| You should find any form or application you need here. If you are unsure which form to use, or you believe the form you need isn't here, please contact customer service. To view and print these documents, you will need the Adobe Acrobat Reader | ||||||||
Product |
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Additional Forms |
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| CORP-SP_0507 | BROCHURE | CENTRAL UNITED LIFE CORPORATE BROCHURE - SPANISH | ||||||
| CORP_0507 | BROCHURE | CENTRAL UNITED LIFE CORPORATE BROCHURE | ||||||
| HEIGHT & WEIGHT | UND HT-WT | Height & Weight Chart | ||||||
| NONE-HIPPA | FORMS | HIPPA Release of Protected Health Information to Agent | ||||||
Bank Draft Authorization |
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| MLIC-1012-0397 | BANK DRAFT | Bankdraft Premium Deduction Authorization Manhattan Life | ||||||
| 05-1012-0397 | BANK DRAFT | Bank Draft Authorization Central United Life | ||||||
| 05-1012-0397 AM STATES | BANK DRAFT | Bank Draft Authorization American States | ||||||
| 05-1012-0397 IC | BANK DRAFT | Bank Draft Authorization Investors Consolidated | ||||||
| 05-1012-0397 SUN | BANK DRAFT | Bank Draft Authorization Sun American | ||||||
| 05-1012-0397 FIRST UNUM | BANK DRAFT | Bank Draft Authorization First Unum | ||||||
| 05-1012-0397 GOLD CROSS | BANK DRAFT | Bank Draft Authorization Gold Cross | ||||||
| 05-1012-0397 LOYAL AM | BANK DRAFT | Bank Draft Authorization Loyal American | ||||||
| 05-1012-0397 UNILIFE | BANK DRAFT | Bank Draft Authorization UniLife | ||||||
| 05-1012-0397 UNUM | BANK DRAFT | Bank Draft Authorization Unum | ||||||
Claims |
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| AC-S10-97 | CLAIMS | Report of Accident or Sickness | ||||||
| AC-S10-97MLIC | CLAIMS | Report of Accident or Sickness | ||||||
| AC-S10-97MLIC.PDF | CLAIMS | Report of Accident or Sickness | ||||||
| CA-01-02/03 CUL | CLAIMS | Cancer Benefit Claim Central United Life and | ||||||
| all other companies not mentioned elsewhere | ||||||||
| CA-01-0905 | CLAIMS | Colonial Cancer Advantage & Life Of Georgia Cancer Claim | ||||||
| CA-01-2/03 | CLAIMS | Report of Cancer or Specified Disease Claim | ||||||
| CA-01-2/03 INVESTORS CONS | CLAIMS | Cancer Benefit Claim Investor Consolidated | ||||||
| CA-01-2/03 LOYAL | CLAIMS | Cancer Benefit Claims Loyal American | ||||||
| CI-C 0903 | CLAIMS | Critical Protection & Recovery Cancer Claim Form | ||||||
| CI-CAB 0903 | CLAIMS | Critical Protection & Recovery Coronary Artery Bypass Claim | ||||||
| CI-HM 0903 | CLAIMS | Critical Protection & Recovery Heart Attack/MI Claim Form | ||||||
| CI-MOT 0903 | CLAIMS | Critical Protection & Recovery Major Organ Transplant Claim | ||||||
| CI-MS 0903 | CLAIMS | Critical Protection & Recovery Multiple Sclerosis Cliam Form | ||||||
| CI-RF 0903 | CLAIMS | Critical Protection & Recovery Renal Failure Claim Form | ||||||
| CI-SC 0903 | CLAIMS | Critical Protection & Recovery Stroke/CVA /claim Form | ||||||
| CL-01-10-96 | CLAIMS | Medical Expense Claim Form | ||||||
| CL-01-2/03 | CLAIMS | Medical Expense Claim Form Central United & Investors | ||||||
| CSB 1-98 | CLAIMS | Express Cancer Screening Benefit Claim Form | ||||||
| CUL & AMERICAN STATES | CLAIMS | Premium Waiver Own Occupation Physician's Form | ||||||
| CUL IC & SUN AMERICA | CLAIMS | Premium Waiver Disability Claim Doctor's Form | ||||||
| CUL REV 0305 | CLAIMS | Disability Claim Form ALL Companies | ||||||
| DENT-CLM | CLAIMS | DENTAL Claim Form to be Completed by the Dentist | ||||||
