| Type | Description | Form Number |
| Application Packets
|---|
| Application Packets | Online Privacy Policy | Online Privacy Policy |
| Application Packets | Application Transmittal Form | PLB-3394 |
| Application Packets | Informal Transmittal | F-LAD-325 |
| Application Packets | TeleLife Fax Pre-Application for Term/UL | U-664-G |
| Application Packets | Electronic Policy Delivery Form | ADMIN-2494214 |
| Fixed Annuity Forms
|---|
| Fixed Annuity Forms | ProSaver Secure II Disclosure Statement | LAD-1228 Secure II Disclosure |
| Fixed Annuity Forms | ProSaver Secure R Disclosure Statement | LAD-1229 Secure R Disclosure |
| Fixed Annuity Forms | Protective Income Builder Rising Income Benefit Election | LAD-1233-RIB |
| Fixed Annuity Forms | Protective Income Manager Withdrawal Form | LAD-1216 |
| Riders/Benefits Forms
|---|
| Riders/Benefits Forms | Hold Harmless Agreement for Employer Owned Policy with ECR | HHA-ECR-Employer |
| Riders/Benefits Forms | Hold Harmless Agreement for Trust Owned policy with ECR | HHA-ECR-Trust |
| Riders/Benefits Forms | Hold Harmless Agreement-One Insured-Multiple Policies with ECR | HHA-OneIns-MultECR |
| Questionnaires
|---|
| Questionnaires | Confidential Financial Statement | ICC20-405R |
| Questionnaires | Diabetic Questionnaire | U-102P-11/83 |
| Questionnaires | Military Questionnaire | ICC18-PL602 |
| Conversion & Replacement Forms
|---|
| Conversion & Replacement Forms | Assignment/Transfer of Ownership Section 1035 Exchange | F-LAD-277 |
| Conversion & Replacement Forms | (Life) Replacement Form (External/Internal) | A-2043-N (Life) |
| Conversion & Replacement Forms | 1035 Exchange Form | U-379-R6 |
| Conversion & Replacement Forms | Assignment/Transfer of Ownership with Transfer of Outstanding Loan | U-640 |
| Conversion & Replacement Forms | Dimensions V RightTime Election Form | LAD-1198 DIM V |
| Conversion & Replacement Forms | NJ CONVERSIONS | NJ CONVERSIONS |
| Authorization Forms
|---|
| Authorization Forms | Kaiser Permanente Form - All States | Kaiser Permanente |
| Premium Payment
|---|
| Premium Payment | Pre-Authorized Withdrawal Form | PL-104 |
| Premium Payment | Conditional Life Receipt | PL-CR |
| Premium Payment | Employee Payroll Deduction Authorization Form | F-LAD-416 (12/08) |
| Premium Payment | Pre-Authorized Withdrawal Form | F-706-R8 |
| Transfer of Assets and Administrative Annuity Forms
|---|
| Transfer of Assets and Administrative Annuity Forms | Annuity Suitability Form | LAD-1243R Annuity Suitability |
| Transfer of Assets and Administrative Annuity Forms | Assignment of Policy as Collateral Security for Annuities | LAD-1235 |
| Transfer of Assets and Administrative Annuity Forms | FIA Indexed Annuity Allocations | LAD-1232 |
| Transfer of Assets and Administrative Annuity Forms | Investors Series - Allocation Adjustment Program | LAD-1236-PVA-IS |
| Miscellaneous
|---|
| Miscellaneous | Premium Financing Disc & Acknowledgement | F-LAD-411 |
| Miscellaneous | Statement of Owner Intent (SOLI/IOLI) | ICC14-PL702 |
| Miscellaneous | Trust Certification (SOLI/IOLI) | ICC13-LAD410 |
| Miscellaneous | Continuation of Information | ICC13-406A |
| Miscellaneous | Supplement to Life Insurance Application (SOLI/IOLI) ** REQUIRED FORM** | ICC14-PL701 |
| Miscellaneous | Advertising Request Form | MK-269 (5/00) |
| Miscellaneous | Description of Information Practices | PL-DIP-G |
