USBA 2for1 Military Life Insurance Online Application: Free Rate Quote

USBA Applicant Information

Answering the following questions will help determine whether or not you qualify for insurance with USBA. It does not in any way indicate whether or not your application will be accepted and insurance granted to you.

Begin here:

Are you currently a USBA Member; that is, are you currently holding an active policy with USBA?

YesNo

Login Information:

So that you can easily come back to this application later please supply:

First Name:
Middle Initial:
Last Name:
Email Address:
Confirm Email Address:
Password:
Verify Password:

We’ll send you an email with your information right away, save it so you can login again later if needed.

For New USBA Members:

Applying as an Associate Member?		YesNo USBA Associate Member Help. A USBA Associate Member is either a spouse or eligible child age 18-22 of someone who is eligible for USBA membership. (Note: your spouse or parent does not have to be insured for you to be an Associate Member, they just need to be eligible).
If Member of ROTC Unit: Reserve Assignment or ROTC University:
Duty Status
Service Branch:
Federal Agency:
Pay Grade:
Rank:
Actual (Or estimated) date of separation or retirement:

For Current USBA Members:

Member Type:		USBA MemberUSBA Associate Member
Member ID#:
Retrieve My Member Information?		Yes, I’d like to retrieve information from my USBA profile to help fill out my online application (you’ll need to enter your Member Service Center user ID and password).

IMPORTANT: If you are working with an agent, you have been provided with an agent number to use on this application. Please enter the number in the field below. If you are working with an agent, and do not have the agent number to enter here, contact your agent so you can enter the number below before proceeding.

If you are not working with an agent, leave the field blank and click “Next.”

Agent #:

State application written in:

Apply Online for USBA Military Double Value TWO for ONE® Life Insurance