| FOB1 | CLAIMS | First Occurrence/Diagnosis Benefit | ||||||
| M-832-SL(REV 0301) CUL | CLAIMS | For Continuation of an Established Disability Claim | ||||||
| Central United Life | ||||||||
| M-832-SL(REV 0301) IC | CLAIMS | For Continuation of an Extablished Disability Claim | ||||||
| Investors Consolidated Insurance Company | ||||||||
| M-832-SL(REV 10/77) MLIC | CLAIMS | Claimant's Statement for Continuance of Disability Benefits | ||||||
| M-832-SL(REV 11/00)-NM | CLAIMS | For Continuation of an Established Disability Claim | ||||||
| New Mexico Residents Central United Life | ||||||||
| M-832-SL(10/77)-DC MLIC | CLAIMS | Claimant's Statement for Continuance | ||||||
| of Disability Benefits | ||||||||
| M-832-SL(10/77)-NY MLIC | CLAIMS | Claimant's Statement for Continuance | ||||||
| of Disability Benefits | ||||||||
| TRANS1 | CLAIMS | Transportation / Mileage Reimbusement Form | ||||||
| V-A0/97MLIC | CLAIMS | Vision Claim Form | ||||||
| V-10/97 | CLAIMS | Vision Claim Form | ||||||
| V-10/97MLIC | CLAIMS | Vision Claim Form | ||||||
| 701 FIRST UNUM | CLAIMS | Premium Waiver Due To Disability | ||||||
| 701 MANHATTAN | CLAIMS | Premium Waiver Due To Disability | ||||||
| The Manhattan Life Insurance Company | ||||||||
| 701 UNUM | CLAIMS | Premium Waiver Due To Disability | ||||||
| 701-CUL IC | CLAIMS L | Life Premium Waiver Due To Disability Central & Investors | ||||||
| 701-DC | CLAIMS | Premium Waiver Due To Disability MLIC | ||||||
| 701-NM | CLAIMS | Premium Waiver Due To Disability | ||||||
| For All Companies New Mexico Residents | ||||||||
| 701-NY | CLAIMS | Premium Waiver Due To Disability MLIC | ||||||
FAMILY LIFE INTERNATIONAL |
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| FAMV41A | SOFTWARE | Family Life Illustration Software | ||||||
| FLIC-APS | APP | ATTENDING PHYSICIAN STATEMENT | ||||||
| FLIC-APS-SP | APP | DECLARACION DE MEDICO ASISTENTE | ||||||
| FLIC-AQ-SP | FORMS | CUESTIONARIO DE AVIACION | ||||||
| FLIC-HIVQ | APP | HIV QUESTIONNAIRE | ||||||
| FLIC-HIVQ-SP | APP | HIV QUESTIONNAIRE-SPANISH | ||||||
| FLIC-INT-1 | APP | FAMILY LIFE INTERNATIONAL APPLICATION | ||||||
| FLIC-INT-1-SP | APP | FAMILY LIFE INTERNATIONAL APPLICATION - SPANISH | ||||||
| FLIC-INT2 | APP | MEDICAL EXAM APPLICATION | ||||||
| FLIC-INT2-SP | APP | MEDICAL EXAM APPLICATION - SPANISH | ||||||
| FLIC-PPA | APP | PREMIUM PAYMENT AGREEMENT | ||||||
| FLIC-5025 | APP | INTERNATIONAL NETTING TRANSMITTAL | ||||||
| FLIC-5027 | APP | FLIC CREDIT CARD AUTHORIZATION | ||||||
| FLIC-5027-SP | APP | CREDIT CARD AUTHORIZATION-SPANISH | ||||||
Health Forms |
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| HEIGHT & WEIGHT | UND HT-WT | Height & Weight Chart | ||||||
| HLTHCAN | CANCEL | Health Policy Cancellation Form | ||||||
| HPC 0505 | CHANGE | Health Policy Change Form | ||||||
| MT-REPLACE | NEW BUS | Montana Notice To Applicant Regarding Replacement | ||||||
| Of Accident And Sickness Insurance | ||||||||
| NC-GAA | FORMS | GUARANTY ASSOCIATION ACT | ||||||
| NONE | CHANGE | Dental/Vision Policy Change Application | ||||||
| NONE1 | APP | Application to Surrender Health Policy Persistency Bonus or | ||||||
| Return of Premium Benefit | ||||||||
| NONE2 | LOST POL | Affidavit of Lost Health Policy | ||||||
| (a $10 processing fee is required) | ||||||||
| SGH-04 | APP | Statement Of Good Health | ||||||
International New Business |
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| FITCH_SP | BROCHURE | FITCH RATING - SP | ||||||
| ML-APS | APP | Attending Physician Statement | ||||||
| ML-APS-SP | APP | Spanish Attending Physician Statement | ||||||
