Individual & Family Plan Applications
California
Medicare Rx
Medicare Supplement
- Anthem Blue Cross of California
- Blue Shield of California
- Combined Insurance Company of America
- Continental Life Insurance Co of Tennessee
- Health Net
- Humana
- Loyal American Life Insurance Company
- Mutual of Omaha Insurance Company
- National General
- Oxford Life Insurance Company
- United American Insurance Company
Accident
- National General - Vital Guard
Dental
- Anthem Blue Cross of California
- Blue Shield of California
- Delta Dental of California
- Humana Dental
- Nationwide Multiflex Dental
Term Life
- American General Life Insurance Company
- ABA Form (Transfer to Trustee)
- Absolute Assignment (AGLC0010) - 1035 exchange
- Accident Expense Plus Application - Nationwide
- Addendum to Part A or B application
- Affidavit Naming Children as Insured
- Affidavit of Heirship
- Agent Certification Form
- Annuitization Request
- Annuity Claimant Statement
- Aviation Questionnaire - Nationwide
- Avocation Questionnaire - Nationwide
- Bank Draft Authorization RB 5-28-10
- Business Financial Questionnaire
- Certification of Taxes and Laws for Foreign National and Visa Holders
- Change of Beneficiary
- Change of Ownership
- Collateral Assignment
- Collateral Assignment Form
- Collateral Assignment Form - Annuities
- Commercial Insurance Solicitation Record - Military
- Credit Card Authorization - Initial Premium ONLY
- Disability Income Continuation Form - Generic
- Disclosure for Sales to Senior Citizens - CA
- Disclosure for Term Life Insurance (AGL) - CA & SC
- Disclosure Form for Military Sales
- Drug/Alcohol Questionnaire - Nationwide
- Electronic Funds Transfer Authorization - EFT
- Employer
- Exempt Employee Certification - CA
- Financial Institution Source of Funds Certification
- Financial Institution Source of Funds Certification
- Financial Products Disclosure - CA
- Financial Questionnaire - Nationwide
- Foreign Travel or Residence Supplement - Nationwide
- HIPAA Authorization - Claim
- HIPAA Authorization - Claim (CA)
- HIPAA Authorization - Life New Business
- HIPAA Privacy Notice - REV0311
- HIPPA Authorization - CA
- HIV Testing Consent - CA
- How to Convert Group to Individual
- Illustration Acknowledgement and Certification
- In-Force Change Application - CA
- Lien Agreement
- Life Application Part A - CA
- Life Application Part B - CA
- Life Insurance Information for Military Personnel
- Limited Power of Attorney
- Medi-Cal Eligibility Notice Regarding Standards for Senior Citizens
- Name and Address Change
- Outline of Coverage for Disability Income Rider - Generic
- Personal Commercial Solicitation Evaluation - Military
- Personal Financial Questionnaire
- Policy Delivery Receipt - AGL version
- Premium Financing Disclosure for Proposed Insureds
- Proof of Heirship Affidavit Statement
- Reinstatement Application - CA
- Replacement Form - CA
- Replacement Form - CA, IL, NE, NM, NC, OH
- Replacement Instruction Sheet
- Replacement Policies and Guidelines - D (agent only)
- Request for Direct Rollover
- Required Minimum Distribution Election Form
- ROTH IRA Acknowledgment
- Salary Allotment - Employer
- Salary Allotment Authorization
- Salary Reduction Agreement
- Service Request
- Service Request
- Short Health Statement - Nationwide
- Supplemental Deferred Annuity Application
- Systematic Premium Preauthorized Debit Form
- Systematic Withdrawal Request
- Term Application Part A - CA
- Term Child Rider Attachment - Generic
- Term Conversion Request Form
- Transmittal Form - Split Dollar Checklist
- Transmittal Form and Checklist - IAG and LBG
- AXA Equitable Life Insurance Company
- Acknowledgement of Disclosure for Employer-Owned Life Insurance Policies
- Application For Individual Life Insurance (Section A & D) (nonn-ICC)
- AXA Advisors Privacy Policy
- Captive Insurer Acknowledgement & Hold Harmless Form
- Disclosure for commercial financed life policies
- DISCLOSURE FOR EMPLOYER-OWNED LIFE INSURANCE POLICIES
- Financial Questionnaire (Section C) non-ICC
- Financial Supplement II
- Guaranteed Issue Life Application - CA
- HIPAA Authorization
- HIPAA Release Information (non-ICC)
- HIV Test Consent
- Instructions for New Life Application
- Language Barrier Statement for Agent
- Life Insurance and Annuity Disclosure to Active Duty Members of the Armed Forces
- Limited Temporary Insurance Agreement/Receipts (non-ICC)
- Living Benefits Rider Brochure
- Living Benefits Rider Brochure
