APPLICATION TERMS AND CONDITIONS FOR NO MEDICAL EXAM & INSTANT LIFE INSURANCE COVERAGE ($5K,$10K, $15K)

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In order to qualify for coverage, I understand and agree to the following:
 
I represent that I am an Illinois resident or otherwise agree that Illinois law applies to this
policy in the event that I am not a resident or cease to be an Illinois resident.
 
I represent that I am over the age of 17 but under the age of 66; am not a smoker; do not
have and have never been treated for diabetes, asthma, COVID-19, lung disease, COPD,
depression or any mental health problem, hepatitis, drug or alcohol abuse, heart disease or
heart attack, stroke, seizures, Alzheimer's disease, cancer, or liver or kidney disease; am
not currently hospitalized, in a nursing home or assisted living facility, or under hospice
care; am taking all medications as prescribed by a licensed physician; have not been
diagnosed with a terminal disease, illness, or condition by a licensed physician; and am not
obese (i.e. BMI under 30).

I represent that this application is not intended to replace any other coverage I may have.
I also agree to email proof of identify to admin@lifeassurancecoa.com in a form listed
below:

(U.S. Citizenship is not required, but you must email a driver’s license, foreign driver’s
license, passport, foreign passport, Visa, foreign birth certificate, state ID, or any other
acceptable form agreed to by Life Assurance Company of America, that matches your full
name)