| ML-FTQ | APP | Foreign Residence/Travel Questionnaire | ||||||
| ML-FTQ-SP | APP | Spanish Foreign Residence/Travel Questionnaire | ||||||
| ML-HAQ-SP | APP | Spanish Hypertension | ||||||
| ML-3000 | FORMS | Source of Funds Questionnaire | ||||||
| ML-5018 | FORMS | Auth Agreement for Prearranged Payments | ||||||
| ML-5019 | NEW BUS | Examiner Questionnaire INTERNATIONAL | ||||||
| ML-5020 | NEW BUS | Laboratory Questionnaire INTERNATIONAL | ||||||
| ML-5022 | NEW BUS | Request for Medical Fee Reimbursement | ||||||
| ML-5023 | NEW BUS | New Business Transmittal INTERNATIONAL | ||||||
| ML-5025 | FORMS | International Netting Transmittal | ||||||
| ML-5028 | FORMS | Collateral Assignment of Policy | ||||||
| ML-5029 | FORMS | International Letter of Intent | ||||||
| ML-5029-SP | FORMS | Spanish International Letter of Intent | ||||||
| ML-5030 | FORMS | Business Insurance Questionnaire | ||||||
| ML-5030-SP | FORMS | Spanish Business Insurance Questionnaire | ||||||
| ML-5269 | FORMS | Agent Agreement | ||||||
| ML-5269-SP | APP | Spanish Agent Agreement | ||||||
| ML-5270 | FORMS | Authority to Remit Net Premiums | ||||||
| MLIC - FITCH - ENGLISH | FORMS | MLIC- FITCH RATING-ENGLISH | ||||||
| MLIC- D&B-ENGLISH | FORMS | MLIC - DUN & BRADSTREET - ENGLISH | ||||||
| MLIC-D&B | FORMS | MLIC - Dun & Bradstreet - SP | ||||||
| MLIC_INTERNATGUIDE | UND GUIDE | International New Business & Underwriting Guidelines | ||||||
| MLIC_INTERNATGUIDE-SP | UND GUIDE | Guia Para Nuevos Negocios Y Suscripcion De | ||||||
Life Forms |
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| AP-ME06 | APP | EXAM QUESTIONAIRE | ||||||
| AP-ME06-AR | APP | Exam Questionaire | ||||||
| AP-ME06-CO | APP | Exam Questionaire | ||||||
| AP-ME06-GA | APP | Exam Questionaire | ||||||
| AP-ME06-ID | APP | Exam Questionaire | ||||||
| AP-ME06-MD | APP | Exam Questionaire | ||||||
| AP-ME06-MO | APP | Exam Questionaire | ||||||
| AP-ME06-NC | APP | Exam Questionaire | ||||||
| AP-ME06-PA | APP | Exam Questionaire | ||||||
| BENEFICIARY CHANGE | REPLACE | Add/Change Beneficiary | ||||||
| CASH SURRENDER | CASH SURR | Request For Cash Surrender - Life Insurance | ||||||
| EXHIBIT A & B-IL | REPLACE | Replacement of Life Insurance A & B Illinois | ||||||
| L-REPLACE-GA | REPLACE | Notice Regarding Replacement - Life Insurance Georgia | ||||||
| L-REPLACE-KY | REPLACE | Notice Regarding Replacement of Life Insurance Kentucky | ||||||
| L-REPLACE-NC | REPLACE | Notice Regarding Replacement - Life Insurance North Carolina | ||||||
| L-REPLACE-NM | REPLACE | Replacement of Life Insurance New Mexico | ||||||
| L-REPLACE-OH | REPLACE | Replacing Your Life Insurance Policy Ohio | ||||||
| L-REPLACE-TN | REPLACE | Notice Regarding Replacement - Life Insurance Tennesse | ||||||
| L-REPLACE-WI | REPLACE | Important Notice Required . Life Replacement Form Wisconsin | ||||||
| MS-REPLACE-A CUL | REPLACE | Notice Regarding Replacement - Life Insurance Mississippi | ||||||
| OK-REPLACE | REPLACE | Notice To Applicant Regarding Replacement of Life Ins | ||||||
| Oklahoma | ||||||||
| OWNER CHANGE | CHANGE | OWNER CHANGE REQUEST | ||||||
| REPLACE-A | REPLACE | Submit with application if applicant has existing insurance. | ||||||
| Use in CO-IA-LA-MD-MT-NH-OR | ||||||||
| REPLACE-B | REPLACE | Submit REPLACE-A & B if applicant is replacing coverage or B | ||||||
| if applicant has NO existing coverage. CO-IA-LA-MD-MT-NH-OR | ||||||||
| RRC | REPLACE | Replacement regulation Compliance Instructions | ||||||
| For REPLACE-A & REPLACE-B in CO,IA,LA,MD,MT,NH,OR | ||||||||
