Form Number Description Type
Application Packets
Online Privacy Policy Online Privacy PolicyApplication Packets
PLB-3394Application Transmittal FormApplication Packets
F-LAD-325Informal TransmittalApplication Packets
ICC21-400R KS shortTerm and Universal Life Application (Includes basic forms - single print)Application Packets
ICC21-400R KS packetTerm and Universal Life Application (Includes supplemental forms - two sided print)Application Packets
Riders/Benefits Forms
ICC18-437RIncome Provider OptionRiders/Benefits Forms
ICC20-403RRider WorksheetRiders/Benefits Forms
F-ILD-249 7/03Pre-Determined Death Benefit Settlement Option ElectionRiders/Benefits Forms
ICC17-404RChild Rider Medical DeclarationsRiders/Benefits Forms
CTR Packet CompactChild Term Rider PacketRiders/Benefits Forms
HHA-ECR-EmployerHold Harmless Agreement for Employer Owned Policy with ECRRiders/Benefits Forms
HHA-ECR-TrustHold Harmless Agreement for Trust Owned policy with ECRRiders/Benefits Forms
HHA-OneIns-MultECRHold Harmless Agreement-One Insured-Multiple Policies with ECRRiders/Benefits Forms
L652-DSCSummary and Disclosure Form for Chronic Illness Accelerated Death Benefit RiderRiders/Benefits Forms
F-LAD-423 (6/09)Summary Disclosure Statement for Accelerated Death Benefit Riders/Benefits Forms
Questionnaires
ICC13-PU646Foreign Travel and Residence QuestionnaireQuestionnaires
ICC19-U663Aviation/Scuba/Racing QuestionnaireQuestionnaires
ICC19-U657Mountain/Rock Climbing QuestionnaireQuestionnaires
ICC20-603Drug and Alcohol Use QuestionnaireQuestionnaires
ICC13-PU601Parachute/Sky Diving QuestionnaireQuestionnaires
ICC20-405RConfidential Financial StatementQuestionnaires
ICC15-601Foreign National QuestionnaireQuestionnaires
ICC18-PL602Military QuestionnaireQuestionnaires
ICC12-600 10/12Tobacco Use Questionnaire (for New Business)Questionnaires
Conversion & Replacement Forms
A-1128c(RM) (Life)Life - Replacement Form (External/Internal)Conversion & Replacement Forms
F-LAD-277 Assignment/Transfer of Ownership for Section 1035 ExchangeConversion & Replacement Forms
U-640Assignment/Transfer of Ownership with Transfer of Outstanding LoanConversion & Replacement Forms
ICC13-502 Pkt GenericLife - Application for Conversion or ExchangeConversion & Replacement Forms
Authorization Forms
ICC21-HIPAA3Authorization to Obtain and Disclose InformationAuthorization Forms
PLX-425Cross Border Sales CertificationAuthorization Forms
Kaiser Permanente FormKaiser Permanente Form - All StatesAuthorization Forms
PLX-U398Parental Consent for Life Insurance PoliciesAuthorization Forms
Premium Payment
PL-104 Pre-Authorized Withdrawal (PAW) AgreementPremium Payment
PL-TLR for KSTemporary Life Receipt - KSPremium Payment
Miscellaneous
ICC14-PL701Supplement to Life Insurance Application (SOLI/IOLI) **REQUIRED FORM**Miscellaneous
F-LAD-411Premium Financing Disc & AcknowledgementMiscellaneous
ICC14-PL702Statement of Owner Intent (SOLI/IOLI)Miscellaneous
ICC13-LAD410Trust Certification (SOLI/IOLI)Miscellaneous
PLX-588Life Insurance Illustration Certification & AcknowledgementMiscellaneous
Military DA Form 2056Military DA Form 2056Miscellaneous
DD Form 2885Military - Personal Commercial Solicitation EvaluationMiscellaneous
PLAG.2807 07/12IDG UW RequirementsMiscellaneous
U-422 12/99HIV Informed ConsentMiscellaneous
ICC12-402Non-Medical Declarations (Part 1A Medical)Miscellaneous
ICC13-406AContinuation of InformationMiscellaneous
PLBD.1657.08.12Rate Class Evaluation FormMiscellaneous
PL-DIP Description of Information PracticesMiscellaneous
Explanation of CoverageExplanation of Coverage - for Broker/Dealer use only.Miscellaneous
PLX-602Military Sales Disclosure FormMiscellaneous
EOLINotice and Consent for Employer Owned Life InsuranceMiscellaneous
ICC21-PN-100RSave Age FormMiscellaneous
Policy Service Forms
F-LAD-233 with PAWService Request FormPolicy Service Forms
SVC-128-PLPartial Assignment of Policy as Collateral SecurityPolicy Service Forms
SVC-130-PLCollateral Assignment FormPolicy Service Forms
F-787 9/99Request for Change of Beneficiary to Trustee Under a Last Will & TestamentPolicy Service Forms
SVC-101-PLAutomatic Premium LoanPolicy Service Forms
SVC-102-PLBeneficiary ChangePolicy Service Forms
SVC-103-PLBeneficiary with Mode of SettlementPolicy Service Forms
SVC-104-PLChange of BrokerPolicy Service Forms
SVC-106-PLCo-Owner, Joint Owner, Ownership Common, ContingentPolicy Service Forms
SVC-105-PLContingent OwnershipPolicy Service Forms
SVC-107-PLCovered Insured BeneficiaryPolicy Service Forms
SVC-108-PLDividend and CouponPolicy Service Forms
SVC-109-PLDuplicate Policy - Policy Not LostPolicy Service Forms
F-ILD-228GIO - Request to Exercise Option to Purchase Additional Life InsurancePolicy Service Forms
SVC-125-PLIndexed Universal Life Fund Transfer/Allocation Change FormPolicy Service Forms
SVC-111-PLLoan FormPolicy Service Forms
SVC-135-PLMonthly Level Transfer (MLT) for Indexed Universal Life InsurancePolicy Service Forms
SVC-114-PLName ChangePolicy Service Forms
SVC-115-PLNon Forfeiture OptionsPolicy Service Forms
U-582 MECNotice Regarding Tax Treatment of Modified Endowment ContractsPolicy Service Forms
SVC-116-PLPartial SurrenderPolicy Service Forms
PLX-510Policy Change Application No EvidencePolicy Service Forms
ICC13-P526 generic HIV packetPolicy Change with Evidence PacketPolicy Service Forms
SVC-117-PLPre Authorized WithdrawalPolicy Service Forms
ICC13-P525 generic HIV packetReinstatement PacketPolicy Service Forms
SVC-131-PLRelease of AssignmentPolicy Service Forms
U-253Statement of HealthPolicy Service Forms
SVC-118-PLSurrender Paid Up AdditionsPolicy Service Forms
Tobacco Packet KSTobacco Use Questionnaire (for Rate Reclassification)Policy Service Forms
SVC-119-PLTransfer of OwnershipPolicy Service Forms
W-8BENW-8BEN Tax FormPolicy Service Forms
W-8BEN InstructionsW-8BEN Tax Form InstructionsPolicy Service Forms
SVC-120-PLWaiver of Community PropertyPolicy Service Forms
Agent Specific Forms
PLX-408Broker/Representative ReportAgent Specific Forms