Statements to the Medical Examiner
Form PA9377 (Approved in most StatesState Specific Forms
Florida - Form PA9377-FLIndiana - Form PA9377-IN
North Carolina - Form PA9377-NC
Oregon - Form PA9377-OR
Virginia - Form PA9377-VA
State HIV Informed Consent Forms
Arkansas - Form 8326Arizona - Form 8550
California - Form 8321
Colorado - Form PA9551-CO
Connecticut - Form 8740
District of Columbia - Form 8305
Delaware - Form 8358
Florida - Form 8332
Georgia - Form 8304
Iowa - Form 8423
Illinois - Form PA9551-IL C
Indiana - Form PA9551-IN
Kansas - Form PA9551-KS
Kentucky - Form 8529
Massachusetts - Form 8359
Maryland - Form 9248
Maine - Form 8430
Missouri - Form 8320
Montana - Form 9253
North Dakota - Form 8460
New Jersey - Form 8488
Ohio - Form PA84545
Oregon - Form 8338
Rhode Island - Form PA9551-RI
Texas - Form 8136
Utah - Form 8568
Virginia - Form 8468
Washington - Form 8385
West Virginia - Form 8593
Claim Forms
Proofs of Death-Claimant's Statement (C-5082)Policy Holder Disability Benefit Claim Report (5122)
Physician's Statement (C-2)
Small Estate Affidavit
Federal Income Tax Withholding Election
Accelerated Living Benefit Claim Form - Critical Illness
Application for Accelerated Benefits - Terminal Illness
Confined Care Claim Form
Nursing Home Waiver of Premium Claim Form
Chronic Illness Accelerated Death Benefit Claim Form
Waiver of Premium for Unemployment Rider