You are communicating with Rip Curtis.
This form will prompt you for personal information of the following nature:
 
- occupational
- financial (can be deferred)
- lifestyle (can be deferred)
- medical (can be deferred)
 
Why is this information necessary?   Because risk factors determine what is available, at what cost, and what underwriting requirements will be called for.  Since insurers have different risk tolerances, placement decisions are heavily influenced by personal information.
 
Not for enrollments.
To enroll someone, change your selection to Enrollment.
How would you prefer to do this? *
Are you the person to be insured? *
What is your relationship with the person to be insured? *
 
From here on out, the term "you" refers to your client.
From here on out, the term "you" refers to the employee to be enrolled.
Where are you in the process? *
The information you provide on this form will be used to prepare the application kit.
Where in the process is the group? * 🛈
Please use the legal name of the group, as this will be on the policy.