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ASSURING LIFE INSURANCE COMPANY Application for SIMPLIFIED LIFE INSURANCE Post Office Box 82533, Lincoln, NE 685012533 (402) 4766500 (800) 2767619 FAX (402) 4374591 PLEASE PRINT WITH BLACK INK 1.
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How to fill out Assurity Life Insurance Company:

01
Visit the Assurity Life Insurance Company website or contact their customer service to obtain the necessary forms and information.
02
Carefully read through the application form and any accompanying instructions to ensure you understand all the requirements and questions.
03
Gather all the required documents and information that are needed for the application. This may include personal identification, medical history, financial information, and beneficiary details.
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Complete the application form accurately and provide all the requested information. Double-check your responses to ensure there are no mistakes or missing information.
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If you have any questions or need clarification on any section of the application form, contact Assurity Life Insurance Company for assistance.
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Review the completed application form one final time to ensure everything is filled out correctly and all necessary documents are attached or included.
07
Sign and date the application form as required. If there are any additional signatures required from witnesses, make sure to obtain them.
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Submit the filled-out application form and any required documents to Assurity Life Insurance Company by mail or through their online submission process. Keep copies of all documents for your records.

Who needs Assurity Life Insurance Company:

01
Individuals who want to financially protect their loved ones in the event of their own death.
02
People with dependents such as children or spouses who rely on their income.
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Individuals who have outstanding debts, such as a mortgage or loans, that they want to ensure are taken care of in case of their passing.
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Those who want to leave a financial legacy or charitable contribution to a specific person or organization.
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People who are concerned about the potential financial burden their funeral and final expenses may pose on their loved ones.
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Individuals with high-risk occupations or health conditions that may make it more difficult for them to obtain life insurance elsewhere.
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Business owners who want to protect their business and ensure its continuity in the event of their death.
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Individuals who want to build cash value over time with the option to borrow against it in the future.
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Assurity Life Insurance Company is a life insurance company that offers various insurance products and services.
Policyholders who have purchased life insurance from Assurity Life Insurance Company may be required to file certain forms or reports.
To fill out Assurity Life Insurance Company forms, policyholders may need to provide personal information, policy details, and any other requested information.
The purpose of Assurity Life Insurance Company is to provide financial protection and security to policyholders and their beneficiaries in case of unexpected events.
Policyholders may need to report their personal information, policy details, beneficiaries, and any changes to their policy.
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