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 resident of a nursing home or assisted living facility; am not a smoker; do not have and have never been treated for COVID-19, diabetes, asthma, heart disease, cancer, or liver or kidney disease; 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 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)

Life Assurance Company of America
17W220 22nd Street - Suite 410
Oakbrook Terrace, IL 60181

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