| 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 |
| Riders/Benefits Forms
|---|
| F-ILD-249 7/03 | Pre-Determined Death Benefit Settlement Option Election | 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 |
| Questionnaires
|---|
| ICC20-405R | Confidential Financial Statement | Questionnaires |
| Conversion & Replacement Forms
|---|
| A-2043-N (Life) | Life - Replacement Form (External/Internal) | Conversion & Replacement Forms |
| NJ CONVERSIONS | NJ CONVERSIONS | 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 |
| Authorization Forms
|---|
| Kaiser Permanente Form | Kaiser Permanente Form - All States | 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 |
| 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 12/99 | HIV Informed Consent | 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-G | 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 |
| 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 |
| SVC-125-PL | Indexed Universal Life Fund Transfer/Allocation Change Form | Policy Service Forms |
| SVC-111-PL | Loan Form | 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-P525 generic HIV packet | Reinstatement Packet | Policy Service Forms |
| U-253 | Statement of Health | 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-G_ICC13-406A | Medical Exam Form | Examiner Forms (For Medical Examiner Use Only) |
| Agent Specific Forms
|---|
| PLX-408 | Broker/Representative Report | Agent Specific Forms |
Life and Annuity Division