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Statements to the Medical Examiner

Form GL202 (approved in most states)

State Specific Forms

Connecticut - Form GL202CT
Florida - 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 BTCGEN
Arkansas - 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

Policy Forms

Bank Draft Authorization
Beneficiary Change
Changes To Policy Plan
Duplicate Policy Form
Ownership/Payor Change Request
Policy Cancellation Request
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