Required fields are Bold.
First Name:

Contact Us

Security National Life Insurance Company

5300 South 360 West
Salt Lake City, Utah 84123

Phone:
(800) 288-4810

Fax:
(866) 397-9668

Email Us

Last Name:
Address:
City:
State:
Zip / Postal Code:
Phone Number:
Email Address:
Country (USA if blank):
Policy Number (if reviewing):
Effective Date:
Check all coverages you desire:          



Premium:
Total:
Select payment method:


Credit Card Number:
CVV-Security Code:
Expiration Date:  /
Referred By:
Dive Name:
To be put on dive tag. If blank,
we will use your first name.
13 characters max

Important! By submitting this form you understand that NO coverage is in force until payment is received by DSI PRIOR TO ANY COVERED ACCIDENT! In addition, you agree to pay the total amount shown as required by your credit card agreement. For more information or questions, call DSI at 1-800-288-4810 or email us .

About DSI

Diver's Security Insurance was formed by divers for divers in 1987. It continues to be operated for divers by divers. Since 1987, we have insured tens of thousands of divers across the world and continue to be the industry leader in providing divers and water sports insurance. DSI is a division of Capital Investors Life Insurance Company of Orlando, Florida, a wholly owned subsidiary of Security National Financial Corporation.