Application Guide NGL Asset Guard The Standard NGL

Application Guide NGL Asset. Guard

The Standard NGL Asset. Guard Application Form 2735 FE 12/08 (Applications will vary by state; before writing new business, please verify the current version approved for your use on My. NGLIC)

Application Example: Insured/Annuitant Information Be sure to indicate Male or Female Where should the policy be mailed? Complete all information on this line, if applicable Complete all information on this line Any missing information could result in issuance delay

Payment Methods & Modes

The Health Question*: Determines Underwriting Class Health question must be answered “NO” for Standard Issue. If answered “YES” or not answered, Guaranteed Issue will be used. * May vary by state.

Payment Plan + Mode 5, 000. 00 X Bank Of America 12345678 70 -1238901 15 th Remember to check box C to indicate growth rate! * “Increased Face Amount” (based on funeral price) or “Inflation Protected” amount. Use Premium Calculators on My. NGLIC to best calculate Face Amount.

Beneficiary Information NGL Funeral Expense Trust Write the name and address of where proceeds should be directed. If it is Insured’s Estate, please write “Estate of Insured”. If assigning to one of NGL’s Trusts, please be sure to specify which: NGL Funeral Expense Trust or NGL Estate Planning Trust.

The Signature Section(s) If your state application includes any replacement questions, all of the questions must be completed. Remember to complete both Applicant’s AND Agent’s Sections State of Sale City/Town where sale is MADE Insured Signature Agent Signature Date Agent PRINTS Name Owner Signature NGL Agent # Here Date Agent License # Only use 2 nd line in Agent Statement if splitting commissions %

Acknowledgment of Payment John Smith Agent Signature 5, 000 Date

Trust Assignments NGL Funeral Expense Trust NGL Estate Planning Trust

NGL Funeral Expense Trust Assignment Form (#2591 -FET*) John E. Smith Mary K. Smith (Optional) Owner Signature Date • Use this trust if the client is concerned with Medicaid Qualification • Excess proceeds paid to the Estate of the Insured (or the state, if your state requires it) • Policyholder must sign. If Power of Attorney (POA), include POA paperwork. * May be state-specific. Please check My. NGLIC.

NGL Funeral Expense Trust Assignment Form For NGL Use Only. Use ONLY if your client needs to immediately apply for Medicaid and transfer the ownership rights immediately.

NGL Estate Planning Trust Assignment Form (#2591 -EPT) John E. Smith Mary K. Smith John E. Smith, Jr. Owner Signature Date • Excess proceeds paid to the beneficiary named on the form • Policyholder must sign. If Power of Attorney (POA), include POA paperwork. • May be used in combination with the Funeral Expense Trust. Total value of the combined policies may not exceed the Estate Planning Trust maximum (may vary by state).

Reminders and FAQs

Helpful Reminders To ensure that your application can be processed quickly, please remember: • Indicate where/to whom the policy should be sent on the top of the application. • If EFT is being drawn from a: – Checking Account: Please include a voided check. – Savings Account: Please have the applicant contact the bank to get the correct bank information and verify that EFT withdrawals are allowed.

Common Application Errors • Incomplete/Missing Information: – Agent statement and replacement questions are incomplete – Signature Date is missing – Missing or incomplete state requirements such as disclosures or trust assignment forms • May be caused by using old forms, which may not have all the current state requirements included • Premium Discrepancies: – Using standard rates on guarantee issue cases • Payment Type Issues: – Agent’s personal checks are not accepted – Money Orders must be purchased by the applicant (not the agent) and MUST be signed. • For any contract or policy changes, please contact the Agent Support Team

Submitting Applications and Claims

Submitting Applications via Fax • Complete Application Cover Page (#2802) • Fax with Application to: 866. 228. 9927 • Please ensure this form is the FIRST PAGE of your fax. • Do not fax and mail your application materials; send via fax or via mail, not both. Please fax the application just ONCE. • We are only able to accept faxed payment for initial premium from one account. Initial premium payments from multiple accounts must be mailed to NGL with checks from each account. • Business should not be sent to NGL until it is ready to be issued.

Claims Process • Claims may be submitted via fax and are generally processed in two business days or less. • A copy of the death certificate is required: • If death occurs within the first two years of issue on a standard issue policy, a death certificate is required • In Kentucky, Louisiana, Ohio and Wisconsin.

Covered Funeral and Burial Items Copies of bills for the funeral (or other related services) should be submitted with the claim form. These may include: • Professional services • Embalming and other treatment of remains • Cremation • Caskets • Vaults • Funeral home facilities and services • Stationery • Flowers • Transportation of the body • Opening and closing of the grave • Cemetery charges

Submitting Claims via Fax • Complete the appropriate Claim Form: – NGL Funeral Expense Trust Claim Form (#FE-CF)* – NGL Estate Planning Trust Claim Form (#EP-CF)* – Beneficiary Claim Form (#2803 PNCF)* – Multiple Payees Claim Form (#FE-MP-CF)* • Fax to: 866. 228. 9450 * Some states use state-specific forms. Check My. NGLIC to ensure correct form usage.

Questions? Call 800. 356. 5306 for assistance! © 2010 National Guardian Life Insurance Company, Madison, WI. NGL, National Guardian and the tree of life logo are registered trademarks of National Guardian Life Insurance Company is not affiliated with the Guardian Life Insurance Company of America, a/k/a The Guardian or Guardian Life. For Agent Use Only. ABLAG-BSP