Files are organized into these sections: Administrative Forms, Sales, Underwriting, and Miscellaneous.
You can either download the file you need or view and print from your browser.
NOTE: You MUST have a Free copy of Adobe Reader version 5.0 or higher installed on your computer in order to view & print these files correctly. Click here to download a free copy.
-
Page last updated: 12/01/05
- New Business Transmittal Form (S1080 R04)
- Bank Draft Authorization (F1080 R05) - September '05
- Report of Larger Mode Collected on Delivery of Policy (S1308)
- Phone Interview (LPV-97)
- Supply Order Form (S1139)
- Print Ad Order Form (GA-AAR05) - April '05
Administrative Forms
- A.M. Best Order Form
- Issue Age vs. Attained Age (F4411)
- High Deductible Plan F Flyer (HDFLY-05R)
- High Deductible Plan F Information Sheet (F4590)
- Before You Buy Long Term Care Insurance
- Delaware: LTCINFO7
- All Other Applicable States: LTCINF
- Long Term Care Insurance Personal Worksheet
- Alabama, Delaware, Illinois, Louisiana, Nebraska, New Mexico: LTCPW1
- Alaska, Arizona: LTCPW2(02)
- Virginia: LTCPW45
- All Other Applicable States: LTCPW2
- UA Partners Review (F3844-G R0405)
- UA Partners Enrollment Form
- Alabama, Connecticut & Montana: F4300-I(01)
- All Other Applicable States: F4300-I
- UA Partners Provider Letter (UAP PL05)
Sales
- Agent Manual including Underwriting and SBR Instructions (F4303)
- ProCare Application MA14 Instructions (F5025)
- Life Height/Weight Chart (L-HWC)
- HIPAA Authorization Form (F3978)
- Consumer Form (3728-G 0405)
- Authorization to Obtain & Disclose Information (F1224)
- MIB/Notice of Information Practices (U1342)
- Sole Proprietor (SP 9/01)
Underwriting
- Reserve Fund Annuity Transaction Form (USFMS-TF)
- Reserve Fund Annuity Enrollment Form
- Arkansas: USFMS-AP(03)
- District of Columbia, Tennessee: USFMS-AP(08)
- Florida: USFMS-AP(09)
- Georgia, Texas: USFMS-AP(42)
- Hawaii: UFPA8-AP E66
- Kentucky, New Mexico, Ohio: USFMS-AP(34)
- Kansas: USFMS-AP(15)
- Louisiana, North Carolina: USFMS-AP(17)
- Maine: USFMS-AP(18)
- Maryland: USFMS-AP(19)
- Oklahoma: USFMS-AP(35)
- Oregon: USFMS-AP(36)
- Pennsylvania: USFMS-AP(37)
- South Dakota: USFMS-AP(40)
- Virginia: USFMS-AP(45)
- All Other Applicable States: USFMS-AP
- Deposit Fund Rider Enrollment Form (F3773 R)
- Deposit Fund Transaction Form (F3774)
- OBRA - Medicare Comparison Form
- Connecticut & Missouri: U-1366 CT-MO
- Kentucky: U-1366 KY
- Louisiana: U-1366 LA
- All Other Applicable States: U-1366
- Medicare Supplement Replacement Form
- AK, CA, HI, PA & VA: U-1318MSM
- Idaho: REPMSM(11)
- Louisiana: REPMSM(17)
- New Hampshire: REPMSM(28)
- North Carolina: REPMSM(32)
- Texas: REPMSM(42)
- Washington: U-1318MSM(46)
- Wisconsin: REPMSM(48)
- All Other Applicable States: REPMSM
- Health Replacement Form
- Colorado: U-1318(05)
- Florida: U-1318(09)
- Idaho: U-1318(11)
- New Hampshire: U-1318(28)
- Pennsylvania: U-1318(37)
- South Carolina: U-1318(39)
- Wisconsin: U-1318(48)
- All Other Applicable States: U-1318
- Life Replacement Form
- Arizona, Kansas, Ohio, Rhode Island: REP S/79
- Michigan & West Virginia: REP S/79 & CIF
- CA, ID, IL, NE, SC, TN, VA: REP S/84
- Delaware: REP-DE
- Florida: REP-FL & CIF
- Georgia: REP-GA
- Indiana: REP-AR
- Kentucky: REP-KY
- Massachusetts: REP-MA
- Missouri: REP S/79 & REP-MO
- Nevada: REP-NV
- Oklahoma: REP-OK1 & REP-OK2
- Pennsylvania: REP-NM2
- South Dakota: REP-SD
- Washington: REP-WA1 & REP-WA2
- Wisconsin: REP WI1
- Wyoming: REP-UT
- All Other Applicable States: REPNOT/00
- Long Term Care Replacement Form
- Delaware: U-1318LTC2(07)
- New Jersey: U-1318LTC2(29)
- Oregon: U-1318LTC2(36)
- Georgia, Idaho, Maine & Massachusetts: U-1318LTC3
- All Other Applicable States: U-1318LTC2
- MSNOT06 - Notice to Applicants that this is not a Med-Supp Policy
- Cancer/Critical Illness:
- Maine: MSNOT06-1(18)
- Vermont: MSNOT-1
- All Other Applicable States: MSNOT06-1
- Hospital Incomes:
- Maine: MSNOT06-2(18)
- Vermont: MSNOT-2
- All Other Applicable States: MSNOT06-2
- Long Term Care:
- All Applicable States: MSNOT06-3Q, MSNOT06-4Q, MSNOT06-4
- Basic Hospital Surgical:
- Idaho: MSNOT06-5(11)
- All Other Applicable States: MSNOT06-5
- Medical Surgical:
- Maine: MSNOT06-8(18)
- Vermont: MSNOT-8
- All Other Applicable States: MSNOT06-8
Miscellaneous
NOTE: You MUST have a Free copy of Adobe Reader version 5.0 or higher installed on your computer in order to view & print these files correctly. Click here to download a free copy.
