Life Insurance Made Simple: Get Covered in Minutes

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GET LIFE INSURANCE ONLINE TODAY
Instant pricing, NO medical exams and NO long wait for coverage to begin!

BUY LIFE INSURANCE ONLINE TODAY

Let’s get started!

Name*

First Middle Last

Sex*

Male

Female

Email*

NOTE: This is the address that we will use to communicate with you. Please be sure that you have full access to it.

Choose coverage amount.

Coverage Amount*

NOTE: Coverage available from $10,000 to $100,000 up to age 50, and from $10,000 to $50,000 from age 51 to 65.

10,000

25,000

50,000

100,000

Choose Age

Male – 10,000

Male – 25,000

Male – 50,000

Male – 100,000

Available for men 50 and younger

Female – 10,000

Female – 25,000

Female – 50,000

Female – 100,000

Your personalized Tristar quote is ready!

Your personalized Tristar quote:

Coverage amount (05/01/2026):
$ @{:5}

NOTE: Premiums of $500 or less per year, must be paid on an annual basis.

Monthly Premium:
@{:129.2}

Annual Premium:
@{:127.2}

Monthly Premium

Price: $0.00

Semi-Annual Premium

Price: $0.00

Annual Premium

Price: $0.00

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I would like to pay…

Once your completed application is submitted, you will receive an email within two business days containing instructions on how to setup payment details for your policy. After setting this up, your life insurance contract will be sent to the email address you entered on this form within two business days.

Policy underwritten by New Providence Life Insurance Company Ltd. With offices located RoyalStar House, John F. Kennedy Drive, Nassau, Bahamas

You are almost there!

Now that you know how affordable coverage will be, we need to collect some more information in order to qualify you for a policy.

Address*

Phone*

Date of Birth*

Status*

Policy quotes are valid for Bahamian citizens and those with legal status only.

I am a Bahamian citizen

I have legal status

Document Proving Legal Status*

Please upload a scanned copy or clear photo of your valid work permit, voter’s card, permanent resident or spousal permit document to confirm your legal status. Allowed file types are JPG, PDF, PNG or GIF

Accepted file types: png, pdf, jpg, gif, Max. file size: 50 MB.

Medical Questions

1. Within the past year, have you been hospitalized; confined to a nursing facility; bedridden; used a wheelchair or any kind of oxygen equipment?*

Yes

No

2. Within the past 3 years have you been medically diagnosed or treated by a physician for: a. heart disease, heart failure, chest pain, or treated but uncontrolled high blood pressure? b. Chronic respiratory disease, cancer, diabetes, liver disease, or alcoholism? c. Stroke, Alzheimer's disease, dementia, mental disorder, AIDS or ARC (AIDS-related complex)? d. Disease or disorder of the nervous system including multiple sclerosis, ALS, Lou Gehrig's disease, systemic lupus, or rheumatoid arthritis?*

Yes

No

3. Have you ever been advised to have any surgical procedure or diagnostic testing that has not been done?*

Yes

No

Coverage Not Available

Due to your medical history we cannot offer you a life insurance policy. If you would like to learn more about the qualification requirements, please call our office and a friendly customer care representative will be happy to speak with you.

Phone: 242-502-9400

Physician’s Information

Do you have a family or personal physician?

Yes

No

Name of Physician

Address

Phone Contact

Where did you last visit a physician?

Date of your last visit to a physician.

An approximate date is fine if you do not remember the exact date.

Height and Weight

Please enter your weight in pounds*

Choose your Height*

Is your weight within the minimum and maximum limits as shown in the chart below?*

For example, if you are 5 feet 6 inches tall, the acceptable weight range for you would be between103 and 241 pounds.

Yes

No

4 Feet Tall	Minimum Weight	Maximum Weight
4’8″	74	173
4’9″	77	180
4’10”	79	186
4’11”	82	193

5 Feet Tall	Minimum Weight	Maximum Weight
5′	85	199
5’1″	88	206
5’2″	91	213
5’3″	94	220
5’4″	97	227
5’5″	100	234
5’6″	103	241
5’7″	106	249
5’8″	109	256
5’9″	112	264
5’10”	115	271
5’11”	119	279

6 Feet Tall	Minimum Weight	Maximum Weight
6′	122	287
6’1″	126	295
6’2″	129	303
6’3″	133	312
6’4″	136	320
6’5″	140	328
6’6″	143	337
6’7″	147	346
6’8″	151	355
6’9″	154	363

Coverage Not Available

Due to your weight being out of range for your height, we cannot offer you a life insurance policy. If you would like to learn more about the qualification requirements, please call our office and a friendly customer care representative will be happy to speak with you.

Phone: 242-502-9400

Additional Information

Employer*

Ex: Commonwealth Bank or Self Employed

Occupation*

NIB Number*

Are your currently married?

Yes

No

Beneficiary Information

Please add one or more beneficiaries.

Name of Beneficiary	Is the beneficary under the age of 18?	Name of Trustee	Beneficiary’s Date of Birth	Beneficiary’s Relationship to You	Choose the Amount that this Beneficiary Should Receive	Actions

There are no Beneficiaries.

Agent

Did a TRISTAR agent assist you leading up to your choice to purchase life insurance? If so, please choose their name from the list below.

