Applications & Forms

Applications for Life Insurance: These applications are used for face amounts less than $50,000:
•	LA-20 Application for Life Insurance CT, IN, MI, NJ, WI
•	LA-20 IL Application for Life Insurance IlIinois Only
•	LA-19 MA Application for Life Insurance Massachusetts Only
•	Info Practices Notice of Information Practices Massachusetts Only
•	LA-10 NY Application for Life Insurance New York Only
•	NYSQ NEW YORK SUITABILITY QUESTIONNAIRE
•	LA-20 OH Application for Life Insurance Ohio Only
•	LA-20 PA Application for Life Insurance Pennsylvania Only
•	MA-20 Application for Membership Pennsylvania Only

These applications are used for face amounts $50,000 and over:
•	LAL-14 Application for Life Insurance MI, NJ,OH,PA, WI
•	OH-ADDM-0113 Addendum for Life Insurance Ohio Only
•	LAL-14 CT Application for Life Insurance Connecticut Only
•	DTPN CT Designation of Third Party Notice Connecticut Only
•	LAL-14 IL Application for Life Insurance Illinois Only
•	LAL-14 IN Application for Life Insurance Indiania Only
•	LAL-19 MA Application for Life Insurance Massachusetts Only
•	LAL-10 NY Application for Life Insurance New York Only
•	NYSQ NEW YORK SUITABILITY QUESTIONNAIRE

Applications for Annuity:
•	AA-10 Application for Annuity CT, IN, MI, NJ, OH, PA, WI
•	OH-ADDM-0113 Addendum for Annuity Ohio Only
•	AA-14 IL Application for Annuity Illinois Only
•	AA-10 MA Application for Annuity Massachusetts Only
•	AD 0222 Annuity Disclosure
•	ASQ 0315 Annuity Suitability Questionnaire
•	QBIS 0222 Qualified Best Interest Statement

Replacement & Transfers:
•	1035 Exchange
•	Authorization to Transfer Funds
•	Notice Regarding Replacement of Life and Annuity
•	Notice of Replacement of Life and Annuity Massachusetts Only

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