Policy Number. Increasing Amount: Yes No Plan Name: If increasing, ultimate amount: Birth Date Tobacco Pref Last Name First Middle M/D/Y Sex Class Use Joint Insured Life Specify others, e.g. Second Life, Waiver, ADB, etc. Previous inforce with co.: Of which we retain: Now applying for: Of which we will retain:
Policy Number. Specimen Beneficiary: Xxxx Xxx Policy Effective Date: July 1, 1997 Date of Birth: January 1, 1959 Income Tax Status: Non-Qualified Tax ID Number: 999-99-9999 Initial Premium: $20,000 Annuity Date: July 1, 2044 -------------------------------------------------------------- ------------------------------------------------------------ Owner Information Annuitant Information -------------------------------------------------------------- ------------------------------------------------------------ Owner: Xxxx Xxx Xxxxxxxxx: Xxxx Xxx Date of Birth: January 1, 1959 Date of Birth: January 1, 1959 Tax ID Number: 999-99-9999 Tax ID Number: 999-99-9999 -------------------------------------------------------------- ------------------------------------------------------------ -------------------------------------------------------------- ------------------------------------------------------------ Joint Owner Information Joint Annuitant Information -------------------------------------------------------------- ------------------------------------------------------------ Joint Owner: Xxxx Xxx Joint Annuitant: Xxxx Xxx Date of Birth: January 1, 1959 Date of Birth: January 1, 1959 Tax ID Number : 999-99-9999 Tax ID Number: 999-99-9999 -------------------------------------------------------------- ------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------- Allocation of Initial Premium --------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------ Variable Sub-accounts [Alliance VPF Premier Growth ____% Xxxxxx Xxxxxxx UF Fixed Income] ____% Alliance VPF Growth and Income] ____% Xxxxxx Xxxxxxx UF High Yield] ____% Xxxxx American Income and Growth ____% Xxxxxx Xxxxxxx UF International Magnum] ____% Dreyfus VIF Capital Appreciation ____% OCC Accumulation Trust Managed ____% Dreyfus VIF Small Cap] ____% OCC Accumulation Trust Small Cap ____% Janus Aspen Balance ____% Transamerica VIF Growth Fund ____% Janus Aspen Worldwide Growth ____% Transamerica VIF Money Market Portfolio ____%] MFS VIT Emerging Growth ____% Fixed Account ____% MFS VIT Growth and Income ____% MFS VIT Research ____% Total Allocation: 100% -------------------------------------------------------------- ---...
Policy Number. 002500684 Insured: Xxxxxxxx X. Xxxx Issue Age: 37 Date of birth: 5/28/55 Issue Date: 3/28/92 Face amount of policy: $250,000 Amount reinsured by SECURITY: $50,000 Premium: Same as in the Agreement
Examples of Policy Number in a sentence
Notice should include the Employer's name, the Policy Number and the claimant's name and address.
The Policy means the policy which We issued to the Policyholder under the Policy Number shown on the face page.
Company: Policy Number: My child/ward is covered by his/her school’s activities medical base insurance plan.
Such notice must include Your name, Your address and the Policy Number.
The Policy means the Policy which We issued to the Policyholder under the Policy Number shown on the face page.
