What if my name does not match?

If the insured’s name on the application differs from the original policy, provide supporting ID or a legal name change document. Name mismatches often trigger manual verification and delay conversion until identity is confirmed.

Can I eSign the conversion form?

Yes, most conversions can be executed electronically where carrier policy and state law permit. Electronic execution must capture signer intent, consent, and an auditable trail to meet ESIGN (15 U.S.C. §7001) and applicable state UETA standards.

Is notarization required?

Notarization depends on carrier rules and state law. If a carrier or state requires notarization or witnesses, obtain those authentications; otherwise a compliant electronic signature or agent attestation may suffice.

What supporting documents are needed?

Common attachments include the original policy schedule, recent premium payment receipt, and a copy of government-issued ID. Missing documents commonly prompt underwriting to request additional evidence.

How long does processing take?

Processing times vary by carrier and complexity; simple conversions with complete information are often processed within days, while cases requiring manual underwriting or additional documentation can take several weeks.

Who signs the application?

The policy owner or an authorized representative must sign. If the owner differs from the insured, ensure authority documentation is attached. For corporate-owned policies, an officer with authority must sign and provide organizational proof.

Electronic Signature
Templates
Insurance
Insurance Term Conversion Application

Insurance Term Conversion Application

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

INSURANCE TERM CONVERSION APPLICATION

Applicant / Insured Information

Applicant Name Insured Name (if different) Mailing Address

Phone:

Email:

Date of Birth:

Social Security Number:

State of Residence:

Current Policy Information

Insurer Name:

Policy Number:

Original Issue Date:

Original Face Amount: $

Current Death Benefit: $

Policy Owner (if different from Applicant):

Conversion Eligibility and Election

I request conversion of the policy identified above pursuant to the conversion provisions of that policy. I elect one of the following methods for conversion (check applicable):

Conversion under guaranteed conversion provision (no evidence of insurability required within guaranteed limits) Conversion requiring underwriting or evidence of insurability (for amounts above guaranteed limit) Partial conversion of policy (reduce term coverage and convert remaining portion)

If conversion is limited by time or amount, specify latest conversion date or amount eligible:

Requested New Policy

I hereby request issuance of the following form of permanent coverage (select one or more):

Whole Life Universal Life Indexed Universal Life Variable Universal Life Other:

Requested Face Amount: $

Requested Effective Date:

Premium Payment Mode (select one):

Monthly Quarterly Annual Anticipated First Premium Amount: $

Riders and Additional Benefits

Waiver of Premium Accidental Death Rider Guaranteed Insurability Rider Other Riders / Instructions:

Beneficiary Designation

Primary Beneficiary #1 Name

Relationship:

Share Percentage: %

Primary Beneficiary #2 Name

Relationship:

Share Percentage: %

Contingent Beneficiary Name

Relationship:

Share Percentage: %

Medical and Underwriting Questions

The following questions must be answered truthfully. A "Yes" answer may require additional underwriting and documentation.

Within the past 12 months, has the Proposed Insured used tobacco or nicotine products? Yes No

In the past 5 years, has the Proposed Insured been hospitalized or received treatment for a serious illness or been advised to have surgery? Yes No

If Yes to any medical question, provide details

Documentation Checklist

Attach the following documents with this application (check all enclosed):

Copy of current policy declarations page Proof of identity (driver's license or government ID) Assignment or ownership documentation (if applicable) Medical records or attending physician statements (if requested)

Exclusions, Limitations and Acknowledgements

I acknowledge that conversion is subject to the terms of the existing policy and the policy form to be issued. The insurer retains all defenses available under the law and the provisions of the policy, including contestability for material misstatement and suicide limitations as stated in the policy form. Any change in risk classification, amount of coverage, premium, riders, or policy features will be governed by the terms of the new policy issued upon conversion.

I understand that conversion under a guaranteed provision is limited to amounts and timeframes set forth in the original policy and that amounts in excess of guaranteed limits may require evidence of insurability. I further acknowledge that premium rates for the new policy will be based on the insurer's rates in effect at the time of conversion for the age, sex, class, and underwriting decision applicable to the Proposed Insured.

