Can I sign the application electronically?

Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states; New York uses ESRA. Ensure consumer-facing disclosures are provided when required and that the eSignature method captures intent, consent, attribution, and record retention.

When is a notary required?

Most insurance applications do not require notarization, but certain authority/assignment forms or state-specific replacement notices may. Verify the carrier’s instructions and state rules before obtaining notarization to avoid unnecessary fees.

What happens if information is incorrect?

Material inaccuracies can lead to underwriting delays, rescission, claim denial, or producer discipline. Correct obvious errors immediately and document the correction per carrier policy to reduce regulatory and claim risk.

How should I provide medical authorizations?

Use the exact release language requested on the application, sign and date authorizations, and retain copies. When PHI is involved, ensure workflows and vendors meet HIPAA requirements and that a BAA is in place.

Is a witness required for the signature?

Witness requirements vary by state and by the form; most standard life insurance applications do not require a witness. Check carrier instructions and state law when the application includes testamentary or assignment elements.

How do I resolve a rejected application?

Address the carrier’s stated reason, provide requested documentation, and resubmit corrected pages with a cover note referencing the underwriting file number; maintain copies of all correspondence for audit and appeal purposes.

Electronic Signature
Templates
Insurance
Globe Life Insurance Application

Globe Life Insurance Application

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Application for Reinstatement

United Home Life Insurance Company • 225 S. East St. • P.O. Box 7192 • Indianapolis, IN 46207-7192 • 1-800-428-3001

Policy Number

Proposed Insured

Spouse (If spouse coverage)

Premium Collected

Mode/Method of Payment

Home Office Use Only

I hereby apply for Reinstatement.

As an inducement to the Company to approve this application, I agree that:

a. The statements and answers in this application are true and complete.

b. No insurance will be in force until this application is approved:

1. during the lifetime and sound health of the proposed insured; and

2. also during the lifetime and sound health of the spouse and the children, if they are covered under the policy or any rider being reinstated.

c. Approval of this application will be void if at any time within two years from the approval date any of the statements or answers are found to be untrue.

d. If approved:

1. this application, along with the original application, will become part of the policy described above; and

2. a copy will be returned to the policyowner to attach to the policy.

If Spouse coverage, complete 1a and 2a.

1. Proposed Insured’s Occupation

2. Exact Height

Weight

Date of Birth

Has weight changed more than 10 lbs. in past year? Yes No If yes, amount of increase decrease

1a. Spouse’s Occupation

2a. Exact Height

Weight

Date of Birth

Has weight changed more than 10 lbs. in past year? Yes No If yes, amount of increase decrease

The representations made below apply to EACH PERSON who would be insured under the policy, including any riders, if reinstated. These individuals include: the insured; any person other than the insured on whose death the premiums would be waived; the insured’s spouse or children; and any other individual covered by the stated policy.

3. Since the date of the original application has any proposed insured:

a. Had any consultation or treatment by a member of the medical profession, physician or practitioner, examination in a clinic, hospital, dispensary, or sanitarium; any surgical operation, x-ray, electrocardiogram, or other tests, or been told there is a need for them?

Yes No

b. Had or been told they have any disease, illness, impairment or injury, either physical or mental, by a member of the medical profession?

Yes No

c. Ever been diagnosed or treated by a member of the medical profession for Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC) or any other immune disorder?

Yes No

d. Been exempted or discharged as unfit from military service; applied for any kind of disability compensation; or had an application for life or health insurance: declined; postponed; limited; or issued other than as applied for?

Yes No

e. Engaged in or contemplate engaging in scuba or sky diving, racing, or other hazardous sports; or made or contemplate making flights as a pilot or student pilot?

Yes No

f. Had a driver’s license revoked or suspended or been convicted of a felony; sought or received advice, counseling or treatment by a member of the medical profession for the abuse of alcohol or drugs; used (other than as prescribed by a member of the medical profession) narcotics, cocaine, heroin, amphetamines, barbiturates, hallucinogens, or marijuana; used alcohol to the point of intoxication on a regular basis?

Yes No

g. Used any nicotine products in the past 12 months?

Yes No

Details of “Yes” answers to any questions:

Page 2 - Signatures and Authorization

***WARNING***

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Dated at

Month

Day

Year

Signature of Agent

Signature of Proposed Insured

Signature of Witness, if Agent not Present

Signature of Spouse

Current Address of Payor

Signature of Owner – If Other Than Proposed Insured

City/State/Zip of Payor

Signature of Owner – If Other Than Proposed Insured

Social Security Number of Insured/Owner

Authorization

I hereby authorize any: licensed physician; medical practitioner; hospital; clinic or other medical or medically related facility; insurance company; MIB, Inc.; or other organization, institution or person, that has any records or knowledge of me or my dependents or our health, to give the United Home Life Insurance Company or its reinsurer(s) any such information.

