Sem:Life enrollment

* Required field

SCHOOL INFORMATION

I certify that I am a full-time student at the following seminary (or affiliated college):

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(ex: MM/DD/YYYY)    
STUDENT INFORMATION
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(ex: ###-##-####)    
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(ex: MM/DD/YYYY)    
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(ex: #####)    
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(ex: ###-###-####)    
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BENEFICIARY INFORMATION

I designate the following person(s) as my beneficiary(ies) to receive benefits payable from Sem:Life:

PRIMARY BENEFICIARY **
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(ex: MM/DD/YYYY)
(ex: ###-##-####)
SECONDARY BENEFICIARY **
(ex: MM/DD/YYYY)
(ex: ###-##-####)

** In order for a minor child(ren) to receive a death benefit, a guardian may need to be legally appointed to administer the property. If you designate more than one beneficiary, the benefit will be paid to your primary beneficiary(ies) living at the time of your death, in equal shares unless otherwise indicated. If no primary beneficiary survives you, the benefit will be paid to the secondary beneficiary(ies) living at the time of your death and in equal shares unless otherwise indicated. If no primary or secondary beneficiary survives you, payment will be made according to the terms of the plan. All prior designations, if any, are revoked.

I acknowledge and agree to the following: (a) any statements on the application are true and accurate to the best of my knowledge and belief; (b) only the Plan document contains the terms and provisions of the Plan (such as eligibility requirements, benefits, limitations or exclusions) and in the event of a conflict with other material to the Plan, the Plan document will control; (c) my student status will be verified at the time of claim; and (d) GuideStone Financial Resources reserves the right to change or cancel these programs at any time.

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