Page 27 - Customer-Booklet_Texas
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Loyal American Life Insurance Company®
PO Box 559015, Austin, TX 78755-9015 • Toll Free: 866-459-4272
NOTICE TO APPLICANT REGARDING
REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE
According to your application and information you have furnished, you intend to lapse or otherwise terminate existing
accident and sickness insurance and replace it with a policy to be issued by Loyal American Life Insurance Company®.
For your information and protection, you should be aware of and seriously consider certain factors which may affect the
insurance protection available to you under the new policy.
1. Health conditions which you may presently have may not be immediately or fully covered under the new policy. This
could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been
payable under your present policy.
2. You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your
policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors
involved in replacing your present coverage.
3. If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain
that all questions on the application concerning your medical/health history are truthfully and completely answered. Fail-
ure to include all material medical information on an application may provide a basis for the company to deny any future
claims and to refund your premium as though your policy had never been in force. After the application has been com-
pleted, it should be carefully reviewed before being signed to be certain that all information has been properly recorded.
4. New policies may be issued at an older age than that used for issuance of your present policy; therefore, the cost of the
new policy, depending upon the benefits, may be higher than you are paying for your present policy.
5. The renewal provisions of the new policy should be reviewed so as to make sure of your rights to periodically renew
the policy.
The above “Notice to Applicant” was delivered to me on:
________________________________________________
Date
Witness _________________________________________
Writing Agent
________________________________________________
Applicant’s Signature
LY-RPN-FL 07/12
PO Box 559015, Austin, TX 78755-9015 • Toll Free: 866-459-4272
NOTICE TO APPLICANT REGARDING
REPLACEMENT OF ACCIDENT AND SICKNESS INSURANCE
According to your application and information you have furnished, you intend to lapse or otherwise terminate existing
accident and sickness insurance and replace it with a policy to be issued by Loyal American Life Insurance Company®.
For your information and protection, you should be aware of and seriously consider certain factors which may affect the
insurance protection available to you under the new policy.
1. Health conditions which you may presently have may not be immediately or fully covered under the new policy. This
could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been
payable under your present policy.
2. You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your
policy. This is not only your right, but it is also in your best interest to make sure you understand all the relevant factors
involved in replacing your present coverage.
3. If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain
that all questions on the application concerning your medical/health history are truthfully and completely answered. Fail-
ure to include all material medical information on an application may provide a basis for the company to deny any future
claims and to refund your premium as though your policy had never been in force. After the application has been com-
pleted, it should be carefully reviewed before being signed to be certain that all information has been properly recorded.
4. New policies may be issued at an older age than that used for issuance of your present policy; therefore, the cost of the
new policy, depending upon the benefits, may be higher than you are paying for your present policy.
5. The renewal provisions of the new policy should be reviewed so as to make sure of your rights to periodically renew
the policy.
The above “Notice to Applicant” was delivered to me on:
________________________________________________
Date
Witness _________________________________________
Writing Agent
________________________________________________
Applicant’s Signature
LY-RPN-FL 07/12