| Miscellaneous | Explanation of Coverage - for Broker/Dealer use only. | Explanation of Coverage |
| Miscellaneous | HIV Consent Form | U-422 |
| Miscellaneous | Intent to Buy - fillable | Intent to Buy |
| Miscellaneous | Life Insurance Illustration Certification & Acknowledgement | PLX-588 |
| Miscellaneous | Military - Personal Commercial Solicitation Evaluation | DD Form 2885 |
| Miscellaneous | Military DA Form 2056 | Military DA Form 2056 |
| Miscellaneous | Military Sales Disclosure Form | PLX-602 |
| Miscellaneous | Notice and Consent for Employer Owned Life Insurance | EOLI |
| Miscellaneous | Order Form for Business Cards, Letterhead & Envelopes | MK-283 (7/00) |
| Miscellaneous | UL Exchange | F-1241 |
| Miscellaneous | W9 Tax Form | W-9 |
| Policy Service Forms
|---|
| Policy Service Forms | Automatic Premium Loan | SVC-101-PL |
| Policy Service Forms | Beneficiary Change | SVC-102-PL |
| Policy Service Forms | Beneficiary Change of Last Will & Testament | F-787 (9/99) |
| Policy Service Forms | Beneficiary Information Request | LAD-1225 |
| Policy Service Forms | Beneficiary with Mode of Settlement | SVC-103-PL |
| Policy Service Forms | Change of Broker | SVC-104-PL |
| Policy Service Forms | Co-Owner, Joint Owner, Ownership Common, Contingent | SVC-106-PL |
| Policy Service Forms | Collateral Assignment Form | SVC-130-PL |
| Policy Service Forms | Contingent Ownership | SVC-105-PL |
| Policy Service Forms | Covered Insured Beneficiary | SVC-107-PL |
| Policy Service Forms | Dividend and Coupon | SVC-108-PL |
| Policy Service Forms | Duplicate Policy - Policy Not Lost | SVC-109-PL |
| Policy Service Forms | Indexed Universal Life Fund Transfer/Allocation Change Form | SVC-125-PL |
| Policy Service Forms | Loan Form | SVC-111-PL |
| Policy Service Forms | Name Change | SVC-114-PL |
| Policy Service Forms | Non Forfeiture Options | SVC-115-PL |
| Policy Service Forms | Notice Regarding Tax Treatment of Modified Endowment Contracts | U-582 MEC |
| Policy Service Forms | Partial Assignment of Policy as Collateral Security | SVC-128-PL |
| Policy Service Forms | Partial Surrender | SVC-116-PL |
| Policy Service Forms | Policy Change Application No Evidence | PLX-510 |
| Policy Service Forms | Reinstatement Packet | ICC13-P525 generic HIV packet |
| Policy Service Forms | Service Request Form | F-LAD-233 with PAW |
| Policy Service Forms | Statement of Health | U-253 |
| Policy Service Forms | Surrender Paid Up Additions | SVC-118-PL |
| Policy Service Forms | Transfer of Ownership | SVC-119-PL |
| Policy Service Forms | W-8BEN Tax Form | W-8BEN |
| Policy Service Forms | W-8BEN Tax Form Instructions | W-8BEN Instructions |
| Policy Service Forms | Waiver of Community Property | SVC-120-PL |
| Examiner Forms (For Medical Examiner Use Only)
|---|
| Examiner Forms (For Medical Examiner Use Only) | Part II Statements Made to Examiner | PL-103-G_ICC13-406A |
| Examiner Forms (For Medical Examiner Use Only) | Authorization to Obtain and Disclose Information (HIPAA) | ICC21-HIPAA3 medical examiner |
| Examiner Forms (For Medical Examiner Use Only) | Landmark Copy Drawing Test **FOR EXAMINER USE ONLY** | F-LAD-402 |
| Examiner Forms (For Medical Examiner Use Only) | Supplemental Underwriting Application ** FOR MEDICAL EXAMINER USE ONLY | ICC13-P226 |
| Agent Specific Forms
|---|
| Agent Specific Forms | Broker/Representative Report | PLX-408 |
| Agent Specific Forms | APS Reimbursement Request Form | PL-APS |