Applicant Acknowledgement (check to confirm) I acknowledge and understand the foregoing exclusions, limitations, and conditions of conversion.

Authorization and Certification

I certify that the statements and answers in this application are true, complete and correctly recorded to the best of my knowledge and belief. I understand that any material misstatement may render any policy issued as a result of this application voidable or subject to contest during the contestability period. I authorize the insurer and its representatives to obtain information necessary to underwrite this conversion, including medical, financial, and other records. This authorization extends to any physician, medical practitioner, hospital, clinic, or other medically related facility, employer, consumer reporting agency, or other individual or organization that has any records or knowledge of me or my health.

I authorize release of any such information to the insurer, its reinsurers, and any independent medical examiners requested by the insurer. A photocopy of this authorization shall be as valid as the original. I understand that acceptance of this application and issuance of a new policy is subject to approval by the insurer and any required payment of premiums and forms.

Signature Certification

By signing below, I certify under penalty of perjury that the information provided in this application is true and complete. I understand that the new policy will take effect only upon acceptance by the insurer and receipt of any required initial premium unless otherwise specified in the insurer's written notice of acceptance.

Applicant / Insured:

By:

Date:

What the Insurance Term Conversion Application Is

The Insurance Term Conversion Application is a formal request a policyholder submits to convert an existing term life policy to a permanent life product when the original contract includes a conversion option. The form records the original policy number, insured information, requested permanent product, requested effective date, and any adjustments to face amount or premiums. Carriers use the application to update underwriting files, calculate new premiums, and issue the replacement policy schedule. The form commonly requires signatures, identity verification, and copies of the current policy schedule or endorsement.

Why this Application Matters for Policyholders and Carriers

A properly completed conversion application preserves conversion rights, often avoids new medical underwriting, and documents the transition to permanent coverage. Accurate entries reduce processing time, prevent errors in premium recalculation, and protect both the insured and the insurer during administrative review and policy issuance.

Who Typically Completes or Receives the Application

Policyholders, producers (agents or brokers), and insurer underwriting and policy administration teams commonly prepare, submit, or review Insurance Term Conversion Applications.

Policyholder — owner or insured requests conversion and must provide accurate personal and policy details to preserve conversion rights.
Agent/Broker — prepares the application, confirms available conversion products, and submits the request to the carrier on the client’s behalf.
Underwriting/Policy Admin — verifies eligibility, recalculates premiums, and issues the new permanent policy schedule when conversion conditions are met.

Clear delineation of responsibilities among these parties helps accelerate underwriting review and reduces requests for supplemental information.

Step-by-Step: Submit a Conversion Application

Follow these sequential steps to complete and submit a conversion application correctly to the insurer.

01

Gather Details: Collect policy number, insured data, and the original policy schedule.
02

Select Product: Choose the permanent policy option and confirm the plan code with the carrier.
03

Complete Form: Fill every required field, sign, and date the application.
04

Submit: Send the signed application via agent portal, mail, or a compliant eSignature solution.

Setting Up an Online Conversion Workflow

Configure an online workflow that collects required fields, authenticates signers, and routes the completed application to underwriting for review.

Form Field or Workflow Setting Name	Configuration
Signer Authentication Method (email and phone)	Email plus SMS code for two-factor authentication.
Conditional Field Logic for Riders	Show rider and beneficiary fields only when applicable.
Document Routing and Notifications	Automatically route to underwriting queue after final signature.
Signature Type and Audit Trail Options	Enable ESIGN consent and a timestamped audit trail.

How Electronic Submission Typically Works

This flow outlines sender and signer actions from document preparation through insurer receipt and underwriting intake for a conversion application.

Upload Document: Attach the completed application and any supporting files.
Place Fields: Add signature, date, and required data fields for each signer.
Authenticate Signer: Use email link, SMS code, or stronger KBA where required.
Deliver to Insurer: Send the signed copy with an audit trail to underwriting.

Digital Signing and System Compatibility

Choose a platform that supports required file formats, signer authentication, and secure record retention for insurance conversions.

