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William Penn

New Business

Life Application Kit

Replacement Forms

Step 1:

Reg.60 Request For Policy Info.
(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 Disclosure Kit for Term to Term
(req. w/replacements)

Reg.60 Disclosure Kit for Term to UL or Whole Life
(req. w/replacements)

Misc. Forms

1035 Exchange Form

Accelerated Death Benefit Disclosure

Address Change

Alcohol Usage Questionnaire

Aviation Questionnaire

Bank Draft Form - Newly Issued Policy

Bank Draft Form - Inforce Policy

Beneficiary Change

Best Interest Suitability Disclosure

Blood Test Form

Chest Pain Questionnaire

Collateral Assignment Form

Conversion Application

Coronary Artery Quote Form

Daily Activity Questionnaire

Definition of Replacement

Diabetic Questionnaire

Diabetic Quote Form

Drug / Alcohol Usage Form

Employer Owned Acknowledgement

Foreign Travel Questionnaire

Hazardous Avocation Questionnaire

Health Statement

Hepatitis Quote Form


Illustration Certification

Lost Policy Form

Mitral Valve Prolapse Quote Form

Ownership Change Form

Part B Medical Exam

Policy Change Form
(Face Amount Reduction, etc.)

Policy Service Form

Reinstatement Form

Scuba Questionnaire

Single Case Agreement

Sleep Apnea Quote Form

Term Conversion Form

Tobacco Questionnaire

Trust Certification






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Last modified: 05-Mar-2023