Prudential Veteran'S Group Life Insurance - Application For Reinstatement Of Coverage

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Office of Servicemembers’ Group Life Insurance
P.O. Box 41618
Philadelphia, PA
19176-9913
Office of Servicemembers'
Group Life Insurance
800-419-1473
Contact Center
Toll free, worldwide
Apply Online at
D
,
EAR VETERAN
PLEASE FOLLOW THE INSTRUCTIONS BELOW TO APPLY FOR REINSTATEMENT OF YOUR
VETERANS’ GROUP LIFE INSURANCE (VGLI) COVERAGE .
Application for Reinstatement of Veterans’ Group Life Insurance
S
1 - V
I
ECTION
ETERAN
NFORMATION
Please provide all requested information.
S
2 - C
O
H
ECTION
ERTIFICATION
F
EALTH
Complete Section 2 if your lapse date is less than 6 months ago. You do not need to complete
the health questions in Section 3 if your lapse date is less than 6 months ago.
S
3 - C
O
H
ECTION
ERTIFICATION
F
EALTH
Complete Section 3 if your lapse date is more than 6 months ago.
S
Y
C
A
:
END
OUR
OMPLETED
PPLICATION TO
Office of Servicemembers’ Group Life Insurance
P.O. Box 41618
Philadelphia, PA
19176-9913
R
A
EINSTATEMENT
MOUNT
The reinstatement amount is equal to three (3) times your monthly premium (based on the
insured’s current age). For questions, please call the contact center at 800-419-1473, Monday
through Friday from 8:00 a.m. to 5:00 p.m. Eastern Time, Toll Free, Worldwide.
You can also determine your premium online with the “premium calculator” at:
Under “Online Policy Access” select “Apply for VGLI Online”
Thank you for your service.
Office of Servicemembers’ Group Life Insurance
Ed. 03/2012

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