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Term Life (ages 18-64)
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Guaranteed Issue Term Life (ages 45-75)
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Presented and Administered
by Selman & Company

Guaranteed Issue Term Life
:: Eligibility Verification

Please answer the following:

* Required Field

NOTE: Members and spouses ages 45-75 are eligible for coverage.

How did you hear about our Guaranteed Term Life Insurance Program?*

Are you a current Police and Fire Federal Credit Union member?*

Yes No

If you received a letter in the mail, please enter the PromoCode located beneath the 'Reply By Date' of your letter (otherwise, leave blank):

State in wich you permanently reside
Coverage Type
Member Information
Date of Birth
Gender
Amount of Coverage

Guaranteed Issue Group Term Life Insurance
Underwritten by Monumental Life Insurance Company, Cedar Rapids, IA, an AEGON company
Sponsored by Police and Fire Federal Credit Union
Form Number TL1000GPM
NAIC # 66281
Presented and Administered by Selman & Company
6110 Parkland Boulevard
Cleveland, OH 44124
877-665-7563 - Phone
440-646-9339 - Facsimile
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1013 WS-CU
26142165