- No Conforming Illustration Certificate
- NOTICE AND CONSENT FORM FOR EMPLOYER OWNED LIFE INSURANCE
- Owner Questionnaire (Section C) non-ICC
- Request for Systematic Plan
- Term LIfe-Product Information (Section B) non- ICC
- Underwriting Page (non-ICC)
- Variable Universal Life Supplement
- Variable Universal Life Supplement
- Banner Life Insurance Company
- 3rd Party Translator
- Acknowledgement of Non-Illustrated Application
- Additional Details Supplement to Application (Part I)
- Additional Details Supplement to Application (Part II)
- California Applicant (65 Years or Older) Verification of Disclosure Statements
- California Disclosure Notice to Persons Age 65 and Older
- Conditional Receipt
- First Financial Inspection Request
- Life Insurance Application (CA)
- Notice and Consent for Blood Testing (CA)
- Privacy Policy - Explanation
- Release of Health-Related Information - HIPAA Privacy
- Genworth Life and Annuity Insurance Co
- 1035 Exchange Agreement
- Application
- Application Overflow
- Authorization for Release of Health-Related Information
- Certification of trustee powers
- Computer screen illustration waiver acknowledgment
- Consumer Complaints Listing
- Declaration of attorney-in-fact
- Disclosure Statement (Term only) (CA)
- Disclosure Statement (UL only)
- Electronic fund transfer (EFT) authorization (Policyholder Services)
- Electronic Fund Transfer Authorization (EFT) (New Business)
- Employer life insurance application addendum (Qualified Plans)
- HIV Consent
- HIV Consent (CA)
- HIV Counseling (CA)
- IGO APP QUICKCHECK GUIDE
- Illustration waiver acknowledgement
- Joint Life Application
- Notice and Consent to Employer
- Notice Regarding Standards for Medi-Cal Eligibility
- Personal Commercial Solicitation Evaluation
- Premium Financing Disclosure Statement
- Required disclusures regarding sales to military personnel
- Statement Regarding Sales Outside Owner Resident State
- Statement Regarding Sales Outside Owner Resident State
- Supplement to Life Application Part I
- Verification of Disclosures to California Residents 65 and Older
- Genworth Life Insurance Company
- 1035 Exchange Agreement
- Application
- Application Overflow
- Authorization for Release of Health-Related Information
- Certification of trustee powers
- Computer screen illustration waiver acknowledgment
- Consumer Complaints Listing
- Declaration of attorney-in-fact
- Disclosure Statement (Term only) (CA)
- Disclosure Statement (UL only)
- Electronic fund transfer (EFT) authorization (Policyholder Services)
- Electronic Fund Transfer Authorization (EFT) (New Business)
- Employer life insurance application addendum (Qualified Plans)
- HIV Consent
- HIV Consent (CA)
- HIV Counseling (CA)
- IGO APP QUICKCHECK GUIDE
- Illustration waiver acknowledgement
- Life Quick Request Agent Worksheet
- Life Quick Request Temporary Insurance Application and Agreement (TIAA) Worksheet
- Life Quick Request Worksheet
- Notice and Consent to Employer
- Notice Regarding Standards for Medi-Cal Eligibility
- Personal Commercial Solicitation Evaluation
- Premium Financing Disclosure Statement
- Quick App Fulfillment Worksheet - Overflow
- Required disclusures regarding sales to military personnel
- Statement Regarding Sales Outside Owner Resident State
- Statement Regarding Sales Outside Owner Resident State
- Supplement to Application - Mortgage Certification
- Supplement to Life Application Part I
- Verification of Disclosures to California Residents 65 and Older
- Lincoln National Life Insurance Company
- Administrative Form for Universal Life Insurance
- Application for Life Insurance
- Authorization for Release of Information-CA (HIPAA & MIB)
- Backdating Letter
- California Aids Counseling Facilities
- Disclosure Form for Lincoln LifeElements Level Term (2009)
- Disclosure Notice to Persons Age 65 and Older-CA
- Disclosure Statement Required with Flexible Premium-CA
- Disclosure Statement-ABR
- Disclosure Statement-ABR
- Disclosure Statement-ABR
- Disclosure Statement-CA
- Disclosure-Universal Life-CA
- Electronic Funds Transfer (EFT) Authorization
- Employer Owned Life Insurance Consent and Notice
- Financial Institution Disclosure Notice
- HIV Infection and AIDS: An Overview
- Illustration Compliance Certification Form
- Life Insurance Buyers Guide
- Military Sales Disclosure
- Notice and Consent for HIV-Related Testing
- Out-of-State Sale Verification Form
- Premium Financing Lender Certification
