Docstoc

To Apply

Document Sample
To Apply Powered By Docstoc
					    The University of Texas at San Antonio Alumni Association




                                                                To Apply:
                                                                Complete this form and return with your premium check
                                                                payable to:
                                                                ADMINISTRATOR
                                                                ALUMNI GROUP INSURANCE PROGRAM
                                                                P.O. BOX 10374
                                                                Des Moines, IA 50306-0374
                                                                QUESTIONS?
                                                                Call: 1-888-560-2586
                                                                Send No Money Now

    Name:
             Last            First            MI
    Add 1:
    Add 2:                                                      Request for Group Insurance From:
    City, St., Zip:                                                               .
                                                                New York Life Insurance Company
                                                                51 Madison Ave. New York, NY 10010




      G-29124-0

      GMA-PRS1

                                                                                                 34059/39250/ 1018/49741

                                                                                                    0000065-0000001-0000725
                                    *00320801000*




    G-29124-0


   GMA-PRS1

                0000066-0000002-0000725
    G-29124-0


   GMA-PRS1

                0000067-0000003-0000725
                                    *00330802000*




    G-29124-0


   GMA-PRS1

                0000068-0000004-0000725
    G-29124-0


   GMA-PRS1

                0000069-0000005-0000725
THIS PAGE IS INTENTIONALLY LEFT BLANK.




                                                             *00340803000*




                                         0000070-0000006-0000725

             0000071-0000007-0000725
THIS PAGE IS INTENTIONALLY LEFT BLANK.




                                                             *00350804000*




                                         0000072-0000008-0000725
    The University of Texas at San Antonio Alumni Association Sponsored Life
                               Insurance Program



      Attention The University of Texas at San Antonio Alumni Association




                                                                 0000073-0000009-0000725
                                                             Please call toll-free at 1-888-560-2586 for more
                                                             information about these and other insurance products.



    Alumni and their spouses under age 65 are eligible to
    apply for this plan. (Coverage may not be available in
    all states. Call Marsh U.S. Consumer at
    1-888-560-2586 for details).

                                                                 Marsh/Alumni Services
                                                                 P.O. Box 10374
                                                                 Des Moines, IA 50306-0374


                                                                                                                       *00360805000*





                                                                                                   0000074-0000010-0000725
    Administered by:



    Marsh U.S. Consumer,
    a service of Seabury & Smith, Inc.
    P.O. Box 10374
    Des Moines, IA 50306-0374
    Questions?
    If you have any questions or need more information
    about the Alumni-sponsored 10-Year Group Term Life
    Insurance Plan, please call toll-free at 1-888-560-2586.
    Underwritten by:




    New York Life Insurance Company
    51 Madison Ave.
   New York, NY 10010




                                                               0000075-0000011-0000725
THIS PAGE IS INTENTIONALLY LEFT BLANK.




                                                             *00370806000*




                                         0000076-0000012-0000725
                                                           The 10-Year Group Term Life Insurance Plan is
                                                           sponsored by UTSAAA Alumni as an Alumni
                                                           service to you. It allows you and your spouse to
                                                           supplement your current insurance plan at an
                                                           affordable group rate. UTSAAA Alumni incur no
                                                           expense through the sponsorship of these programs.
                                                           Administered by:


                                                           Marsh U.S. Consumer,
                                                           a service of Seabury & Smith, Inc.
                                                           P.O. Box 10374
                                                           Des Moines, IA 50306-0374




    If you have any questions or need more information about the UTSAAA Alumni-sponsored 10-Year
    Group Term Life Insurance Plan, please call toll-free at 1-888-560-2586.
                Underwritten by:
                New York Life Insurance Company
                51 Madison Ave.
                New York, NY 10010
    This brochure provides a general description of the insurance plan offered and is not a contract.
    Complete terms are detailed in Group Policy No. G-29124-0 (Policy Form GMR) issued to the Group
    Policyholder, The Trustees of the Alumni Group Insurance Trust. Each insured individual will be
   provided with a Certificate of Insurance that summarizes the policy provisions affecting his/her coverage.




                                                                                            0000077-0000013-0000725
                        *00380807000*








    0000078-0000014-0000725

             0000079-0000015-0000725
    Residents of Puerto Rico:
    Please send the completed application to:
    Global Insurance Agency, Inc.
    P.O. Box 9023918
    San Juan, Puerto Rico 00902-3918
    The 10-Year Level Term Life Plan is underwritten by:




    New York Life Insurance Company
    51 Madison Ave.
    New York, NY 10010
    The 10-Year Level Term Life Plan is administered by:


    Marsh U.S. Consumer,
    a service of Seabury & Smith, Inc.
    P.O. Box 10374
    Des Moines, IA 50306-0374
    AR Ins. Lic. #245544
    CA Ins. Lic. #0633005
    d/b/a in CA Seabury & Smith Insurance Program
    Management
    Questions?
    If you have any questions or need more information
    about the 10-Year Group Term Life Insurance Plan or
    other insurance products, please call toll-free at
    1-888-560-2586.
    This brochure provides a general description of the
    insurance plan offered and is not a contract. Complete
    terms are detailed in Group Policy No. G-29124-0
    (Policy Form GMR) issued to the Group Policyholder,
    The Trustee of the Alumni Group Insurance Trust. Each
    insured individual will be provided with a Certificate of
    Insurance that summarizes the policy provisions
    affecting his/her coverage.
                                           LYA113P-34059


                                                               *00390808000*

                                           November 2010




                                           0000080-0000016-0000725

				
DOCUMENT INFO
Categories:
Tags:
Stats:
views:0
posted:5/31/2012
language:
pages:16