The following are maintenance forms applicable to existing
group life policies.
Notice
of Conversion Form --use this to notify group insurance
of the desire of an individual to convert his Group
Insurance coverage to a permanent Individual Insurance.
Enrollment
Card - Employee**--use
this to acquire basic information about the insured
employee as well as the designated beneficiary (ies).
Enrollment
Card - Individual**--use
this to acquire basic information about the insured
member as well as the designated beneficiary (ies).
Declaration
of Good Health and Insurability**--use
this if you are required by Group Insurance Department
to Declare your state of health. This is being used
for the evaluation of an excess coverage. This will
be officially required through a written requirement
issued by Group Insurance.
** To
view the form, you must have Adobe Acrobat Reader installed
in your PC. Otherwise, download your free Acrobat
Reader. Please do not fax the forms as we need your
original signature. Before printing, please make sure
that the Fit to Page option is checked. Submit the forms
to any of our Customer
Service Centers or to Group
Insurance Department.
