Foreign National Questionnaire

Please complete the following questionnaire to determine eligibility for coverage.

Important Information

Please read the following important information before proceeding with the Foreign National Questionnaire:

A response generated following completion of this form is not an offer or approval for life insurance. The company/USL/AGL will fully evaluate an application following receipt of a life insurance application. Once an application is submitted, the application is subject to underwriting review before a policy of insurance can be fully evaluated.

I have read and understand the above information and agree to proceed with the questionnaire.

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Do you have a social security number or ITIN?

Do you have a US Bank account for minimally 6 months in the name of the insured, owner or payor on the application?

What is your country of citizenship?

Age of Applicant?

Do you reside in the United States at least 10 or more months per year?

What type of valid visa do you have?

Have you been living in the US for three years or longer?

Do you have at least 6 months remaining validity on your visa?

Do you have EAD (Employment Authorization Document or valid I797A form with at least 6 months of remaining validity)?

Have you spent a minimum of 15 days in the US in the last 12 months PLUS 15 days within the prior 48 months?

Do you meet one of the following:

Own real estate in the US
Own a business in the US
Work for a US company
Have a verifiable US tax liability
Have an immediate family member residing in the US

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