Companion Life Electronic Consent
COMPANION LIFE INSURANCE COMPANY
ELECTRONIC CONSENT FORM
Disclosure and Consent Regarding Conducting Business Electronically - This is a
disclosure and consent to do business with Companion Life Insurance Company electronically.
By indicating your acceptance, you are agreeing that you affirmatively consent to conduct
business with us electronically.
Scope of Consent - Your consent applies to all documents made available electronically over
the course of your relationship with Companion Life Insurance Company, including transactions
conducted through our website and documents signed electronically. Please note that some
states do not permit certain documents to be delivered electronically. If applicable, you will
receive such documents in paper form only.
Consent is voluntary - You are not required to conduct business electronically. If you wish to
receive and/or sign paper documents, you can decline to provide your consent to this
disclosure.
Right to Withdraw Consent - Once you provide your consent to do business electronically, you
will have the right at any time to withdraw your consent. You must provide us with notice of your
desire to withdraw your consent. The instructions for notifying us are below under the heading
“Contact Information.” Once we have received your notice to withdraw consent, it will be made
effective as soon as reasonably possible. Once your consent is withdrawn, you will receive
documents covered by this consent in paper form.
Updated Information – Some records may be delivered electronically according to contact
information you provide. If the information needed to contact you electronically should ever
change, you must notify us of the change and provide updated information. The instructions for
notifying us of updated contact information are below under the heading “Contact Information.”
Computer Hardware and Software Requirements - You will need access to a computer with a
current internet browser which supports the HTTPS protocol, HTML, and acceptance of cookies
in your security settings. You will need an operating system that allows you to save files or print
web pages and documents. You will need Adobe Reader or similar software to view and retain
documents in PDF format. If we should ever have a change in the hardware or software
requirements needed to access or retain documents electronically, we will advise you of the
revised hardware and software requirements.
Right to obtain paper copies - You will have the ability to download and print any documents
we send or make available to you electronically. You may also request delivery of paper copies
by contacting us as outlined in the “Contact Information” section below. We will provide paper
copies at your request, free of charge, on an annual basis.
Companion Life Electronic Consent
Contact Information - Please use one of the following methods to contact us to withdraw your
consent to do business electronically, request a free paper copy of electronically delivered
documents annually, or report a change in your email address:
Email: CompanionAcctMgmt@companionlife.net
Telephone: (877) 676-5789 Option 2
Paper: Companion Life Insurance Life Company
P.O. Box 1535
Dubuque IA 52004-1535
Website: www.companionlife.com
Agreement - By consenting to do business electronically, you understand and agree that you
are able to access and read this consent and disclosure electronically and also were able to
print it on paper or electronically save it for your future reference and access. Until or unless you
notify us as described above, you consent to receive from us through electronic means all
documents made available electronically.