- Premium Financing Supplement-CA
- Privacy Practices Notice
- Required Producer & Representative Certification Regarding SOLI
- Short Form Request for Individual Tax Return Transcript
- Temporary Life Insurance Agreement
- North American Co for Life and Health
- 1035 Exchange
- CA Elder Law Notice
- CA Senior Notice
- Certification of Trust Agreement
- COLI Consent Form
- Consumer Protection Notice
- Credit Card Billing Authorization
- Disclosure for IUL
- Disclosure Form - Guarantee No Lapse Provision (UL) (CA)
- Electronic Fund Transfer Authorization
- HIV Consent (CA)
- IUL Disclosure
- IUL Supplement to Application
- Life Agent Report
- Life Application Part I B (CA)
- Life Insurance Application (CA)
- NAC HIPAA Authorization
- Pension Max Disclosure Statement
- Policy Settlement Agreement - Beneficiary Designation
- Red Cross HIV Testing Brochure
- SIUL App for Election of Accelerated Benefits
- SIUL Benefit Worksheet and Payment Notice
- Statements About Illustrations
- Temporary Insurance Agreement
- Transmittal Report
- Protective Life Insurance Company
- Application Packet - Brokerage Life Insurance
- Authorization to Obtain and Disclose Information (HIPAA)
- Authorization to Release Underwriting Information
- Broker/Representative
- California NOTICE REGARDING STANDARDS
- Conditional Receipt / Temporary Life Receipt Agreement
- Confidential Financial Statement
- Consent and Authorization to Obtain and Disclose Information
- Critical Illness Application (CA)
- Disclosure and Acknowledgement (Replaces 9/08 version)
- Election of Paid-Up Endowment Option
- Electronic Policy Delivery Form
- HIPAA Compliant Authorization to Release Confidential Medical Information
- Income Provider Option
- Informal Inquiry
- Landmark Drawing Copy Test
- MIB Disclosure (CA)
- Military - Personal Commercial Solicitation Evaluation
- Military DA Form 2056
- Military Questionnaire (Generic)
- Military Sales Disclosure Form
- NAIC No Illustration Form (CA)
- Non-Licensed Territory Declaration (New York)
- Notice and Consent for HIV/AIDS Testing (CA)
- Notice Regarding Save-Age Dating of Policy
- Notice to Applicants Aged 65 or Older
- Other Kaiser or Medical Institutional Forms (CA)
- Other Kaiser or Medical Institutional Forms (CA)
- Other Kaiser or Medical Institutional Forms (CA)
- Other Kaiser or Medical Institutional Forms (CA)
- Other Kaiser or Medical Institutional Forms (CA)
- Pre-Authorized Withdrawal
- Sample Notice and Consent Document for Employer-Owned Life Insurance
- Statement of Owner Intent
- SUPPLEMENT TO LIFE INSURANCE APPLICATION
- Supplemental Application Large Case
- Tax Treatment of Modified Endowment Contracts (MEC)
- TeleLife Application Fax Pre-App
- Trust Certification
- UL Disclosures
- UL Disclosures (CA)
- UL Disclosures (CA)
- Underwriting Transmittal
- Written Notice to California Seniors Aged 65 or Over
- Pruco Life Insurance Company
- 2010 Application Authorization - Stand-alone
- 2010 Application for Life Insurance - GENERIC
- 2010 Important Notice About Your Application for Life Insurance - Stand-alone
- 2010 Instructions For Completion of Application for Life Insurance - GENERIC
- 2010 Instructions for Completion of Xpress Package - GENERIC
- 2010 Prudential Xpress Quickform
- 2010 What to Expect Next
- 2011 Individual Agent
- 2011 Juvenile Agent
- Agent
- Application for Survivorship
- Application for Variable Universal Life
- Authorization to Disclose Medical Information
- HIV Consent Form - CO
- Important Notice Regarding Replacement
- Notice Regarding Modified Endowment Contracts
- PREPAID CASES ONLY. 2010 Limited Insurance Agreement - Stand-alone
- Request for initial Premium (E-PAY)
- ReliaStar Life Insurance Company (ING)
- Accelerated Benefit Rider Disclosure
- Accelerated Benefit/Living Benefit Rider Disclosure - (Generic UL & VUL)
- Acknowledgement in Lieu of Illustration
- Age 71+ Questionnaire
- Application for Life Insurance - fillable - UL or VUL
- Blood Consent
- California Assembly Bill 2107 Disclosure (ages 65 plus)
- CHIRA® Acknowledgement and Disclosure
- Credit Card Authorization/EFT Request
- ERISA DISCLOSURE AND ACKNOWLEDGEMENT
- Formal New Business Transmittal Checklist
- Fund Allocation of Premium Payments Supplement
- Fund Allocation of Premium Payments Supplement
- Government / Military Allotment
- Guaranteed Benefit Policy Acknowledgement
- ING ROP Endowment Term Life Insurance - Supplement to Application
