Apply for Insurance (under 40) in PA and MA

  1. Using your printer and the Adobe® PDF file, print an application for each person you want covered.

    Application in Portable Document Format (PDF)

    The Adobe® Acrobat Reader is required to view PDF documents. If you do not have Acrobat Reader click the button above to download it free from Adobe's site.

  2. Send no money at this time. Send the completed application to:
    Catholic Holy Family Society, P.O. Box 2909, Joliet, IL 60434

  3. When the application is received in our office, your insurance policy will be sent directly to you for examination. Look it over and be sure it meets your needs. A bill for your first monthly premium will be included.


After your first premium is paid, your policy will be in force immediately as of the effective date shown on the policy.

Monthly Premiums are Based Upon the Present Age of the Insured

After 10 annual premiums have been paid, this policy is paid up and no additional payment is needed.

 
$5,000 Policy
$10,000 Policy
Issue Age
Male Monthly Premium
Female Monthly Premium
Male Monthly Premium
Female Monthly Premium

0

$7.75

$6.75

$11.50

$10.00

1

$7.95

$6.95

$11.95

$10.45

2

$8.15

$7.15

$12.40

$10.90

3

$8.35

$7.35

$12.85

$11.35

4

$8.55

$7.55

$13.30

$11.80

5

$8.75

$7.75

$13.75

$12.25

6

$9.00

$8.00

$14.20

$12.70

7

$9.25

$8.25

$14.65

$13.15

8

$9.50

$8.50

$15.10

$13.60

9

$9.75

$8.75

$15.55

$14.05

10

$10.00

$9.00

$16.00

$14.50

11

$10.10

$9.15

$16.25

$14.75

12

$10.20

$9.30

$16.50

$15.00

13

$10.30

$9.45

$16.75

$15.25

14

$10.40

$9.60

$17.00

$15.50

15

$10.50

$9.75

$17.25

$15.75

16

$10.65

$9.95

$17.50

$16.00

17

$10.80

$10.15

$17.75

$16.25

18

$10.95

$10.35

$18.00

$16.50

19

$11.10

$10.55

$18.25

$16.75

20

$11.25

$10.75

$18.50

$17.00

21

$11.40

$10.90

$18.85

$17.35

22

$11.55

$11.05

$19.20

$17.70

23

$11.70

$11.20

$19.55

$18.05

24

$11.85

$11.35

$19.90

$18.40

25

$12.00

$11.55

$20.25

$18.75

26

$12.20

$11.75

$20.60

$19.10

27

$12.40

$11.95

$20.95

$19.45

28

$12.60

$12.15

$21.30

$19.80

29

$12.80

$12.35

$21.65

$20.15

30

$13.00

$12.50

$22.00

$20.50

31

$13.30

$12.75

$22.60

$21.05

32

$13.60

$13.00

$23.20

$21.60

33

$13.90

$13.25

$23.80

$22.15

34

$14.20

$13.50

$24.40

$22.70

35

$14.50

$13.75

$25.00

$23.25

36

$14.80

$14.05

$25.60

$23.80

37

$15.10

$14.35

$26.20

$24.35

38

$15.40

$14.65

$26.80

$24.90

39

$15.70

$14.95

$27.40

$25.45

$10,000 LIFETIME INSURANCE COVERAGE
(also available at $5,000)

 
Annual
Premium
Total Lifetime
Payment
Guaranteed
20th Year
Cash Value

Female Age 0

$120.00

$1,200.00

$1,306.00

Male Age 0

$138.00

$1,380.00

$1,556.00
       

Female Age 10

$174.00

$1,740.00

$1,815.00

Male Age 10

$192.00

$1,920.00

$2,126.00
       

Female Age 20

$204.00

$2,040.00

$2,528.00

Male Age 20

$222.00

$2,220.00

$2,955.00
       

Female Age 35

$279.00

$2,790.00

$3,995.00

Male Age 35

$300.00

$3,000.00

$4,643.00

Plus…

  • The policy provides for constantly increasing cash surrender values.
  • You are permitted to borrow money on your policy when sufficient values have accumulated.
  • You may decide to have your policy on a paidup basis and no further premiums would be required. This means that at death, a fixed amount is paid.
  • If sometime in the future, you are unable to pay your premiums, the values accumulated in the policy, if any, will pay any past due premium and the interest thereon. This is called the Automatic Loan Provision and there is NO CHARGE for this benefit.
©2006 - Holy Family Society of the U.S.A.