Veteran Coverage Eligibility File

Confidential Licensed Review – Not a Government Application

Identity Verification

Full Legal Name *

Date of birth *

Phone Number *

Email *

Gender *

Male

Female

Street Address *

City *

State *

Zip code *

🔒 This form is encrypted and federally compliant. Your information is confidential and will never be sold, shared, or used for spam.

Not affiliated with the Department of Veterans Affairs. Trusted by Aetna, Mutual of Omaha, Americo, and more.

Existing Coverage Check

Do you currently have life insurance? *

Company name *

Monthly Premium *

$

Coverage Amount *

$

Health/income changes past 12 months *

🔒 This form is encrypted and federally compliant. Your information is confidential and will never be sold, shared, or used for spam.

Not affiliated with the Department of Veterans Affairs. Trusted by Aetna, Mutual of Omaha, Americo, and more.

Beneficiary Details

Beneficiary Full Name *

Relationship *

Beneficiary Date of Birth *

🔒 This form is encrypted and federally compliant. Your information is confidential and will never be sold, shared, or used for spam.

Not affiliated with the Department of Veterans Affairs. Trusted by Aetna, Mutual of Omaha, Americo, and more.

Draft Information (Secure) 🔒

Bank Name *

Account Number *

Routing Number *

Preferred draft date *

🔒 This form is encrypted and federally compliant. Your information is confidential and will never be sold, shared, or used for spam.

Not affiliated with the Department of Veterans Affairs. Trusted by Aetna, Mutual of Omaha, Americo, and more.

Final Identification

Social Security Number *

Driver's License (optional)

State of Issue (optional)

🔒 This form is encrypted and federally compliant. Your information is confidential and will never be sold, shared, or used for spam.

Not affiliated with the Department of Veterans Affairs. Trusted by Aetna, Mutual of Omaha, Americo, and more.

Empowering Your Financial Future

Tailored Solutions for Life, Insurance, and Investments

I'm Nathaniel P Ruiz with Ruiz Prestige Financial

Been in the industry over 5 years, We offer any type of life insurance option you can think of final expense, term, mortgage protection, whole life, iul, infinite banking, fixed index annuities. does not matter medical coniditions, age, health, we can get everyone immediate coverage based on your financial needs. i am a veteran as well

National Producer Number: 19998800
email: [email protected]
Contact Number: 5755453012

Signature

Nathaniel P Ruiz

Empowering Your Financial Future

Tailored Solutions for Life, Insurance, and Investments

I'm Nathaniel P Ruiz with Ruiz Prestige Financial

Been in the industry over 5 years, We offer any type of life insurance option you can think of final expense, term, mortgage protection, whole life, iul, infinite banking, fixed index annuities. does not matter medical coniditions, age, health, we can get everyone immediate coverage based on your financial needs. i am a veteran as well

National Producer Number: 19998800
email: [email protected]
Contact Number: 5755453012

Signature

Nathaniel P Ruiz

🔒 Your information is encrypted and federally compliant. No VA or government affiliation. Used only for licensed benefit evaluation.