Gerber Life Grow-Up® Plan Application

Payment Protection Option: An optional insurance rider on the Grow-Up® policy with a separate premium. To qualify, the owner and premium payer must be the same person between 18–50 years of age.

Gerber Life will not charge your account any money until 1-3 days after your application is approved.

Your name and address from Section 2 above will be used on the payment authorization. Coverage is not binding until the application is approved and the first premium is received.

I AGREE THAT: The above answers are true and complete to the best of my knowledge and belief. This application shall be the basis for and part of the policy. I understand that no insurance shall take effect until this application is approved and the first premium is received by Gerber Life Insurance Company during the lifetime of the insured.

Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.

Both the children and I are citizens or permanent legal residents of the United States.

Payment Protection Option — I AGREE THAT: The above answers are true and complete to the best of my knowledge and belief. This application shall be the basis for and part of the option/rider. I understand that no insurance shall take effect until this application is approved and the first premium is received by Gerber Life Insurance Company during the lifetime of the owner.

Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense and subject to penalties under state law.

Both the child(ren) and I are citizens or permanent legal residents of the United States.