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US/Canada: (866) INSU-BUY, International: (972) 985-4400
Confidential Insurable Interest Life Insurance

Paper Application

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Now a third party individual can insure against financial loss as a result of the death of another person, with whom there is an insurable interest.

Unpaid Loans
  • Business
  • Personal
Ongoing Obligations
  • Divorce Settlements
  • Child Support
  • Pledges
Performance Agreements
  • Business Agents or Managers
  • Investors

A New Concept in Life Insurance
  • There must be a documented (written agreement) insurable interest between the two parties.
  • Insure without the knowledge of the insured.
  • Insure without medical examination.
  • $50,000 minimum - $3,000,000 maximum.
  • Will NOT consider blood relatives nor married couples.
  • This is an annual policy. Must be renewed annually.

Rate Indications (Subject to Change Without Notice)
Age
Per $1,000
18-39
4.00
40
4.25
41
4.75
42
5.25
43
5.80
44
6.50
45
7.20
46
7.80
47
8.70
48
9.50
49
10.50
50
11.25
51
11.70
52
12.25
53
12.80
54
13.50
55
14.50
56
16.70
57
19.00
58
21.25
59
23.50
60
25.50
Over 60
Please Inquire

Annual Premiums Only
$100 policy fee
Minimum Premium - $750 before policy fee

General Conditions and Exceptions
  1. The definition of death shall mean death from any cause including Insured Persons being "presumed dead" (with appropriate certificate).

  2. In the event that the insurable interest between the Applicant and the Insured Person is terminated, Underwriters' liability will cease hereunder from the date of the termination of the insurable interest.

  3. It is a condition precedent to liability that the Applicant does not know of any physical and/or medical impairment(s) which would affect the insurability of the Insured Person.

  4. Notification of any circumstances known to the Applicant which are likely to result in a loss must be made within 7 days to the insurer's representative.

  5. This insurance does not cover death directly or indirectly resulting from or consequent upon:
    1. War, invasion, acts of foreign enemies, hostilities (whether declared or not), civil war, rebellion, revolution, insurrection or military usurped power.

    2. The life assured engaging in or taking part in Naval, military or Air Force service operations.

  6. This policy excludes claims or liability arising from and condition directly or indirectly caused by or associated with Human T-Cell Lymphotropic Virus type III (HTVL III) or Lymphadenopathy Associated Virus (LAV) or the mutants, derivatives or variations thereof or in any way related to Acquired Immune Deficiency Syndrome (AIDS) or any syndrome or condition of a similar kind howsoever it may be named.

  7. This policy does not cover losses directly or indirectly caused or contributed to by the Insured person being under a state of intoxication from alcoholism or being under the influence of drugs or narcotics that are not lawfully available unless prescribed by a qualified medical practitioner.


PRIVACY POLICY STATEMENT
Petersen International Underwriters
Petersen International Underwriters want you to understand how they protect the confidentiality of non-public personal information they collected about you.

Information PIU Collects
PIU collects non-public information about you from numerous sources including, but not limited to:
  1. Information PIU receives from you on applications and other forms;
  2. Information about your transactions with the affiliates, others or PIU;
  3. Information PIU receives from consumer-reporting agencies; and
  4. Financial and medical sources.
Information PIU Discloses
PIU does not disclose any non-public information about you to anyone except as is necessary in order to provide the products or services to you or otherwise as required or permitted by law (e.g. subpoena, fraud investigation, regulatory reporting, etc.).

Right to access or correct your personal information.
You have a right to request access to or correction of your personal information in PIU's possession.

Confidentiality and Security
PIU restricts access to non-public personal information about you to PIU's employees, PIU's affiliates' employees or others who need to know that information to service your account. PIU maintains physical, electronic and procedural safeguards to protect your non-public personal information.

Contacting PIU
If you have any further questions about this privacy statement or would like to learn more about how PIU protects your privacy, please contact us.

ADMINISTRATOR & UNDERWRITER
This plan is administered by

Petersen International Underwriters
23929 Valencia Boulevard, Suite 215
Valencia, CA 91355-2186

It is underwritten by Certain Underwriters at Lloyd's that is rated A "Excellent" by A.M. Best.



This is not intended to be a complete outline of coverage. Actual wording may change without notice.