1-800-555-0955

Getting Started

Please complete the following information. Note that before we complete your proposal an Ameritas Advisor Consultant will contact you or your advisor by phone to briefly discuss how you plan to use your life insurance so the proposal can be tailored to meet your needs. When you receive your proposal, you will also receive a prospectus which provides detailed information about policy limitations, risks, charges and expenses. Please read it carefully before investing or sending money.  Variable products have investment risk, including the possible loss of principal.

Below is a detailed list of forms to be completed to start the process.

What is your State of Residence?

   State:

Does applicant have existing coverage? Yes    No
Is applicant replacing existing coverage? Yes    No

Transfer $ from other company?

1035 Exchange      None

Select all that apply:
Diabetic   Aviation   Hazardous Hobbies   Military  
Travel   Alcohol   Drugs

      

Keep in mind replacement may not be right for everyone. There can be significant penalties and charges when surrendering an existing variable life policy.
Need Help?
Contact our salaried professionals
at 1-800-555-0955 or e-mail us at direct@ameritas.com.
Ameritas Advisor VUL (Form 4051) is issued by Ameritas Life Insurance Corp. and underwritten by affiliate Ameritas Investment Corp. Product available in most states.  Variable products have investment risk, including the possible loss of principal. Before investing, carefully consider the investment objectives, risks, charges, expenses and other important information about the policy issuer and underlying investment options. This information can be found in the policy and  investment option prospectuses. Read the prospectuses carefully before investing. It is possible that coverage may lapse if policy costs reach maximum guaranteed levels, and premiums continue to be paid at the initial planned premium level.

AD-VULW 006 Rev. 12-08
Copyright 2009 Contact Us | Privacy | Legal