Important Information

There are 3 ways to Apply for your FreeLife Application

1. Email application
Download application form Click here and e-mail us back your signed application to

2. Fax-on-demand aplication (application faxed to your fax machine):
dial 844-8724-4968, ext. 710 and follow the prompt.

3. Online application:
1. Fill in all sections of the enrollment form below.
2. Complete pages 1 &and2. After completion of page 1, click “next page” follow the arrow at the right top of the form, and proceed to the next page.
3. Click “Submit form” when done. For other questions, and help with the Free Accidental Life Insurance enrollment form, contact us:

Toll-free number: 1-844-USA4-YOU (1-844-872-4968)

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