Get Qualified

Qualifications are based on age and state availability

Where the applicant resides

Child 1

Date of Birth*

Birth date of individual to be insured

Replacement Coverage*

Does the Proposed Insured have existing life insurance or annuity contracts with The Union Labor Life Insurance Company (Union Labor Life) or any other company? *

Yes No

The current amount of total life insurance or annuity contracts the Proposed Insured has or that you are applying for with other companies (not including any coverage through your employer) is: *

If approved, do you plan to replace or change a current life insurance policy or annuity contract with the Union Labor Life insurance policy? *

Yes No

Child 2

Date of Birth*

Birth date of individual to be insured

Replacement Coverage*

Replacement Policy

Does the Proposed Insured have existing life insurance or annuity contracts with The Union Labor Life Insurance Company (Union Labor Life) or any other company? *

Yes No

The current amount of total life insurance or annuity contracts the Proposed Insured has or that you are applying for with other companies (not including any coverage through your employer) is: *

If approved, do you plan to replace or change a current life insurance policy or annuity contract with the Union Labor Life insurance policy? *

Yes No

Child 3

Date of Birth*

Birth date of individual to be insured

Replacement Coverage*

Replacement Policy

Does the Proposed Insured have existing life insurance or annuity contracts with The Union Labor Life Insurance Company (Union Labor Life) or any other company? *

Yes No

The current amount of total life insurance or annuity contracts the Proposed Insured has or that you are applying for with other companies (not including any coverage through your employer) is: *

If approved, do you plan to replace or change a current life insurance policy or annuity contract with the Union Labor Life insurance policy? *

Yes No

Child 4

Date of Birth*

Birth date of individual to be insured

Replacement Coverage*

Replacement Policy

Does the Proposed Insured have existing life insurance or annuity contracts with The Union Labor Life Insurance Company (Union Labor Life) or any other company? *

Yes No

The current amount of total life insurance or annuity contracts the Proposed Insured has or that you are applying for with other companies (not including any coverage through your employer) is: *

If approved, do you plan to replace or change a current life insurance policy or annuity contract with the Union Labor Life insurance policy? *

Yes No

Child 5

Date of Birth*

Birth date of individual to be insured

Replacement Coverage*

Replacement Policy

Does the Proposed Insured have existing life insurance or annuity contracts with The Union Labor Life Insurance Company (Union Labor Life) or any other company? *

Yes No

The current amount of total life insurance or annuity contracts the Proposed Insured has or that you are applying for with other companies (not including any coverage through your employer) is: *

If approved, do you plan to replace or change a current life insurance policy or annuity contract with the Union Labor Life insurance policy? *

Yes No

Child 6

Date of Birth*

Birth date of individual to be insured

Replacement Coverage*

Replacement Policy

Does the Proposed Insured have existing life insurance or annuity contracts with The Union Labor Life Insurance Company (Union Labor Life) or any other company? *

Yes No

The current amount of total life insurance or annuity contracts the Proposed Insured has or that you are applying for with other companies (not including any coverage through your employer) is: *

If approved, do you plan to replace or change a current life insurance policy or annuity contract with the Union Labor Life insurance policy? *

Yes No

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

NOTICE REGARDING REPLACEMENT
REPLACING YOUR LIFE INSURANCE POLICY OR ANNUITY

Spouse includes Domestic Partner, Civil Union Partner, or Legal Partner as recognized by the jurisdiction in which you reside.

Note: *Domestic Partner and Civil Union Partner

With respect to your "spouse" or "Domestic Partner" or "Civil Union Partner" the following definitions apply:

The term "spouse" means a legally married man and woman.

The term "Domestic Partner" or "Civil Union Partner" means two people of the same or opposite sex who have entered into a personal relationship or union that is recognized by a state or government without the implicit historical and religious meaning associated with the term "marriage." A "domestic partner" or "civil union partner" does not include:

persons younger than 18 years of age;
persons who enter into a personal relationship or union prior to the dissolution of a legal marriage, previous personal relationship or union, or substantially similar legal relationship of one of the parties;
persons who are ancestors, descendents, or siblings whether the relationship is by the half or the whole blood or by adoption;
aunts or uncles and a niece or nephew, whether the relationship is by the half or the whole blood or by adoption; nor
first cousins.

*Spouse includes Domestic Partner or Legal Partner as recognized by the jurisdiction in which you reside.

According to the laws of the state of Virginia, spouse is defined as a person of the opposite sex to whom you are legally married.

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Individual Juvenile Term Life Insurance

Get qualified, get a quote and get coverage in five easy steps

Qualify

Verify Eligibility

1

Quote

Review Offer

2

Enroll

Purchase Coverage

3

Payment

Subscribe to Plan

4

Finalize

Complete Purchase

5

Get Qualified

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Individual Juvenile Term Life Insurance

Get qualified, get a quote and get coverage in five easy steps

Qualify

Verify Eligibility

1

Quote

Review Offer

2

Enroll

Purchase Coverage

3

Payment

Subscribe to Plan

4

Finalize

Complete Purchase

5

Get Qualified

Child 1

Child 2

Child 3

Child 4

Child 5

Child 6

Replacement Coverage

ILLINOIS RELIGIOUS FREEDOM PROTECTION AND CIVIL UNION ACTEffective June 1, 2011

Spouse Note:

REPLACEMENT NOTICE

Ullico Select

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ILLINOIS RELIGIOUS FREEDOM PROTECTION AND CIVIL UNION ACT
Effective June 1, 2011