Use the below guidelines and the Enrollment Form to master all necessary requirements when filling out an enrollment form. Please note: Enrollment forms may differ based on the product being sold.

General Information

Instructions

1. Applicant

2. Beneficiary (for excess proceeds)

3. Preplanned Amount

4. Payment Selection

Example: Single Pay/Down Payment ($1,000) + Time Pay ($214.20) = Total Amount of the first cheque or draft ($1,214.20)

5. Applicant Health Questions

6. Signature

Reminder: Any person holding power of attorney can also sign for the applicant on the line provided on a Guaranteed Issue Plan only. This POA signature should be followed by “POA (insert name) acting on behalf of (applicant name).” In this scenario, the applicant would still be the certificate owner. A POA signature does not make the POA the certificate owner unless he/she separately has insurable interest.

7. Certificate Owner

8. Representative Signature and Information

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