File Formats: PDF and DOCX supported.
Integrations: Integrates with CRMs and insurer systems.
Authentication: Email, SMS, or advanced KBA options.

eSignature Pricing and Feature Comparison

Basic pricing and core features for common eSignature providers; signNow is listed first per platform comparison conventions.

	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	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Key Information Required on the Application

Policy Number: Insurer policy identifier

Insured Name: Full legal name

Date of Birth: MM/DD/YYYY format

Requested Product: Permanent policy type

Face Amount: Exact dollar amount

Signatures: Required signers and dates

Consequences of Incorrect or Incomplete Applications

Processing Delay: Underwriting requests for missing data

Conversion Denial: Eligibility not established

Premium Miscalculation: Incorrect billing or refunds

Coverage Gap: Unintended lapse or reduced benefits

Identity Issues: Verification failures

Record Rejection: Unsigned or invalid submissions

Common Preparation Errors to Avoid

Using an incorrect policy number or insurer identifier that prevents retrieval of the original policy and stalls processing for days or weeks.
Entering a name that does not match government ID; this often triggers manual identity verification and delays conversion completion.
Leaving conditional fields blank when riders or beneficiaries must transfer, causing underwriters to request supplemental forms or documentation.
Submitting unsigned or improperly dated forms, or failing to capture required electronic consent under ESIGN, which leads to outright rejection.

Practical Tips for Accurate and Efficient Completion

Apply these best practices to reduce errors, speed processing, and ensure the conversion is recorded correctly.

Verify Policy Data

Cross-check the policy number, insured name, and birthdate against the original policy schedule and the insurer’s records before submission to avoid retrieval failures and underwriting delays.

Use Standard Date Formats

Enter all dates as MM/DD/YYYY and ensure the effective date aligns with contract provisions; inconsistent date formats commonly cause processing errors in automated systems.

Capture Clear Consent

For electronic signing, include the ESIGN consumer disclosure where required, document the signer’s intent, and retain consent evidence to meet legal validity and audit requirements.

Attach Supporting Documents

Include the original policy schedule, any recent endorsements, and proof of premium payment as applicable; missing documentation often triggers follow-up and extends processing time.

Real-World Scenarios and Use Cases

Two practical examples illustrate how the conversion application is used across common situations.

Agent-Assisted Conversion

A 45-year-old policyholder requests conversion before term expiry to obtain lifetime coverage and preserve insurability

Agent files the conversion using the carrier portal and attaches the policy schedule
The carrier updates the file, recalculates premiums, and issues a new permanent policy schedule within the standard processing window, minimizing coverage interruption and avoiding new underwriting evidence.

Client-Initiated eSubmission

A self-service client elects conversion using an insurer’s portal and eSignature

Client uploads ID and signs electronically
The insurer verifies identity, applies the conversion provision, adjusts premium billing, and emails the signed permanent policy schedule with an audit trail for the client’s records.

Frequently Asked Questions and Troubleshooting

Answers to common questions about completing, signing, and submitting an Insurance Term Conversion Application.

Need help? Contact support

What if my name does not match?
If the insured’s name on the application differs from the original policy, provide supporting ID or a legal name change document. Name mismatches often trigger manual verification and delay conversion until identity is confirmed.
Can I eSign the conversion form?
Yes, most conversions can be executed electronically where carrier policy and state law permit. Electronic execution must capture signer intent, consent, and an auditable trail to meet ESIGN (15 U.S.C. §7001) and applicable state UETA standards.
Is notarization required?
Notarization depends on carrier rules and state law. If a carrier or state requires notarization or witnesses, obtain those authentications; otherwise a compliant electronic signature or agent attestation may suffice.
What supporting documents are needed?
Common attachments include the original policy schedule, recent premium payment receipt, and a copy of government-issued ID. Missing documents commonly prompt underwriting to request additional evidence.
How long does processing take?
Processing times vary by carrier and complexity; simple conversions with complete information are often processed within days, while cases requiring manual underwriting or additional documentation can take several weeks.
Who signs the application?
The policy owner or an authorized representative must sign. If the owner differs from the insured, ensure authority documentation is attached. For corporate-owned policies, an officer with authority must sign and provide organizational proof.

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