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 information disclosure. The form allows applicants to apply for new coverage, reinstatement, or an increase in benefits while detailing various optional riders and benefits available. It emphasizes the importance of truthful disclosures and outlines the process for premium payments.

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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.
Proceed to Section A and answer qualifying questions regarding health history. Ensure that all answers are accurate as they determine eligibility.
Complete Part B by selecting coverage options and benefit amounts for each applicant. Specify any optional riders you wish to include.
In Part C, calculate premiums based on selected benefits and payment modes. Ensure all fields are filled accurately before submission.
Review your entries for completeness and accuracy before signing in the acknowledgments section.

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