Forms
PLANHOLDER SERVICES FORM
- PS-003 – APPLICATION FOR REINSTATEMENT (INDIVIDUAL)
- PS-004 – APPLICATION FOR AMENDMENT (INDIVIDUAL)
- PS-011 – PLANHOLDER CONTACT INFORMATION FORM (INDIVIDUAL)
- AFFIDAVIT OF LOSS – CFP
- AFFIDAVIT OF LOSS – PLAN CONTRACT
- BENEFIT SETTLEMENT FORM (BSF) FOR INDIVIDUAL PLANS
- APPLICATION FOR REINSTATEMENT (GROUP PLANS)
- APPLICATION FOR AMENDMENT (GROUP PLANS)
- BENEFIT SETTLEMENT FORM (GROUP PLANS)
- AUTHORITY TO DEPOSIT (GROUP PLANS)
- REISSUANCE AND REPLACEMENT OF CHECKS REQUEST FORM
- DEATH CLAIMS REQUIREMENT
- DISABILITY DISMEMBERMENT CLAIMS REQUIREMENTS
- AUTHORITY TO DEPOSIT – BENEFICIARY (DEATH CLAIM)
- CLAIMANT STATEMENT FORM – DEATH CLAIM
- ATTENDING PHYSICIAN’S STATEMENT – DEATH CLAIM
- CLAIMANT STATEMENT FORM – TOTAL DISABILITY CLAIM
- ATTENDING PHYSICIAN’S STATEMENT – TOTAL DISABILITY
- LIST OF ACCREDITED SERVICING MORTUARIES
- AUTHORITY TO DEPOSIT (ATD) FOR NOMINEE/BENEFICIARY
- AUTHORITY TO DEPOSIT (ATD) FOR LEGAL GUARDIAN