List of TRISTAR agents

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Sig T Maycock

Applicant’s Statement

I understand the broker, agent or agency receiving this application does not have authority to waive any portion of this application or any coverage, condition or restrictions contained in the insurance policy applied for and all information requested in this application must be set forth in writing on the application. I further understand this application will become part of the insurance policy to be issued and the insurer will be utilizing the information contained in this application to determine whether or not to issue the insurance policy applied for.

I understand the broker, agent or agency taking this application from me is an independent representative and is acting on my behalf and not the administrator nor the insurance company offering this insurance. Neither the administrator nor the company offering this insurance can be held liable for any circumstance if the broker, agent or agency taking this application fails now or in the future to transmit or communicate any documentation or funds from the administrator to me and/or any documentation or funds from me to the administrator.

It is understood the insurance applied for shall not become effective until this application is approved and accepted by the insurer, full payment of the first premium is made, and the policy issued subject to all conditions and restrictions contained therein. I understand this policy is not available to permanent resident of the United States or others who reside in the United States. However, if any applicant for coverage, who is accepted and insured by the insurer in the applicant’s country of residence, moves to the United States, the insurer will provide an option to continue insurance coverage.

Signature*

Last Step! Identification Documents.

In order to secure your policy, we are required to collect documents that help us to confirm your identity. If you are able to upload the below requested documents at this time, please do so. If you are not able to upload them right now, don’t worry, simply submit the form without the documents attached and an agent will contact you to assist with gathering them.

Identification

1. Primary Identification

If you are able, please upload either a copy of the photo page of your valid passport or a copy of your driver’s license. Don’t have this available? Not a problem, an agent will contact you. Please continue to complete and submit the form.

Accepted file types: pdf, png, jpg, gif, Max. file size: 512 MB.

2. Secondary Identification

Please upload a photo of your NIB card as a form of personal identification.

Accepted file types: pdf, png, jpg, gif, Max. file size: 512 MB.

Proof of Address

Please provide proof of address, which can be one of the following: Utility bill (within last 90 days), Property Tax Receipt, Lease Agreement, Voter's Card or Bank or credit card statement in your name. If you do not have a bill in your name, please have the homeowner or landlord sign the “Confirmation of Address” form attached.

Don’t have this available? Not a problem, an agent will contact you. Please continue to complete and submit the form.

Accepted file types: pdf, png, jpg, gif, Max. file size: 512 MB.

Download the ‘Confirmation of Address’ form here. The form will open in a new tab.

Please read and sign below the following statements.

Applicant’s Statement

I understand the broker, agent or agency receiving this application does not have authority to modify or waive any portion of this application or any coverage, conditions or restrictions contained in the insurance policy applied for and all the information requested in this application must be set forth in writing on the application. I further understand this application will become part of the insurance policy to be issued and the insurer will be utilizing the information contained in this application to determine whether or not to issue the insurance policy for. I understand the broker, agent or agency taking this application form from me is an independent representative and is acting on my behalf and not the administrator nor the insurance company offering this insurance. Neither the administrator nor the company offering this insurance can be held liable for any circumstances if the broker, agent or agency taking this application fails now or in the future to transmit or communicate any documentation or funds from the administrator to me/or any documentation or funds from me to the administrator. It is understood the insurance applied for shall not become effective until this application is approved and accepted by the insurer, full payment of the first term premium, and the policy issued is subject to all conditions and restrictions contained therein. I understand this policy is not available to permanent resident of the United States or others who reside in the United States. However, if any applicant for coverage, who is accepted and insured by the insurer in the applicant’s country or residence, moves to the United States of America, the insurer will provide an option to continue insurance coverage.

Medical Authorization

I hereby authorize any physician, medical practitioner, hospital, clinic, other medical or medically related facility, the Medical Information Bureau, Inc. (MIB, Inc.) or other organization, consumer reporting agency, insurance or reinsuring company, institution or person having any record or knowledge of me or my health, including any member of my family, to give to the insurer offering the insurance, any reinsurer or its legal representative any and all such information. The nature of the information authorized to be disclosed includes information about all medical evaluation, care, treatment, diagnosis or consultation provided to the undersigned insured, or my dependants. I understand the information obtained by use of this authorization will be used by the insurer offering the insurance, and its reinsurers to determine eligibility and payment of claim benefits under this policy. I direct that a copy of this authorization shall be given the same force and effect as the original. This authorization shall remain valid as long as the policy is in force.

Signature of Proposed Primary Insured*

Date of Signature*

Let’s get started!

Choose coverage amount.

Choose Age

Your personalized Tristar quote is ready!

Your personalized Tristar quote:

Coverage amount (05/01/2026): $ @{:5}

Monthly Premium: @{:129.2} Annual Premium: @{:127.2}

You are almost there!

Medical Questions

Coverage Not Available

Physician’s Information

Height and Weight

Coverage Not Available

Additional Information

Beneficiary Information

Agent

Applicant’s Statement

Applicant’s Statement

Last Step! Identification Documents.

Identification

Proof of Address

Applicant’s Statement

Medical Authorization

Coverage amount (05/01/2026):
$ @{:5}

Monthly Premium:
@{:129.2}

Annual Premium:
@{:127.2}