I understand that I am giving permission to release medical information which may include treatment of: physical and/or emotional illness; communicable diseases; alcohol or drug abuse treatment; and/or HIV, AIDS, or AIDS-related information.

I understand that United Home Life Insurance Company may require that I submit to an HIV (HTL VIII) Screen; I authorize that test for underwriting purposes.

A photographic copy of this authorization shall be as valid as the original. This release may be used for any legitimate insurance purpose for up to two (2) years from the date the contract is reinstated.

Date

Signature of Proposed Insured

(Required on proposed insureds age 15 and up)

Date

Signature of Spouse

Authorization

I hereby authorize any: licensed physician; medical practitioner; hospital; clinic or other medical or medically related facility; insurance company; MIB, Inc.; or other organization, institution or person, that has any records or knowledge of me or my dependents or our health, to give the United Home Life Insurance Company or its reinsurer(s) any such information.

I understand that I am giving permission to release medical information which may include treatment of: physical and/or emotional illness; communicable diseases; alcohol or drug abuse treatment; and/or HIV, AIDS, or AIDS-related information.

I understand that United Home Life Insurance Company may require that I submit to an HIV (HTL VIII) Screen; I authorize that test for underwriting purposes.

A photographic copy of this authorization shall be as valid as the original. This release may be used for any legitimate insurance purpose for up to two (2) years from the date the contract is reinstated.

Date

Signature of Owner

Direct Payment Options

IMPORTANT: All past due premiums must be paid current before an application for reinstatement will be reviewed. If a billing option is not specified and your application is approved, then the policy will be placed on direct monthly billing.

DIRECT PAYMENT OPTIONS

Monthly Quarterly Semi-Annual Annual

MONTHLY BANK DRAFT

TO BEGIN MONTHLY BANK DRAFT, THE AUTHORIZATION BELOW MUST BE COMPLETED AND ACCOMPANIED BY A CHECK MARKED “VOID.” THE MONTHLY DRAFT DATE WILL BE THE SAME AS THE POLICY DATE UNLESS INDICATED.

Bank Name

Bank Account Number

Bank Routing Number

Bank Address: City/State/Zip

Requested Draft Date (1st – 30th)

Checking Savings

AUTHORIZATION TO HONOR CHECKS DRAWN BY THE UNITED HOME LIFE INSURANCE COMPANY

Indianapolis, Indiana

As a convenience to me, I hereby request and authorize you to pay and charge to my account, debit entries drawn on my account by and payable to the order of the United Home Life Insurance Company, Indianapolis, Indiana, provided there are sufficient collected funds in said account to pay the same upon presentation.

I further agree that if any such debit entry be dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability whatsoever even though such dishonor results in the forfeiture of insurance.

Date

Signature of Premium Payor (name must appear on void check)

Fair Credit Reporting Act / MIB Notice

In compliance with the provisions of the FAIR CREDIT REPORTING ACT, this notice is to inform you that in connection with your application for insurance an investigative consumer report may be prepared. Such a report includes information as to the consumer’s character, general reputation, personal characteristics, and mode of living and is obtained through personal interviews with friends, neighbors, and associates of the consumer.

Information regarding your insurability will be treated as confidential. United Home Life Insurance Company or its reinsurer(s) may, however, make a brief report thereon to the MIB, Inc., formerly known as Medical Information Bureau, a non-profit membership organization of life insurance companies, which operates an information exchange on behalf of its members.

I declare that I have read and understand the above notice.

Dated at

Month/Day/Year

Signature of Proposed Insured

Signature of Spouse

Signature of Agent

Signature of Owner – If Other than Proposed Insured

Important Information for Verifying Identification

To help fight the funding of terrorism and money-laundering activities, Federal law requires all financial institutions (including insurance companies) to obtain, verify and record information that identifies each person who engages in certain transactions.

Authorization for Release of Medical Information

United Home Life Insurance Company • P.O. Box 7192, Indianapolis IN 46207-7192

This authorization complies with the HIPAA Privacy Rule.

