Statements to the Medical Examiner
Form GL202 (approved in most states)State Specific Forms
Connecticut - Form GL202CTFlorida - Form GL202FL
Maryland - Form GL202MD
Minnesota - Form GL202MN
Ohio - Form GL202OH
Pennsylvania - Form GL202PA
Vermont - Form GL202VT
State HIV Informed Consent Forms
Alaska, Alabama, Idaho, Louisiana, Minnesota, Mississippi, North Carolina, Pennsylvania, South Carolina
Form BTCGENArkansas - Form BTCAR
Arizona - Form BTCAZ
California - Form BTCCA
Colorado - Form BTCCO
Connecticut - Form BTCCT
District of Columbia - Form BTCDC
Delaware - Form BTCDE
Florida - Form BTCFL
Georgia - Form BTCGA
Hawaii - Form BTCHI
Iowa - Form BTCIA
Indiana - Form BTCIN
Kansas - Form BTCKS
Kentucky - Form BTCKY
Maryland - Form BTCMD
Maine - Form BTCME
Michigan - Form BTCMI
North Dakota - Form BTCND
Nebraska - Form BTCNE
New Hampshire - Form BTCNH
New Jersey - Form BTCNJ
New Mexico - Form BTCNM
Nevada - Form BTCNV
Ohio - Form BTCOH
Oklahoma - Form BTCOK
Rhode Island - Form BTCRI
Oregon - Form BTCOR
Tennessee - Form BTCTN
Texas - Form BTCTX
Utah - Form BTCUT
Washington - Form BTCWA
Wisconsin - Form BTCWI
West Virginia - Form BTCWV
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