More Definitions of Policy Number
Policy Number. [_________]
Policy Number. 146078 Issued by: EMC Insurance Companies Providing for initial death benefit proceeds of $ 500,000 This policy is a life insurance policy on the life of Xxxxxxx X. Xxxxxxx. 180 EXHIBIT "A"
Policy Number. [ ] Signed at Aetna's Home Office in Hartford, Connecticut Date of issue: [ ] on the date of issue. To take effect: [ ] Policy delivered in: New York This policy will be construed in [ line with the law of the State of delivery. President] Based on timely premium payments Aetna agrees with the New York State United Teachers Benefit Trust, to pay benefits [ accordance with the policy terms. Secretary] The duties and the rights of the policyholder will be based solely on the terms of this policy. This [ policy is non-participating. Registrar]
Policy Number. G‐2021‐PREFERRED DIVE ACCIDENT (the “Policy”) Policyholder: XXX WORLD, LTD. (“XXX”) Policyholder Address: X.X. Xxx 00000, 000 Xxxxx Xxxxxx Xxx Xxxxxxxx Xxxxxxxx, Xxxxxxx Xxxxxx Xxxxxx Xxxx, Grand Cayman KY1 ‐1002 Cayman Islands POLICY DECLARATIONS Coverage is provided as described in the Benefit Schedule. Benefits payable for expenses incurred for all benefits shall not exceed the Benefit Limit or Sublimit shown for that benefit in the Benefit Schedule. Benefit Schedule XXX World ‐ Preferred Dive Accident Plan XXX TravelAssist Benefits Benefit Limit Emergency Medical Transportation up to US$150,000 Repatriation of Mortal Remains US$10,000 Sublimit Repatriation for Additional Care Included in US$150,000 Limit Local Burial US$10,000 Sublimit Visit of a Family Member or Friend (includes Traveling Companion) US$1,000 Sublimit Emergency Return Home – Family Death Included in US$150,000 Limit Return of Dependent Children Included in US$150,000 Limit Return of a Traveling Companion Included in US$150,000 Limit Dive Accident Benefits Benefit Limit Dive Accident Medical Expenses up to US$250,000 PO Accidental Death & Dismemberment up to US$25,000 Permanent and Total Disability up to US$25,000 Extra Transportation up to US$5,000 Extra Accommodations up to US$5,000 (US$400/day) Diving Vacation Cancellation up to US$5,000 Diving Vacation Interruption up to US$5,000 PO ‐ Per Occurrence COVERAGE TERRITORY The Coverage Territory is Worldwide, other than the Excluded Countries. Excluded Countries include, and no coverage is provided for losses that occur in, Afghanistan, Algeria, Chad, Iran, Iraq, Libya, Mali, North Korea, Niger, Nigeria, Somalia, South Sudan, Sudan, Syria, Pakistan, and Yemen. The list of excluded countries may be updated at any time by the Policyholder. NOTIFICATION AND PRE‐AUTHORIZATION You, or someone acting on your behalf, must contact the Policyholder (XXX) to obtain pre‐authorization to use any of the benefits and coverages available under this Policy. The Policyholder maintains a 24/7 hotline to confirm your coverage and provide necessary pre‐authorizations. If your situation is life‐ threatening, seek immediate medical attention. Once your situation has stabilized, you can contact the Policyholder (XXX) with the relevant details for any necessary approvals. If you fail to timely notify the Policyholder (XXX), the benefits available to you may be reduced or denied. XXX TravelAssist benefits (including medevac and other emergency travel assistance ...
Policy Number. 1234567-0 INSURED #1: XXXXXX XXXXXXXX POLICY DATE: SEP. 1, 2000 RISK CLASSIFICATION: MALE/SELECT NS MATURITY DATE: SEP. 1, 2065 AGE ON POLICY DATE: 35 INITIAL FACE AMOUNT: $100,000 OWNER(S): XXXXXX XXXXXXXX INSURED #2: XXXX XXXXXXXX RISK CLASSIFICATION: FEMALE/SELECT NS MONTHLY PAYMENT DATE IS THE AGE ON POLICY DATE: 35 1ST DAY OF EACH POLICY MONTH. NOTE: IT IS POSSIBLE THAT COVERAGE WILL EXPIRE PRIOR TO THE MATURITY DATE SHOWN IF THE ACCUMULATED VALUE IS INSUFFICIENT TO PAY THE CHARGES ASSESSED ON A MONTHLY PAYMENT DATE. ACCUMULATED VALUE MAY BE BASED ON THE INVESTMENT RESULTS OF THE SEPARATE ACCOUNT. THE PAYMENT OF INITIAL AND SUBSEQUENT PREMIUMS WILL NOT GUARANTEE THAT THE POLICY WILL REMAIN IN FORCE OR THAT THERE WILL BE ACCUMULATED VALUE AT MATURITY. 0057 Page 3.0 POLICY SPECIFICATIONS 1234567-0 -------------------------------------------------------------------------------- SUMMARY OF COVERAGES EFFECTIVE ON THE POLICY DATE -------------------------------------------------------------------------------- 0056: BASIC COVERAGE FACE AMOUNT: $100,000.00 INSURED #1: XXXXXX XXXXXXXX RISK CLASSIFICATION: MALE/NONSMOKER INSURED #2: XXXX XXXXXXXX RISK CLASSIFICATION: FEMALE/NONSMOKER -------------------------------------------------------------------------------- R96-EPSO: ENHANCED POLICY SPLIT OPTION RIDER -------------------------------------------------------------------------------- R96-PSO: POLICY SPLIT OPTION RIDER Page 3.1 POLICY SPECIFICATIONS 1234567-0 --------------------------------------------------------------------------------
Policy Number. 821900 1018712