Name of proposed insured/patient (please type or print)

Date of Birth

I authorize any health plan, physician, health care professional, hospital, clinic, laboratory, pharmacy or pharmacy benefit manager, medical facility, or other health care provider that has provided payment, treatment or services to me or on my behalf within the past 10 years to disclose my entire medical record, prescription history, medications prescribed and any other protected health information concerning me to United Home Life Insurance Company.

This authorization shall remain in force for 30 months following the date of my signature below, and a copy of this authorization is as valid as the original.

Signature of Proposed Insured/Patient or Personal Representative

Date

Description of Personal Representative’s Authority or Relationship to Patient

What the Globe Life Insurance Application Is and when it’s used

The Globe Life Insurance Application is the formal form applicants complete to request individual life insurance coverage from Globe Life or its affiliates. It collects personal identification, beneficiary designations, health and medical history, coverage selections, payment information, and any required authorizations for medical records and consumer reports. Insurers use the application to begin underwriting, verify insurability, calculate premiums, and establish the policy effective date. Applications may be submitted on paper or electronically, and must be accurate and complete to avoid processing delays or coverage gaps.

Why completing the Globe Life Insurance Application properly matters

A correctly filled application speeds underwriting, reduces follow-up requests, and establishes a clear record of consent and disclosures. Accurate data supports correct premium calculation, valid beneficiary designations, and timely policy issuance while lowering the risk of rescission or claim disputes.

Who interacts with the Globe Life Insurance Application

The form is used by applicants, licensed agents, and carrier underwriters across the policy lifecycle.

Individual applicants completing personal, health, and beneficiary information for a new policy or change request.
Licensed insurance agents and brokers who assist, review, and submit applications on behalf of clients.
Underwriting and policy administration teams who review disclosures, order exams, and make coverage decisions.

Proper handling by each participant preserves legal validity and helps the carrier process coverage efficiently.

Primary roles and signing authority

Agent / Broker

A licensed producer who completes sections with the applicant, attests to their knowledge, and may sign agent declaration fields; agents must follow state producer licensing and agency appointment rules and keep disclosure copies for compliance.

Applicant / Policyowner

The individual applying for coverage who must provide truthful answers, sign authorizations and attestation statements, and is legally responsible for material disclosures that affect underwriting and claim outcomes.

Step-by-step: completing and submitting the application

Follow these four steps to prepare a complete Globe Life Insurance Application for underwriting.

01

Prepare documents: Gather ID, medical records authorization, and beneficiary details before beginning.
02

Enter application data: Complete each field carefully, using MM/DD/YYYY for dates and full legal names.
03

Sign and authorize: Applicant signs required attestation and medical release fields; agent signs agent-declaration fields if applicable.
04

Submit to carrier: Send via the carrier portal, licensed agency system, mail, or an accepted eSubmission channel.

How to configure an online Globe Life Insurance Application workflow

Configure digital workflows so applications route correctly and capture required data, consent, and audit information.

Field	Configuration
Template	Create a reusable application template with required and conditional fields.
Conditional Logic	Show or hide health questions based on prior answers to reduce signer friction.
Signer Authentication	Require email, SMS code, or stronger ID verification per state or carrier rules.
Storage	Archive completed applications to secure storage with retention policy controls.

Common submission routes for the completed application

Choose the destination that matches the agent agreement and carrier intake process.

Carrier Agent Portal: Upload completed application directly into Globe Life’s producer portal for immediate intake.
Underwriting Desk: Submit via designated underwriting email or system to initiate review and exam requests.
Paper Mail: Send signed original if the carrier requests hard copy documentation or original signatures.
Secure eSubmission: Transmit via a secure eSignature provider or agency system that preserves audit trails.

Digital signing and platform considerations

Ensure the eSignature platform you use supports required authentication, audit trails, and secure storage.

Authentication: Email, SMS, or KBA per carrier requirements.
Compliance: ESIGN/UETA compliance and BAA availability for PHI workflows.
Integrations: Connectors for agency management systems and cloud storage.

Choose a platform that provides cryptographic timestamps, an immutable audit trail, and secure export formats to meet carrier and regulatory needs.

eSignature vendor pricing and capability snapshot

Comparison of starting price and a few capabilities across common eSignature vendors; signNow is listed first per platform data.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by vendor	Varies by vendor	Varies by vendor	Varies by vendor
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

How to download, save, and share the completed application

Completed applications should be exported in formats that preserve signatures and audit trails for storage and future retrieval.

PDF/A Export

Save a signed PDF/A copy to preserve signature appearance and improve long-term archival compatibility with document management systems.

