Life and Annuity Division

Form Number Description Type 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 Miscellaneous Explanation of Coverage Explanation of Coverage - for Broker/Dealer use only. Miscellaneous 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-111-PL Loan Form Policy Service Forms SVC-114-PL Name Change Policy Service Forms SVC-115-PL Non Forfeiture Options Policy Service Forms SVC-116-PL Partial Surrender 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

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