b. Part : 1, Part J, L Oral fluid or Urinalysis 1 for first 3 policy years; thereafter need Part H on 8121 aslo Part J: Change to xxx class * May vary with state special forms 1 Oral fluid (if within product/amount guidelines); otherwise urinalysis. Oral Fluid not available on LSW FlexLife, LifeCycle, Advantage 79, Horizon, or IncomeBuilder. 69

70 Change Form(s): * Complete F8121 Questions: Underwriting Requirements: tes: (Indicate Policy # on top of form) Available within the first year: Available on or after first policy anniversary: Change in Class Change to better rate class within tobacco group (preferred) 8121, 8121G, HIV consent form, HIPAA Part A: 1a, 7a, 8a, 10a Part B: 6b; Part, Part H, Part J, Part L xam, blood, urine. APS to be determined upon Und. review Part J: Change to preferred (NT or Tobacco) Change to better rate class within tobacco group (non-preferred) 8121, 8121G, HIV consent form, HIPAA Part A: 1a, 7a, 8a, 10a Part B: 6b; Part, Part H, Part J, Part L To be determined upon Und. review Part J: Change to xxx class Request to reduce or remove rating 8121, 8121G, HIV consent form, HIPAA Part A: 1a, 7a, 8a, 9a, 10a, 11a, 12a, 13a, 14a Part, F, H, J, L To be determined upon Und. review Part J: add Remove or Reduce rating Terminate a Benefit or Rider: (Any) 8121, 8121G Part A: 1a, 7a Part B: 5 (if changing), Part J, Part L Part J: Terminate (rider name(s)) Increase in Face Amt of Coverage: Universal Life PPI: 8121, 8121G, HIV consent form, HIPAA OIR: 8122, 8121G, HIV consent form, HIPAA PartbA: 1a, 7a, 8a, 10a, 11a, 12a, 13a Part B: 2,6b. Part, F, H, J, L Age/Amount requirements for increase amount F8121 Part J: add Increase face amount to $ Available on exception basis only Contact Contract Change at Home Office LSW Term t Available ecrease in Face Amt of Coverage: Universal Life PPI: 8121, 8121G Part A: 1a, 7a Part B: 2, 6b. Part J, Part L Part J: ecrease face amount to $ Available on exception basis only. Contact Contract Change at Home Office ; decrease no more than 25% of largest total face amount in-force within preceding 12 months. New face amount minimum must be minimum plan amount. LSW Term Contact Home Office * May vary with state special forms 70

71 Change: Form(s): * Complete F8121 Questions: Underwriting Requirements: tes: (Indicate Policy # on top of form) Available within the first year: Available on or after first policy anniversary: Change to Owner or Beneficiary: Owner Change Absolute Assignment 1491 Use for owner change to or from business entity, trust or business associate/partners Owner Change Ownership Provision Request 1492 Use for owner change to a person non-business insurance Change beneficiary(ies) 1531 Provide all requested information Owner signature needed on changes Change in Plan of Insurance: Convert LSW Term to LSW UL ** PPI: 8121, 8121G, strategy allocation form if new policy is indexed Part A: 1a, 2a, 5a, 6a, 7a, 15a Part B: 1,2,3,4,5,6,7; Part C, Part G, Part J, Part L 8121 Part J: Convert $ from Policy #LSxxxxxxx Available only thru final conversion date as stated in the policy Convert LSW Term Spousal policy to OIR on spousal policy ** 8121 and all related new business forms 8121: Part A: 1a, 1b thru 15b Part B: 1,3,4,5,6b,7,8 Part C: G, I, J, L All questions related to second proposed insured Part J: Converting LSW Term Spousal Rider on Policy# to OIR on Policy for (PPI name) Available only thru final conversion date as stated in the policy Convert OIR to stand alone policy ** 8121, 8121G, strategy allocation form if new policy is indexed 8121 Part A: 1a, 1b thru 15b Part B: 1,3,4,5,6b,7,8 Part C, G, I, J, L All questions related to second proposed insured Part J: Convert $ from rider on Polidy #LSxxxxxxx Need signatures of Applicant Owner and OIR Term to Term Contact Contract Change at Home Office Change to other Plan of Insurance Contact Home Office Change eath Benefit Option 8121 Part A: 1a, 7a Part B: 4, Part J, Part L Part J: Change to BO * May vary with state special forms ** Riders on the term policy may carry over to the permanent plan. See prior section to add new riders. 71

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78 Part 1 - Proposed Primary Insured Information - Please PRINT 1. How long have you known the Proposed Insured(s)? 7. Which rate class was quoted? 2. Are you related? Proposed Primary Insured 2nd/Proposed Other Insured (If '', relationship?) 3. Proposed Primary Insured's Net Worth $ Household Income $ Household Net Worth $ 4. Are there existing life, disability or annuity contracts? (If '', provide Replacement Forms.) 5. To the best of your knowledge, is this insurance intended to replace any existing coverage? 6. List any sales materials, including illustrations, used relating to the new application: Part 2 - Owner's Information Agent's Report 8. Indicate underwriting requirement(s) PI 2nd/OIR Oral Fluid (Agent collected)* Blood & Urine Blood, Urine & Paramed xam Blood, Urine, Paramed xam & KG Blood, Urine, M xam & KG Blood, Urine, M xam & Stress Test xam service ordered from: *n-preferred classes only for Harbor, Foundation, Provider & LSW Term. 1. Annual Income Net Worth $ $ 2. If a Partnership involved, give full legal name or title If the above Partnership is a Limited Partnership, give name of all general partners (Print names) 4. To your knowledge is any Proposed Insured or the Owner receiving any loans, cash, promises of future benefit, free insurance, or other valuable consideration as an inducement to apply for or become an insured under this life insurance policy? 5. Are you aware that any Proposed Insured or the Owner has been involved in any discussions regarding transfer of ownership of the policy being applied for to a third party, such as (but not limited to) a life settlement company or investor group? 3. If a Corporation involved, give full legal name or title State of incorporation % of stock owned by Proposed Primary Insured % Part 3 - tes Part 4 - Agent's Signature Signature of Licensed Agent If your Agent Number is pending, please provide your address. Licensed Agent's Name (Print) Percent Agent Number/Suffix Phone Signature of Additional Agent Name of Additional Agent (Print) Percent Agent Number/Suffix Phone 8121(0511)G National Life Group is a trade name representing various affiliates, which offer a variety of financial service products. Cat P: Centralized Mailing Address: One National Life rive, Montpelier, VT Home Office: Addison, TX 78

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96 National Life Group is a trade name representing various affiliates, which offer a variety of financial service products. P: F: [email protected] Centralized Mailing Address: One National Life rive, Montpelier VT Home Office:Addison, TX