Puritan Life Insurance Company of Scottsdale, AZ Administrative offices PO Box 11823 Winston-Salem, NC 27116
FOR MEMBER TO COMPLETE
READ BEFORE FILLING OUT THIS FORM!
YOU DO NOT HAVE COVERAGE UNTIL PREMIUM IS PAID. CALL FOR PAYMENT OPTIONS, 800-715-9369.
New Members have access to term life insurance on a guaranteed issue basis for coverage amounts up to $50,000. The guaranteed issue period starts the first day of the month following the membership effective date and lasts for 60 days.
If you are applying for coverage after the guaranteed issue period has ended, or for any amount of coverage over $50,000, you MUST call our office to start the application process.