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US/Canada: (866) INSU-BUY, International: (972) 985-4400
Formerly BuyAmericanInsurance.com
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.

USES
• Bank Loans
• Divorce Settlements
• Investors
• Business Managers/Agents
• Movie Productions
• Business Buy Outs/Buy Ins
• Surrogate Mother Contracts

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.
  • Will NOT consider blood relatives nor married couples.
  • This is an annual policy. Must be renewed annually.

General Conditions and Exceptions
  1. The policy will pay up to the amount shown in the schedule for the direct financial loss suffered by the insured resulting from non-performance of the insured contract due solely to the death or disappearance of the contracting party during the period of insurance. Any disappearance must continue for a period of more than twelve months, and the insured must undertake to repay underwriters in the event that the contracting party is subsequently found alive.

  2. In the event that the insured contract is terminated this insurance shall automatically and immediately come to an end simultaneously with the effective date of termination of the insured contract, without further notice.

  3. The insured warrants that they have made all reasonable inquiries to establish that the contracting party does not suffer any physical impairment, mental impairment or medical condition which does or may increase the risk of non-performance of the insured contract, and that the insured has disclosed to the underwriters all such information known by the insured. The insured will immediately disclose to the underwriters all further such information which comes to the attention of the insured at any time either before or after the inception of this insurance which does or may indicate the existence of any such impairment or medical condition.

  4. This insurance does not cover claims directly or indirectly contributed to or caused by:
    1. The contracting party abusing or having abused, or being under the influence of, alcohol, drugs or controlled substances, other than drugs legally and appropriately prescribed by a qualified medical practitioner.
    2. Suicide or intentional self-injury while sane or insane, or the voluntary disappearance of the contracting party.
    3. Human Immune Deficiency Virus (HIV), Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or any virus, complex or syndrome that is related to the foregoing or any sexually transmitted disease.
    4. By radioactive contamination or exposure to radiation.
    5. By war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, or military or usurped power.

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.

01/01/2008