Va Form 29-389 - Notice Of Lapse
Download a blank fillable Va Form 29-389 - Notice Of Lapse in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Va Form 29-389 - Notice Of Lapse with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2OMB Control No. 2900-0128
Respondent Burden: 12 minutes
NOTICE OF LAPSE
GOVERNMENT LIFE INSURANCE
1. INSURANCE FILE NUMBER
2. POLICY NO. (Including letter prefix)
3. DATE OF LAPSE
4. DATE MAILED BY VA
MONTH / DAY
/ YEAR
F
5. AMOUNT OF INSURANCE
$
ADDRESS OF INSURED
.
.
6. DATE OF LAST TIMELY PAYMENT
7. AMOUNT OF LAST TIMELY PAYMENT
$
8. AMOUNT NEEDED TO REINSTATE
PREMIUMS
A
DUE
$
LESS
B
-
OVERAGE
PLUS
C
+
SHORTAGE
TOTAL
D
AMOUNT DUE
$
Your insurance lapsed on the date shown. You may reinstate your protection now by following the instructions in the
paragraphs checked below.
Complete the application on the back of this form and return it at once with a payment for the total amount due.
Return this form at once with a payment for the total amount due. You do not have to complete the application.
If you submit your application on or after
, add to the total amount due one additional
premium of $
for each month of delay. If you delay reinstatement more than six months from the date
of lapse, interest will be charged on all premiums from date of lapse.
The current term period of your policy ends
. If you reinstate after that date, the
amount required to reinstate is $
based on the renewal premium of $
monthly.
If you reinstate on or before
, evidence that your health is as good on the date of the
application as it was at the end of the grace period is acceptable. Otherwise, a VA Form 29-352, Application For
Reinstatement, will be required.
Unless you meet reinstatement requirements on or before
you will have lost all rights to
reinstate this insurance.
The payment sent on
could not be used to prevent lapse. This payment is included in
Item 8B.
IF YOU HAVE QUESTIONS ABOUT YOUR INSURANCE, CALL TOLL-FREE AT 1-800-669-8477.
Department of Veterans Affairs
Regional Office and Insurance Center
FROM
P.O. Box 8079
Philadelphia, PA 19101
29-389
VA FORM
NOV 2005
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal