| Form Number | Description | Type |
| Application Packets
|---|
| Online Privacy Policy | Online Privacy Policy | Application Packets |
| PLB-3394 | Application Transmittal Form | Application Packets |
| F-LAD-325 | Informal Transmittal | Application Packets |
| PL-400R-FL short | Term and Universal Life Application (Includes basic forms - single print) | Application Packets |
| PL-400R-FL packet | Term and Universal Life Application (Includes supplemental forms - two sided print) | Application Packets |
| Riders/Benefits Forms
|---|
| PL-403R-FL | Rider Worksheet | Riders/Benefits Forms |
| F-ILD-249 7/03 | Pre-Determined Death Benefit Settlement Option Election | Riders/Benefits Forms |
| PL-404R-FL | Child Rider Medical Declarations | Riders/Benefits Forms |
| CTR Packet FL | Child Term Rider Packet | Riders/Benefits Forms |
| HHA-ECR-Employer | Hold Harmless Agreement for Employer Owned Policy with ECR | Riders/Benefits Forms |
| HHA-ECR-Trust | Hold Harmless Agreement for Trust Owned policy with ECR | Riders/Benefits Forms |
| HHA-OneIns-MultECR | Hold Harmless Agreement-One Insured-Multiple Policies with ECR | Riders/Benefits Forms |
| L652-DSC | Summary and Disclosure Form for Chronic Illness Accelerated Death Benefit Rider | Riders/Benefits Forms |
| Questionnaires
|---|
| U-646-FL | Foreign Travel and Residence Questionnaire | Questionnaires |
| PL-U663-FL | Aviation/Scuba/Racing Questionnaire | Questionnaires |
| PL-U657-FL | Mountain/Rock Climbing Questionnaire | Questionnaires |
| PL-603-FL | Drug and Alcohol Use Questionnaire | Questionnaires |
| PL-405R-FL | Confidential Financial Statement | Questionnaires |
| PL-601-FL | Foreign National Questionnaire | Questionnaires |
| PL-602-FL | Military Questionnaire | Questionnaires |
| PL-600-FL 10/12 | Tobacco Use Questionnaire (for New Business) | Questionnaires |
| Conversion & Replacement Forms
|---|
| A-1129-FLA (Ann) | Comparative Information Form For Proposed Insurance | Conversion & Replacement Forms |
| A-1128-FLA (Life) | Notice to Applicant Regarding Replacement of Life Insurance (FL) | Conversion & Replacement Forms |
| PL-502-FL | Application for Conversion or Exchange | Conversion & Replacement Forms |
| F-LAD-277 | Assignment/Transfer of Ownership for Section 1035 Exchange | Conversion & Replacement Forms |
| U-640 | Assignment/Transfer of Ownership with Transfer of Outstanding Loan | Conversion & Replacement Forms |
| PL-V234-FL SOVULII | Application for Conversion to SOVUL II | Conversion & Replacement Forms |
| A-1129-FLA (Life) | Comparative Information Form For Proposed Insurance | Conversion & Replacement Forms |
| Authorization Forms
|---|
| APS-Special Authorization FL | APS-Special Authorization (Cleveland Clinic) | Authorization Forms |
| APS-Special Authorization (Mayo Clinic Florida) | APS-Special Authorization (Mayo Clinic) | Authorization Forms |
| PL-HIPAA3-FL | Authorization to Obtain and Disclose Information | Authorization Forms |
| PLX-425 | Cross Border Sales Certification | Authorization Forms |
| Kaiser Permanente Form | Kaiser Permanente Form - All States | Authorization Forms |
| PLX-U398 | Parental Consent for Life Insurance Policies | Authorization Forms |
| Premium Payment
|---|
| PL-104 | Pre-Authorized Withdrawal (PAW) Agreement | Premium Payment |
| PL-CR | Conditional Life Receipt | Premium Payment |
| F-LAD-416 (12/08) | Employee Payroll Deduction Authorization Form | Premium Payment |
| Miscellaneous
|---|
| PL-701-FL | Supplement to Life Insurance Application (SOLI/IOLI) **REQUIRED FORM** | Miscellaneous |
| F-LAD-411 | Premium Financing Disc & Acknowledgement | Miscellaneous |
| F-LAD-410-FL | Trust Certification (SOLI/IOLI) | Miscellaneous |
| PL-702-FL | Statement of Owner Intent (SOLI/IOLI) | Miscellaneous |
| PLX-588 | Life Insurance Illustration Certification & Acknowledgement | Miscellaneous |
| Military DA Form 2056 | Military DA Form 2056 | Miscellaneous |
| DD Form 2885 | Military - Personal Commercial Solicitation Evaluation | Miscellaneous |
| PLAG.2807 07/12 | IDG UW Requirements | Miscellaneous |
| U-422-FL 4/02 | HIV Informed Consent | Miscellaneous |
| PL-402-FL | Non-Medical Declarations (Part 1A Medical) | Miscellaneous |
| PL-406A-FL | Continuation of Information | Miscellaneous |
| PLBD.1657.08.12 | Rate Class Evaluation Form | Miscellaneous |
| PL-DIP | Description of Information Practices | Miscellaneous |
| Explanation of Coverage | Explanation of Coverage - for Broker/Dealer use only. | Miscellaneous |
| PLX-602 | Military Sales Disclosure Form | Miscellaneous |
| EOLI | Notice and Consent for Employer Owned Life Insurance | Miscellaneous |
| PN-100R-FL | Save Age Form | Miscellaneous |
| Policy Service Forms
|---|
| U-253-FL | Statement of Health | Policy Service Forms |
| F-LAD-233 with PAW | Service Request Form | Policy Service Forms |
| Tobacco Packet FL | Tobacco Use Questionnaire (for Rate Reclassification) | Policy Service Forms |
| SVC-128-PL | Partial Assignment of Policy as Collateral Security | Policy Service Forms |
| SVC-130-PL | Collateral Assignment Form | Policy Service Forms |
| F-787 9/99 | Request for Change of Beneficiary to Trustee Under a Last Will & Testament | Policy Service Forms |
| SVC-101-PL | Automatic Premium Loan | Policy Service Forms |
| SVC-102-PL | Beneficiary Change | Policy Service Forms |
| SVC-103-PL | Beneficiary with Mode of Settlement | Policy Service Forms |
| SVC-104-PL | Change of Broker | Policy Service Forms |
| SVC-106-PL | Co-Owner, Joint Owner, Ownership Common, Contingent | Policy Service Forms |
| SVC-105-PL | Contingent Ownership | Policy Service Forms |
| SVC-107-PL | Covered Insured Beneficiary | Policy Service Forms |
| SVC-108-PL | Dividend and Coupon | Policy Service Forms |
| SVC-109-PL | Duplicate Policy - Policy Not Lost | Policy Service Forms |
| F-ILD-228-FL | GIO - Request to Exercise Option to Purchase Additional Life Insurance | Policy Service Forms |
| SVC-125-PL | Indexed Universal Life Fund Transfer/Allocation Change Form | Policy Service Forms |
| SVC-111-PL | Loan Form | Policy Service Forms |
| SVC-135-PL | Monthly Level Transfer (MLT) for Indexed Universal Life Insurance | Policy Service Forms |
| SVC-114-PL | Name Change | Policy Service Forms |
| SVC-115-PL | Non Forfeiture Options | Policy Service Forms |
| U-582 MEC | Notice Regarding Tax Treatment of Modified Endowment Contracts | Policy Service Forms |
| FL-SA 3/07 | Notification of Right to Name a Secondary Addressee | Policy Service Forms |
| SVC-116-PL | Partial Surrender | Policy Service Forms |
| PLX-510 | Policy Change Application No Evidence | Policy Service Forms |
| PL-526-FL packet | Policy Change with Evidence Packet | Policy Service Forms |
| SVC-117-PL | Pre Authorized Withdrawal | Policy Service Forms |
| PL-525-FL packet | Reinstatement Packet | Policy Service Forms |
| SVC-131-PL | Release of Assignment | Policy Service Forms |
| SVC-118-PL | Surrender Paid Up Additions | Policy Service Forms |
| SVC-119-PL | Transfer of Ownership | Policy Service Forms |
| W-8BEN | W-8BEN Tax Form | Policy Service Forms |
| W-8BEN Instructions | W-8BEN Tax Form Instructions | Policy Service Forms |
| SVC-120-PL | Waiver of Community Property | Policy Service Forms |
| Examiner Forms (For Medical Examiner Use Only)
|---|
| PL-103-FL_PL-406A-FL | Medical Exam Form | Examiner Forms (For Medical Examiner Use Only) |
| PL-226R-FL | Supplemental Underwriting Application **FOR MEDICAL EXAMINER USE ONLY** | Examiner Forms (For Medical Examiner Use Only) |
| Agent Specific Forms
|---|
| PLX-408 | Broker/Representative Report | Agent Specific Forms |
Life and Annuity Division