Download with Audit

Include the platform audit trail (timestamps, IP, signer email) with the downloaded package for evidentiary value.

Cloud Storage

Store signed copies in secure cloud repositories (encrypted at rest) and map to carrier or agency folders for compliance.

Printable Copy

Generate a printable packet when an original wet signature or a mailed original is required by the carrier.

Common mistakes that delay Globe Life Insurance Application processing

Incomplete health answers or missing provider details that force underwriting clarification and slow processing.
Mismatched names or TIN errors that block identity verification and can trigger backup withholding.
Unsigned or undated sections that render the application invalid until re-executed.
Ambiguous beneficiary designations or missing contingent beneficiary details leading to probate or claim disputes.

Risks and potential consequences of incorrect or fraudulent applications

Rescission Risk: Insurer may rescind policy for material misstatements.

Claim Denial: Inaccurate disclosures can result in claim denial.

Tax Withholding: Incorrect TIN may trigger 24% backup withholding.

Regulatory Penalty: Producer noncompliance can lead to licensing sanctions.

Fraud Consequences: Intentional misrepresentation may carry criminal penalties.

Privacy Breach: Improper PHI handling risks HIPAA liability.

Practical tips for accurate and efficient completion

Adopt consistent practices to reduce rework and support smooth underwriting decisions.

Verify identity and TIN

Confirm the applicant’s government ID and Social Security Number before entry; mismatches are a leading cause of processing delays and potential tax withholding issues.

Document health details precisely

Provide provider names, dates, and diagnosis details where requested; precise, verifiable entries reduce the need for medical record retrieval and speed underwriting.

Use clear beneficiary language

Include full names, relationships, and percentage allocations for primary and contingent beneficiaries to limit ambiguity at claim time.

Preserve audit trails

Retain signed copies with audit logs (timestamps, IP, signer identity) to support enforceability and respond to inquiries or audits efficiently.

Key milestones from submission to policy issue

Typical sequential milestones and what to expect at each stage of application processing.

01

Submission Received

Carrier intake logs the application and assigns an underwriting file number.

02

Underwriting Review

Underwriters evaluate risk, order exams, or request records; timeframe often 7–21 days.

03

Conditional Approval

Carrier issues conditional terms or requests additional documents before final acceptance.

04

Policy Issue

Upon acceptance and payment, the policy is issued with an effective date and welcome packet.

Real-world examples of digital signing for insurance workflows

Use cases show how electronic workflows reduce friction for applicants, agents, and carriers.

Martin Properties

A small agency moves applications online to eliminate in-person meetings and lost pages.

Reduced turnaround time for signatures and follow-up actions.
"I can process and execute all of these documents online with 100% compliance and built-in security. Whether on mobile or working offline, I can get forms back to their necessary parties efficiently."

Fertility Centers of Illinois

A healthcare organization integrates e-signatures for patient and beneficiary forms to streamline intake.

Electronic audit trails reduce administrative follow-up.
"The airSlate SignNow team has been exceptional, responsive, the API has been great, and we're extremely happy that we chose airSlate SignNow as a company."

FAQs and troubleshooting for the Globe Life Insurance Application

Frequently asked questions about signature methods, legal validity, and common errors when submitting applications.

Need help? Contact support

Can I sign the application electronically?
Yes. Electronic signatures are enforceable under the ESIGN Act (15 U.S.C. §7001) and UETA in most states; New York uses ESRA. Ensure consumer-facing disclosures are provided when required and that the eSignature method captures intent, consent, attribution, and record retention.
When is a notary required?
Most insurance applications do not require notarization, but certain authority/assignment forms or state-specific replacement notices may. Verify the carrier’s instructions and state rules before obtaining notarization to avoid unnecessary fees.
What happens if information is incorrect?
Material inaccuracies can lead to underwriting delays, rescission, claim denial, or producer discipline. Correct obvious errors immediately and document the correction per carrier policy to reduce regulatory and claim risk.
How should I provide medical authorizations?
Use the exact release language requested on the application, sign and date authorizations, and retain copies. When PHI is involved, ensure workflows and vendors meet HIPAA requirements and that a BAA is in place.
Is a witness required for the signature?
Witness requirements vary by state and by the form; most standard life insurance applications do not require a witness. Check carrier instructions and state law when the application includes testamentary or assignment elements.
How do I resolve a rejected application?
Address the carrier’s stated reason, provide requested documentation, and resubmit corrected pages with a cover note referencing the underwriting file number; maintain copies of all correspondence for audit and appeal purposes.

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