CAT Application

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CAT Application

Life For Life Application

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Collegiate Insurance Trust Application Questions

This page captures the data used when following the apply now link from https://meyerandassoc.com/life-for-life/

CAT Application

Title

You must supply a title

First Name

You must supply a first name.

Last Name

You must supply a last name.

Address

Applicant address is required

City

Applicant city is required

State

Applicant state is required

Zip

Applicant ZIP is required

Social Security #

A valid SSN is required

Phone Number

A valid phone number is required

Email Address

A valid email address is required

Phone Type

Home

Work

Cell

A phone type is required

Date of Birth

Date of Birth is required

State of Birth

Applicant state of birth is required

Country of Birth

Applicant country of birth is required

Sponsor

Sponsor is required

Eligibility Status

Eligibility Status is required

Introduction

From time to time the Administrator (Meyer and Associates or M&A) may utilize the internet, email, digital media, and the like to transmit documents and information. This consent to receive electronic records informs you of your rights when communicating electronically with M&A. By consenting below, you acknowledge receipt of this consent to receive electronic records and agree to the electronic delivery of disclosures, certificates, policy forms, documents, information, privacy policy notices, and/or other notices (hereinafter “records”) on our website and/or through the email address you provide.

Hardware and software requirements.

Before agreeing to receive records electronically, you must determine if you have the necessary hardware and software to access and retain these records electronically. To access your records, you will need an email address, Adobe Acrobat Reader, and a computer or other access device. To retain your records, your access device must have the ability to print or download records, including embedded HTML files, to a hard drive or external media.

Right to withdraw consent and procedures for withdrawal.

You may withdraw your consent to receive records electronically at any time by emailing info@meyerandassoc.com. Withdrawal of your consent shall not affect the legal effectiveness, validity or enforceability of electronic records provided or made available to you prior to implementation of your withdrawal of consent. Your withdrawal of consent shall be effective within 30 days after receipt of the withdrawal request by us.

Option to obtain paper copies of records.

You have the option to request paper copies of those records we provide to you electronically. If you wish to obtain the records in nonelectronic form, email your mailing address to info@meyerandassoc.com.

Updating your contact information.

To update your electronic or mailing address, email info@meyerandassoc.com.

I apply to become a Subscriber to the Collegiate Alumni Trust. CAT enables members of sponsoring organizations to purchase insurance through a single group insurance policy. Subscribing to CAT costs nothing, but is required to become insured. I understand that this program is for my benefit. I request that any dividend or surplus to which I may be entitled as the result of my participation be paid to the Sponsor named above or to any other entity designated by the Sponsor from time to time. I understand that I am not required to do so and may rescind this request by contacting Meyer and Associates at the address below. I authorize email communication from Meyer and Associates about my application and insurance.

By checking this box, I acknowledge that I have read the consent statement and eSignature.

Collegiate Insurance Trust Application Questions

CAT Application

Consent to do business electronically

Introduction

Hardware and software requirements.

Right to withdraw consent and procedures for withdrawal.

Option to obtain paper copies of records.

Updating your contact information.

eSignature