Form Number | Description | Type |
| Application Packets
---|
Online Privacy Policy | Online Privacy Policy | Application Packets |
PLB-3394 | Application Transmittal Form | Application Packets |
| Riders/Benefits Forms
---|
PL-404R-NY | Child Rider Medical Declarations | Riders/Benefits Forms |
CTR Packet NY | Child Term Rider Packet | Riders/Benefits Forms |
PL-403R-NY | Rider Worksheet | Riders/Benefits Forms |
| Questionnaires
---|
PL-U663-NY | Aviation, Scuba Diving, Racing Questionnaire | Questionnaires |
PL-603-NY | Drug and Alcohol Use Questionnaire | Questionnaires |
U-646-NY | Foreign Travel and Residence Questionnaire | Questionnaires |
PL-405R-NY | Confidential Financial Statement | Questionnaires |
PL-601-NY | Foreign National Questionnaire | Questionnaires |
PL-602-NY | Military Questionnaire | Questionnaires |
PL-U657-NY | Mountain/Rock Climbing Questionnaire | Questionnaires |
F-LAD-315-NY | Tobacco Questionnaire | Questionnaires |
| Conversion & Replacement Forms
---|
B-7377 (NY) | Life - Definition of Replacement - Appendix 11 (Life) | Conversion & Replacement Forms |
B-7376 (NY) | Life - Disclosure Statement - Appendix 10A (Life) | Conversion & Replacement Forms |
B-7378 (NY) | Life - Notice Regarding Replacement - Appendix 10C (Life) | Conversion & Replacement Forms |
B-8183-NY | Life - Assignment/Transfer of Ownership Section 1035 Exchange | Conversion & Replacement Forms |
PL-502-NY | Application for Conversion or Exchange | Conversion & Replacement Forms |
Life - NY Reg-60 Pack | Life - New York Reg-60 Pack | Conversion & Replacement Forms |
B-8704NY | Life - Notice to Insurer of Proposed Replacement (Life) | Conversion & Replacement Forms |
| Authorization Forms
---|
PL-HIPAA3-NY | HIPAA Compliant Authorization | Authorization Forms |
B-7032 (NY) | Pre-authorized Bank Draft Agreement | Authorization Forms |
APS-Special Authorization (New York Presbyterian) | APS-Special Authorization (New York Presbyterian) | Authorization Forms |
PLX-425 | Cross Border Sales Certification | Authorization Forms |
Kaiser Permanente Form | Kaiser Permanente Form - All States | Authorization Forms |
PLX-U398-NY | Parental Consent for Life Insurance Policies | Authorization Forms |
| Premium Payment
---|
PL-CR-NY | Conditional Receipt Agreement - NY | Premium Payment |
PL-104-NY | Pre-Authorized Withdrawal Agreement | Premium Payment |
| Miscellaneous
---|
PL-701-NY | Supplement to Life Insurance Application (SOLI/IOLI) **REQUIRED FORM** | Miscellaneous |
PL-DIP-NY | Description of Information Practices | Miscellaneous |
F-LAD-410-NY | Trust Certification (SOLI/IOLI) | Miscellaneous |
B (NY) Info | Who Can Receive HIV Related Information? (Consumer Notice) | Miscellaneous |
B-7375 (NY) | Notice and Consent for Blood Testing | Miscellaneous |
PL-402-NY | Non-Medical Declarations (Part 1A Medical) | 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 |
F-588-R-NY (3/04) | Assignment of Policy as Collateral Security | Miscellaneous |
PL-406-NY | Continuation of Info for Pt I & II (Overflow Page) | Miscellaneous |
EOLI | Notice and Consent for Employer Owned Life Insurance | Miscellaneous |
F-LAD-411-NY | Premium Financing Disc & Acknowledgement | Miscellaneous |
PN-100R-NY | Save Age Form | Miscellaneous |
PL-702-NY | Statement of Owner Intent (SOLI/IOLI) | Miscellaneous |
| Policy Service Forms
---|
Tobacco Packet NY | Tobacco Use Questionnaire (for Rate Reclassification) | Policy Service Forms |
SVC-101-PLA | Automatic Premium Loan | Policy Service Forms |
SVC-102-PLA | Beneficiary Change | Policy Service Forms |
SVC-103-PLA | Beneficiary with Mode of Settlement | Policy Service Forms |
SVC-104-PLA | Change of Broker | Policy Service Forms |
SVC-106-PLA | Co-Owner, Joint Owner, Ownership Common, Contingent | Policy Service Forms |
SVC-130-PLA | Collateral Assignment | Policy Service Forms |
SVC-105-PLA | Contingent Ownership | Policy Service Forms |
SVC-107-PLA | Covered Insured Beneficiary | Policy Service Forms |
SVC-108-PLA | Dividend and Coupon | Policy Service Forms |
SVC-109-PLA | Duplicate Policy - Policy Not Lost | Policy Service Forms |
F-ILD-228-NY | GIO - Request to Exercise Option to Purchase Additional Life Insurance | Policy Service Forms |
SVC-125-PLA | Indexed Universal Life Fund Transfer/Allocation Change Form | Policy Service Forms |
SVC-111-PLA | Loan Form | Policy Service Forms |
SVC-114-PLA | Name Change | Policy Service Forms |
SVC-115-PLA | Non Forfeiture Options | Policy Service Forms |
U-582 MEC | Notice Regarding Tax Treatment of Modified Endowment Contracts | Policy Service Forms |
SVC-128-PLA | Partial Assignment of Policy as Collateral Security | Policy Service Forms |
SVC-116-PLA | Partial Surrender | Policy Service Forms |
PLX-510 | Policy Change Application No Evidence | Policy Service Forms |
PL-526-NY packet | Policy Change with Evidence Packet | Policy Service Forms |
SVC-117-PLA | Pre Authorized Withdrawal | Policy Service Forms |
PL-525-NY packet | Reinstatement Packet | Policy Service Forms |
SVC-131-PLA | Release of Assignment | Policy Service Forms |
SVC-118-PLA | Surrender Paid Up Additions | Policy Service Forms |
SVC-119-PLA | 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-PLA | Waiver of Community Property | Policy Service Forms |
| Examiner Forms (For Medical Examiner Use Only)
---|
PL-103-NY_PL-406-NY | Medical Exam Form | Examiner Forms (For Medical Examiner Use Only) |
PL-226R-NY | Supplemental Underwriting Application **FOR MEDICAL EXAMINER USE ONLY** | Examiner Forms (For Medical Examiner Use Only) |
| Agent Specific Forms
---|
PLX-408-NY | Broker/Representative Report | Agent Specific Forms |