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)