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 |
ICC21-400R MS short | Term and Universal Life Application (Includes basic forms - single print) | Application Packets |
ICC21-400R MS packet | Term and Universal Life Application (Includes supplemental forms - two sided print) | Application Packets |
| Riders/Benefits Forms
---|
ICC18-437R | Income Provider Option | Riders/Benefits Forms |
ICC20-403R | Rider Worksheet | Riders/Benefits Forms |
F-ILD-249 7/03 | Pre-Determined Death Benefit Settlement Option Election | Riders/Benefits Forms |
ICC17-404R | Child Rider Medical Declarations | Riders/Benefits Forms |
CTR Packet MS | 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
---|
ICC13-PU646 | Foreign Travel and Residence Questionnaire | Questionnaires |
ICC19-U663 | Aviation/Scuba/Racing Questionnaire | Questionnaires |
ICC19-U657 | Mountain/Rock Climbing Questionnaire | Questionnaires |
ICC20-603 | Drug and Alcohol Use Questionnaire | Questionnaires |
ICC13-PU601 | Parachute/Sky Diving Questionnaire | Questionnaires |
ICC20-405R | Confidential Financial Statement | Questionnaires |
ICC15-601 | Foreign National Questionnaire | Questionnaires |
ICC18-PL602 | Military Questionnaire | Questionnaires |
ICC12-600 10/12 | Tobacco Use Questionnaire (for New Business) | Questionnaires |
| Conversion & Replacement Forms
---|
A-2043-N (Life) | Life - Replacement Form (External/Internal) | 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 |
ICC13-502 Pkt Generic | Life - Application for Conversion or Exchange | Conversion & Replacement Forms |
| Authorization Forms
---|
ICC21-HIPAA3 | 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
---|
ICC14-PL701 | Supplement to Life Insurance Application (SOLI/IOLI) **REQUIRED FORM** | Miscellaneous |
F-LAD-411 | Premium Financing Disc & Acknowledgement | Miscellaneous |
ICC14-PL702 | Statement of Owner Intent (SOLI/IOLI) | Miscellaneous |
ICC13-LAD410 | Trust Certification (SOLI/IOLI) | Miscellaneous |
PLX-588 | Life Insurance Illustration Certification & Acknowledgement | Miscellaneous |
ARB-MS-DISC | MS Arbitration Disclosure | 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 |
ICC12-402 | Non-Medical Declarations (Part 1A Medical) | Miscellaneous |
ICC13-406A | 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 |
U-423A | HIV Informed Consent | Miscellaneous |
PLX-602 | Military Sales Disclosure Form | Miscellaneous |
EOLI | Notice and Consent for Employer Owned Life Insurance | Miscellaneous |
ICC21-PN-100R | Save Age Form | Miscellaneous |
| Policy Service Forms
---|
F-LAD-233 with PAW | Service Request Form | 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 | 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 |
SVC-116-PL | Partial Surrender | Policy Service Forms |
PLX-510 | Policy Change Application No Evidence | Policy Service Forms |
ICC13-P526 for MS packet | Policy Change with Evidence Packet | Policy Service Forms |
SVC-117-PL | Pre Authorized Withdrawal | Policy Service Forms |
ICC13-P525 generic packet | Reinstatement Packet | Policy Service Forms |
SVC-131-PL | Release of Assignment | Policy Service Forms |
U-253 | Statement of Health | Policy Service Forms |
SVC-118-PL | Surrender Paid Up Additions | Policy Service Forms |
Tobacco Packet MS | Tobacco Use Questionnaire (for Rate Reclassification) | 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 |
| Agent Specific Forms
---|
PLX-408 | Broker/Representative Report | Agent Specific Forms |