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Statement of health

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Select date: April 23, 2014


Statement of Health

FRAUD WARNING

If you reside in or are applying for insurance under a policy issued in one of the following states, please read the applicable warning:

DECLARATIONS AND SIGNATURES

Each person signing below declares that all the information given in this enrollment form, including any medical questions, is true and complete to the best of his/her knowledge and belief. Each person understands that this information will be used by MetLife to determine his or her insurability.

To continue, please check the box(es) to indicate you have read and understand the following:

Electronic Signature (eSignature)

I have completed the Statement of Health. I acknowledge that I have read and understand the Statement of Health and all the notices, declarations and other documents provided. I agree to print and retain a copy of the Statement of Health form for my records. I understand that by entering my password and clicking the " Submit " button below I am providing my electronic signature and submitting the Statement of Health for consideration by MetLife.

If you prefer, you may print out, sign, and mail your Statement of Health form to MetLife.

Note: Document delivery through the mail and processing of your paper applcation will take more time than documents received electronically.Lorem ipsum dolar sit.

Print and mail