Create a Filled Out Electronic Signature Form

Fill in the fields as needed, also check the appropriate boxes.

e-SIGNATURE CONSENT OF USE OF ELECTRONIC SIGNATURES
Thank you for using the electronic application process by National Guardian Life Insurance Company (NGL).
Your consent permits the use of electronic funeral application records and electronic signatures.

PRINT OR DOWNLOAD A COPY FOR YOUR RECORDS.

• By electronically signing this document, you are saying you agree to complete and submit the prefunded funeral contract and this application for life insurance coverage by way of an electronic transaction, including the use of electronic signatures, and to receive electronic versions of certain records.
• You are entitled to change your mind and withdrawal your consent. You may do this by notifying National Guardian Life Insurance Company (NGL) and or you’re your agent. Please remember that if you should withdraw your consent or decline the e-signature process, we will not be able to complete this transaction electronically.
• You agree to keep us informed of any changes in your email and mailing address.
• You agree to receive all completed documents of this transaction via electronic means and confirm you have the software necessary to receive the completed documents.
• You agree to print or download required information for your records. If you have any trouble downloading or printing out the required information, contact NGL and or your agent at the address or telephone number given to you when you signed the prefunded funeral documents.

Electronic Signature Acknowledgement

• This acknowledgement is to make applicants and purchasers aware that by submitting an electronic signature, they are providing an electronic mark that is held to the same standard as a legally binding equivalent of a handwritten signature provided by a signee.
• For purposes of the acknowledgement, a digital mark is considered a typed legal first and last name (legal name may include middle name, initial or suffix) followed by the typed Date. Any document requiring an electronic signature shall contain a signature acknowledgment statement provide in the same area requiring the electronic signature. Specific forms include:
- Revocable Assignment
- PreFunded Funeral Agreement
- Application for Life Insurance
- Premium Withdrawal Authorization

AGREEMENT: By signing this Electronic Signature Acknowledgement Form below, I agree that my electronic signature is the legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.
Please enter your First and Last Name:

Agent



Please report any errors or anomalies to info@creativeteksolutions.com.