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NOTICE AND SIGNATURE AUTHORIZATION
NUMBER 
TITLE
DATE
4397-00A Signature, Declaration & Authorization Form MAY2018

 

 

TEMPORARY INSURANCE CERTIFICATE (TIA)
NUMBER 
TITLE
DATE
5801-00A Golden Protection & No Medical Certificate (TIA) SEP2018
5755-01A
Term & Permanent Certificate (TIA)
   OCT2017

 

 

DATA COLLECTION FORM
NUMBER
TITLE   
DATE
Data Collection Form - Golden Protection & Golden Protection Deferred
Also print the Notice and Sign. form
SEP2018
4798-00A
Data Collection Form - ParPlus Jr.
Also print the Notice and Sign. form
OCT2017
4935-00A
Data Collection Form - Youth Plus
Also print the Notice and Sign. form
OCT2017
5085-00A
Data Collection Form - Total Protection  
Also print the Notice and Sign. form
SEP2018
5397-00A Data Collection Form - Critical Protection
Also print the Notice and Sign. form
OCT2017
5885-01A
Data Collection Form - No Medical Insurance 
Also print the Notice and Sign. form
SEP2018
6241-00A
Lia Worksheet for underwritten products
Also print the Notice and Sign. form
 SEP2018
 

 

 
APPLICATIONS
NUMBER  
TITLE
DATE
5208-01A Application for Accidental Fracture Plus Rider                                                    OCT2013
4815-00A Application for Conversion OCT2017
4615-00A Application for Golden Protection SEP2018
5041-00A
Order form - Golden Protection paper application
JAN2016
Child Insurance Benefit Form
APR2013
Application for conversion of simplified life insurance
SEP2018
5739-00A
Application for modification of the term of a FlexTerm policy
MAR2017
 

 

DECLARATION OF INSURABILITY
NUMBER
TITLE
DATE
Declaration of Insurability - No Medical Life & No Medical Term
 SEP2018
Declaration of Insurability - No Medical Whole Life Plus/ No Medical Term Plus & No Medical Whole Life - Immediate/ No Medical Term - Immediate
 SEP2018
5267-00A Declaration of Insurability - InstaTerm  SEP2018
5269-00A Declaration of Insurability - InstaTerm Deferred SEP2018
5879-00A Declaration of Insurability - No Medical Whole Life - Deferred & No Medical Term - Deferred SEP2018
3952-00A Declaration of Insurability - Traditional Products (including Critical Protection issued since July 2014) SEP2018
4548-00A Declaration of Insurability - Total Protection (only issued from 2004) SEP2018
Declaration of Insurability - Golden Protection & Golden Protection Plus 
SEP2018
Declaration of Insurability - Golden Protection Deferred  SEP2018
Declaration of Insurability - Critical Protection (issued before June 2012)
SEP2018
 

 

CLAIMS
NUMBER
TITLE
DATE
4756-00A Accidental Fracture Plus - Claims Questionnaire NOV2014
4226-00A Attending Physician's Statement - Long-term Disability Benefit         JUL2014
4802-00A Claimant's Statement - Death Claim SEP2017
3998-00A  Claimant's Statement - Extension of Disability        AUG2012
3817-00A Claimant's Statement - Total Disability Claim        NOV2014
4765-00A Foreign Death Questionnaire MAY2014
3073-00A    Physician's Statement - Proof of Death        FEB2012
5411-00A Physician’s Statement – Critical Illness Insurance - Blindness MAR2015
5405-00A Physician’s Statement – Critical Illness Insurance - Cancer - Life-Threatening MAR2015
5403-00A Physician’s Statement – Critical Illness - Neurological Disorders MAR2015
5401-00A Physician’s Statement – Critical Illness Insurance - Cardiovascular Disorders MAR2015
5407-00A Physician’s Statement – Critical Illness Insurance - Organ Failure MAR2015
5409-00A Physician’s Statement – Critical Illness Insurance - Severe Burns MAR2015
Financial Institution Form - Disability insurance based on a loan
SEP2014
Employer's Statement - Disability insurance based on employment income
MAY2014
Critical Illness Claimant Statement
JAN2015
 




CLIENT SERVICE 
NUMBER
TITLE
DATE
4819-00A Life Insurance Policy Replacement Declaration       2010
0000-04A Your Obligations - Life Insurance Policy Replacement        APR2016
3151-00A Policy Loan Repayment DEC2017
3001-00A Policy Service Request DEC2017
4791-00A Request for Preauthorized Debit Plan (PAD) DEC2017
Policy Loan
JUN2018
5251-00A Change of Beneficiary  JUN2018
5623-00A Change of Beneficiary - Substitute Beneficiary Option JUN2018
5283-00A
Change of Beneficiary - Critical Protection
JUN2018
5737-00A Transfers Between Investment Accounts  MAR2018
6261-00A Agent of record change  JUL2018
 

 


UNDERWRITING MEDICAL QUESTIONNAIRES
NUMBER 
TITLE
DATE          
4413-00A Arthritis, Rheumatism or Gout Questionnaire                                        AUG2017
3881-00A Back Pain Questionnaire AUG2017
3884-00A Chest Pain Questionnaire AUG2017
3888-00A Convulsion Questionnaire AUG2017
3886-00A Diabetes Questionnaire AUG2017
3894-00A Gastro-Intestinal Questionnaire AUG2017
3896-00A Heart Examination Questionnaire (Attending Physician) AUG2017
3900-00A Psychological or Nervous Disorder Questionnaire AUG2017
3907-00A Respiratory Disorder Questionnaire AUG2017
Musculoskeletal Disorder Questionnaire
AUG2017
 
UNDERWRITING SPORTS & LIFESTYLE QUESTIONNAIRES
NUMBER
TITLE
DATE
3876-00A Alcohol Use Questionnaire                                                                                  AUG2017
3880-00A Aviation Questionnaire                                                    AUG2017
3887-00A Drug Usage Questionnaire MAY2018
3890-00A Financial Questionnaire AUG2017
3893-00A
Foreign Travel & Residence Questionnaire
AUG2017
3908-01A
Scuba Diving Questionnaire
AUG2017
3910-00A Tobacco Usage Questionnaire
AUG2017
3970-00A Disability Insurance Questionnaire AUG2017
4885-00A Hazardous Sports and Activities Questionnaire AUG2017
4018-00A Driving Record Questionnaire AUG2017
5225-00A Work and Study Permit Questionnaire AUG2017
5337-00A Criminal Activity Questionnaire
MAY2018
 
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