Apph1 07 life 2025

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The document is an application form for a Limited Benefit Policy from Guarantee Trust Life Insurance Company. It includes sections for applicant information, qualifying health questions, coverage selection, premium details, acknowledgments, and authorization for medical information. The form allows applicants to apply for new coverage, reinstatement, or an increase in benefits while detailing various optional riders and benefits available.

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Click ‘Get Form’ to open the application for Limited Benefit Policy in the editor.
Begin by selecting the type of application: New Coverage, Reinstatement, or Increase of Benefits. If applicable, provide the GTL policy/certificate number.
In Part A, fill in the Applicant(s) Information. Enter details such as Last Name, First Name, Birth Date, Social Security Number, and contact information for both applicants.
Complete the Qualifying Information section by answering questions regarding health history. Ensure that you answer truthfully as this impacts eligibility.
Proceed to Part B to select coverage options. Specify daily hospital confinement benefits and any optional riders you wish to include.
In Part C, calculate premiums for each applicant and total them. Choose your preferred payment mode for convenience.
Review all entered information for accuracy before signing in the Acknowledgements & Authorization section.

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