Conservation Form

Recode Pending Business: Attach pending requirements.Re-open: Attach pending underwriting requirement when re-opening a canceled A-250 application within 90 days of the application being signed. Requirements must be filled within 20 days of cancellation. Not taken policies cannot be re-opened.Recode Issued Business: Payroll Deduction to Payroll Deduction. Include new PD Authorization if moving to new account. If conserving entire account, mail check for all back premium and current month to address below and include Worksite Management Information Report. Case must be 60+ days past due. Include Reinstatement Letter if 79+ days past due.Recode Issued Business: Payroll Deduction to Bank Draft. May waive up to 3 months of missed premium. Once 3+ months past due, must reinstate or redate.Reinstatement Bonus: Select ‘Reinstatement’ on Reinstatement Form. Mail with completed bank information and check for all back premiums and current month. Reinstatement Form Required If: Policy is more than 30 days past due. Reinstatement Application Required If Any Items Below Apply: Policy is more than 90 days past due; Face amount is greater than $50,000; Insured has major health changes; OR If an exception is marked on the Reinstatement FormBank Draft Waiver of Premium: Life policies only. No cash value or interest sensitive policies. May waive up to 3 months of missed premium. Once 91+ days past due, must reinstate or redate. Select ‘Waive’ or ‘Waive and Reduce’ on Reinstatement Form. Premium can be reduced maximum of 50% of original premium. Attach completed Life Reinstatement Application (your state version) if face amount $50,001+ or customer has major health changes.Re-Date: Life policies only. No cash value or interest sensitive policies. Lapsed 91+ days and less than 24 months.Select ‘Redate’ on Reinstatement Form. Email with completed bank information (check not required) toCRBackOfficeLN@Globe.Life. Email completed Life Reinstatement Application (your state version) if face amount$50,001+ or customer has major health changes. Premiums cannot be reduced on a Redate.

Policy Number*

ex A123456789

Payor Full Name*

Insured Name*

Bank Name, City, & State*

ex. Wells Fargo, Indianapolis, IN

Routing Number*

9 digits

Bank Account Number*

usually 7-17 numbers on the check

Draft Date*

1-10 ONLY

Agent Number*

12345

Conserving Agent Name*

Date to be Sent to Home Office to CATCH Up Because Funds Are Available*

This is the date the QM will send the form to Home Office as the client will have the funds available to CATCH up.