- Initial Payment Credit Card Authorization Request
- Living Benefit Rider Disclosure
- Military Disclosure - Personnel Financial Services Disclosure Regarding Insurance Products
- Notice of Life or Annuity Sales Visit (CA)
- NOTICE REGARDING STANDARDS (CA)
- Out of State Verificatioin
- Premium Financing Disclosure
- Release of Waiver of Liability Agent as Fiduciary
- Telephone Authorization for VUL Policies
- Term Life Insurance Application - fillable (AR,CA,CT,DE,MT,ND,SD,GU)
- Underwriting Personal Financial Questionnaire
- Underwriting Personal Financial Questionnaire
- Underwriting Personal Financial Questionnaire
- Underwriting Personal Financial Questionnaire
- Sagicor Life Insurance Company
- Product Suitability Form
- Accelerated Benefit Insurance Rider Disclosure Statement
- Accelerated Benefit Insurance Rider Disclosure Statement
- Accelerated Benefit Insurance Rider Disclosure Statement
- Accelerated Benefit Insurance Rider Disclosure Statement
- Accelerated Benefit Insurance Rider Disclosure Statement
- Annuity Application
- Annuity Application
- CA Elder Disclosure
- Certificate In Lieu of Illustration
- Disclosure Statement
- Disclosure Supplement to Application
- HIV Consent Form (upon request)
- Home Meeting Notice (age 65 and older)
- Life Application
- Life Application
- Life Insurance Application (ages 15 Days - 17 Years, face amounts $25,000 To $100,000)
- Life Insurance Application (full underwriting application)
- Life Insurance Application - Part 1
- Life Insurance Application - Part 2 (do not complete, will of tele-interview)
- Product Suitability
- Strategy Disclosure Form
- Savings Bank Life Insurance Co of MA
- Agent Certification
- AIDS Notification and HIV testing consent form
- Application Amendment for Juvenile
- Conditional Receipt Agreement
- FDIC Notice to Insurance Customers
- Financial Supplement
- Life Insurance and Annuity Disclosure for Applicants 65 years of age and older
- Life Insurance Application - Part One
- Military Sales Disclosure
- No Sales Illustration Certification
- Notice and Consent form Employer-Owned Life Insurance
- Notice to Producer
- Notice to Producer
- Notice to Proposed Insured and Owner
- Notice to Senior of a Life Insurance or Annuity Sales Visit (CA)
- Supplement to Life Insurance Application Part I
- Surrender/Exchange Application Supplement
- Transmittal Form
- Security Life of Denver Ins Co (ING)
- Accelerated Benefit Rider Disclosure
- Accelerated Death Benefit Rider Disclosure
- Acknowledgement in Lieu of Illustration
- Age 71+ Questionnaire
- Application for Life Insurance - fillable - UL or VUL
- Blood Consent
- California Assembly Bill 2107 Disclosure (ages 65 plus)
- CHIRA® Acknowledgement and Disclosure
- Corporate-Owned Life Insurance (COLI) California Insurance Code Section 10110.4 Certification
- Election Worksheet
- ERISA DISCLOSURE AND ACKNOWLEDGEMENT
- Formal New Business Transmittal Checklist
- Fund Allocation of Premium Payments Supplement
- Government / Military Allotment
- Guaranteed Benefit Policy Acknowledgement
- ING IUL-Global Plus Disclosure Supplement (Most states)
- M-Financial Fund Allocation of Premium Payments Supplement
- Military Disclosure - Personnel Financial Services Disclosure Regarding Insurance Products
- Notice of Life or Annuity Sales Visit (CA)
- NOTICE REGARDING STANDARDS (CA)
- Out of State Verificatioin
- Premium Financing Disclosure
- Release of Waiver of Liability Agent as Fiduciary
- Telephone Authorization for VUL Policies
- Term Life Insurance Application
- Underwriting Personal Financial Questionnaire
- Underwriting Personal Financial Questionnaire
- Underwriting Personal Financial Questionnaire
- Underwriting Personal Financial Questionnaire
- Transamerica Life Ins Co (Family Mkt)
- Application for Life Insurance
- Buyer
- HIPAA Authorization - Generic & CA
- HIV Consent
- Life Insurance Application - CA
- Supplement to Application
- Supplement to Application
- Terminal Illness Disclosure Form
- Transamerica Life Insurance Company
- Addendum to Application for Life Insurance
- Application for One Life
- Disclosure Military Sales Practice
- HIPAA Authorization - Generic & CA
- HIV Consent - CA
- Personal Financial Supplement - CA
- Supplement to Save Age - Standard
Health Off-Exchange
- Anthem Blue Cross of California
- Blue Shield of California
- Chinese Community
- Health Net
- Kaiser
- Oscar
- Sharp Health Plan
- Sutter Health Plans
- Western Health Advantage