Va Form 29-353 - Application For Reinstatement (Non Medical - Comparative Health Statement) Page 2
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1
2IMPORTANT INFORMATION AND INSTRUCTIONS
1. PURPOSE
This form may be used for reinstatement of Government Life Insurance when application is sent within 6
months from date of lapse.
2. PREMIUMS NEEDED FOR REINSTATEMENT
a. TERM POLICIES - Two premiums: One for the premium month of lapse and one for the premium month in
which the application is sent to the Department of Veterans Affairs.
b. LIFE AND ENDOWMENT POLICIES - All unpaid premiums (without interest) on the amount of insurance to
be reinstated.
3. DISPOSITION OF APPLICATION
When completed and signed by you, send application with payment (needed IMMEDIATELY) to:
Department of Veterans Affairs
Regional Office and Insurance Center
P.O. Box 7208
Philadelphia, PA 19101
I UNDERSTAND THAT:
(a) If my application is approved, the last named beneficiary(ies)
(f) Checks or money orders should be made payable to the
and selection of optional settlement(s) on the policy(ies) reinstated,
Department of Veterans Affairs and sent to the address shown
will continue in effect unless the Department of Veteran Affairs
above.
receives a request for a change in writing over my signature. (VA
Form 29-336 should be used to make any change).
(g) The Department of Veterans Affairs will, if necessary, ask for a
physical examination report in connection with this application.
(b) The amount of payment needed, as explained above, must be
sent before or with this application.
(h) Statements made by me in this application are relied upon, any
deception or false statement either by inference, omission, or
(c) If my application is acceptable, my policy(ies) will be
otherwise may cause cancellation of the insurance or refusal to pay
reinstated on the premium due date in the premium month my
a claim. In either case, premiums may not be returned.
application is sent to the Department of Veterans Affairs. (For
example: If an insurance policy was effective July 17, 1956, a
(i) I must let the Department of Veterans Affairs know of any
premium month would always be from the 17th of each month
change in my health beginning after the date I sign and before the
through the 16th of the following month. If an application for
date I send this form to the Department of Veterans Affairs.
reinstatement was sent January 4, the effective date of
reinstatement would be December 17.) If an acceptable
(j) This form must be fully completed, signed by me and sent
application is sent on a premium due date, reinstatement will
immediately to the address above.
be effective on that date.
(d) To prevent a lapse of my policy(ies) after applying for
reinstatement premiums must be paid when due or within 31 days
after the due date. If premiums are paid monthly, the next premium
will be due on the first monthly premium due date after the date
this application is sent to the Department of Veterans Affairs.
(e) Any indebtedness against my policy(ies) must be paid or
reinstated.
QUESTIONS ABOUT YOUR INSURANCE? CALL US TOLL-FREE AT 1-800-669-8477
VA FORM 29-353, OCT 2010
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