Fillable MGAPB(02) (41478 - Activated, Traditional)

Description
APPLICATION FOR INSURANCE * UNITED AMERICAN INSURANCE COMPANY A LEGAL RESERVE STOCK COMPANY * ADMINISTRATIVE OFFICE: MCKINNEY, TEXAS Requested Effective Date (mm-dd-yyyy) Payment Mode Payment Type ARIZONA Draft Day (01 to 28 only) BASE PLAN - 2 0 Monthly Quarterly Bank Draft Semi-Annual Annually Direct Foundation Signature SeriesTM Primary Insured Spouse Child 1 Child 2 Child 3 Child 4 Child 5 Child 6 Child 7...
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