| 05-1033-0190 | APP | Life Reinstatement Application - Central United Life | ||||||
| 05-1037-87 | LOST POL | Affidavit Of Lost Life Policy | ||||||
| 05-1045-1187 | ANNUITY | Request For Withdrawal Of Annuity Cash Value | ||||||
| 05-1055-0886 | APP | Application For Cash Loan | ||||||
Life Policy Claim Forms |
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| CS-PD05 | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-AZ | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-CA | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-CO | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-FL | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-LA | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-ME | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-NJ | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-NM | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-NY | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-OH | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-OK | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-VA | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-PD05-WI | CLAIMS L | Claimant's Statement...Central United Life | ||||||
| CS-01-97 | CLAIMS L | Claimant's Statement from Beneficiary...Central United Life, | ||||||
| Investors Consolidated, SunAmerica, & UniLife | ||||||||
| CS-01-97-DC MLIC | CLAIMS L | Claimant's Statement from Beneficiary | ||||||
| Manhattan Life Insurance Company | ||||||||
| CS-01-97-NY MLIC | CLAIMS L | Claimant's Statement from Beneficiary - New York | ||||||
| Manhattan Life Insurance Company | ||||||||
| 4514-2 | CLAIMS L | Gold Cross Burial Association Claim Form | ||||||
| 701 SUN AMERICA | CLAIMS L | Life Premium Waiver Due To Disability SunAmerica Ins Co | ||||||
| 701-CUL IC | CLAIMS L | Life Premium Waiver Due To Disability Central & Investors | ||||||
MLIC Forms |
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| ML-ME06 | APP | Exam Questionaire | ||||||
| ML-ME06-ID | APP | Exam Questionaire | ||||||
| ML-ME06-IN | APP | Exam Questionaire | ||||||
| ML-ME06-MO | APP | Exam Questionaire | ||||||
| ML-ME06-WA | APP | Exam Questionaire | ||||||
| ML-MS-REPLACE-A | REPLACE | Mississippi Notice Regarding Replacement - Life Insurance | ||||||
| Manhattan Life Insurance Company | ||||||||
| ML-RFP-GROUP | FORMS | Request For Proposal (RFP) Manhattan Life Ins Co | ||||||
| MLIC-07-1033-1003 | BUYERS GD | Life Insurance Buyer's Guide MLIC | ||||||
| MLIC-2013NY | REG 60 | New York Disclosure Statement | ||||||
| MLIC-2014NY | REG 60 | New York Notice Regarding Replacement or Change | ||||||
| MLIC-60NY-INST | REG 60 | New York Replacement Regulation 60 Instructions | ||||||
| NY REPLACE-60 | REG 60 | New York Request For Policy Information | ||||||
New Business |
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| CC10-0202 | APP | Submit with application if applicant had cancer but | ||||||
| no treatment for 10 years. | ||||||||
| HT/WT | UND HT-WT | Height And Weight Chart | ||||||
| NBT-REV 0202 | NEW BUS | New Business Transmittal Form - CUL | ||||||
| NONE3 | FORMS | Request For Proposal (RFP) Central United Life | ||||||
| NONE4 | FORMS | Letter of Understanding | ||||||
| Certification of Intent to Replace Current Policy | ||||||||
| PAC GROUP | APP | PAC Group Marketing Program | ||||||
| PPA-1 (05/02) | NEW GROUP | Premium Payment Agreement to Establish a New Group Account | ||||||
| PROPOSAL | FORMS | Marketing Proposal Request | ||||||
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