Accident-Only Life Insurance – APPLY NOW

 

 

 

SECURE FORM

Application for ACCIDENT-ONLY life insurance - NO MEDICAL QUESTIONS ASKED

Complete the APPLICATION below


INSURED information:


Premium payment information

If not sure how much your expected premium will be, call (321) 300-1446

Submitter:


Coverage starts after your first premium payment. You will receive a policy by mail. NO MEDICAL EXAM needed for benefits up to $50,000. Over $50,000 it's possible to need physical measurements and urine sample/test, possibly a blood test needed depending on your age, benefit amount applied for and time since last Dr. visit.


Customer Satisfaction Guarantee: you have 30 days to receive full refund, if the coverage does not satisfy your needs. After the first 30 days, you may cancel at any time and coverage will stop at your request. Otherwise, your coverage will last for the life of the policy and premiums will never increase during that time.