Uniformed Services Benefit Association  
  
     

   
State 
Gender    Male     Female
Birthdate   / /
Smoker*  
Request Coverage For My Spouse    Yes     No
Request Coverage   $ ($25,000 to $500,000)
 		     
      
 
 Complete if your spouse needs a quote.
 
          
Gender    Male    Female
Birthdate   / /
Smoker*  
Request Coverage   $ ($25,000 to $500,000)
 		      
  *USBA defines a smoker as anyone who has used tobacco or nicotine in any form, including nicotine patches and nicotine chewing gum, during the past 24 consecutive months.  
       
    

  USBA's Group Life Insurance Plans Are Underwritten by New York Life Insurance Company.  


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