Cass Life

APPLICATION FOR INSURANCE COVERAGE

All pages in this site incorporate a link or selection area that will allow the downloading and printing of our application for insurance coverage. You may print this form, complete it, and fax or mail this application to us. If you prefer, you may select "Apply On Line" from the top menu bar, and apply directly on line. When making application, you agree to the following;

I (we hereby apply to the Cass County Life Insurance Company for a policy on my life (our lives) to be issued without requiring me (us) to undergo a medical examination and for that purpose, I (we) submit to the following representations and agreements:I (we) hereby represent on behalf of myself (ourselves) and everyone who may have or claim an interest in any policy issued on this application, that the following statements and answers are full true and correct. I am (we are) submitting this application with the agreement and understanding that ANY MISSTATEMENTS AS TO THE HEALTH OR PHYSICAL CONDITION OFANY APPLICANT MAY VOID THE POLICY WITHIN THE CONTESTABLE PERIOD AND THE COMPANY SHALL ONLY BE LIABLE FOR THE RETURN OF ALL PREMIUMS PAID. I (we) hereby agree that this application shall become a part of any policy issued hereon. I (we) further agree that no agent has authority to make, alter or discharge contracts or extend the time of payment of premiums or waive forfeitures and that there shall be no liability on the part of the company unless and until a policy is issued, delivered, and accepted by me (us) while I a (we are) alive and free from any disease and bodily injury.

POLICY FOR APPLICATION SUBMISSION

All applications submitted for life insurance coverage are subject to Underwriting Approval. This process normally takes 72 business hours. After approval of applications submitted via this web site, a formal application must be signed by the applicant and at least the first month's premium must be paid. This payment may be made by personal check, money order,or direct debit. Policies will be mailed via the U.S. mail or may be shipped using the FedEx system. Applicable charges will apply if FedEx shipment is requested.

PRINT APPLICATION
Select to download and print the Application: Download Application