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U.S. Life

New Business

Life Application Kit

Replacement Forms

Step 1:

Reg.60 Request For Policy Info. - Life
(Send this form to the company you are replacing )
(ok to submit with application, disclosure to be submitted to h.o. prior to policy issuance)

Step 2:

Reg.60 Life Disclosure Kit
(req. w/replacements)

Reg.60 Business Case Exemption Form

Misc. Forms

1035 Exchange Kit

1035 Exchange Producer Guide

Address Change

Advance Policy Dating

Agent Certification Form

Agent Commission Deposit

Agent of Record Request

Alcohol Use Questionnaire

Annuity Withdrawal Request

Aviation Questionnaire

Avocation Questionnaire

Bank Draft Authorization for Inforce Policies

Bank Draft Authorization for Newly Issued Policies only

Bankruptcy Questionnaire

Beneficiary Change Form

Blood Consent Form

Child Rider Paramedical Exam

Chronic Illness Rider Application

Collateral Assignment Form

Conversion Application

Definition of Replacement

Delivery Receipt

Diabetic Questionnaire

Drug Use Questionnaire

Exam Preparation for Insured

Face Amount Reduction Form

Financial Questionnaire

Financial Questionnaire - Business

Foreign Travel Questionnaire

Health Statement

HIPAA Authorization

Illustration Acknowledgement

Index UL Supplemental Application

Inforce Illustration Request

Insured Request For Lab Results

Name Change Form

New Business Policy Change - Reissue Request

Ownership Change Form

Part B Medical Exam

Premium Financing Disclosure for Insured's

Reinstatement Application

Scuba Questionnaire

Single Case Agreement

Tax Return Request

Term Conversion Application

Term Preliminary Information Statement

Term Product Disclosure

Terminal Illness Rider

Trust Certification






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Last modified: 10-Jan-2024