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  Contact a Benefit Activation Representative

   

Customer Benefit Activation Forms

NEED AN ANSWER QUICKLY? First, check the Frequently Asked Questions page for responses to the most often asked questions. If your question is not addressed, then contact a Benefit Activation Representative.

INSTRUCTIONS

Select the form you need from the list below by clicking on the title. Once the form opens, print it and follow the instructions on the form for completion. The return mailing address is provided on the form. Some of the files are rather large, so please allow a few minutes for your selection to open on your system.

NOTE: You must have Adobe Acrobat Reader 4.0 or above to view the Adobe Portable Document Format (PDF) files on this page. Adobe Acrobat Reader is a free software that lets you view and print PDF files.

 

Credit Card Insurance Forms
Accident and Health/Disability File Online for Disability Now Loss of Life File Online for Loss of Life Now Involuntary Unemployment File Online for Involuntary Unemployment Family Leave of Absence File Online for Leave of Absence Property Loss   Job Retraining   Accountgard Disability   Accountgard Unemployment	New York residents only Accident and Health/Disability Loss of Life Involuntary Unemployment Family Leave of Absence Property Loss Job Retraining

 

Installment Loans, Lines of Credit and Other Loans
Accident and Health/Disability Auto Loss of Life Involuntary Unemployment Property Non-Filing Proof of Loss Musical Instruments	New York residents only Accident and Health/Disability Auto Loss of Life Involuntary Unemployment Property

 

Utility Insurance Benefit Activation Forms

Payment Power Accident and Health / Disability Loss Payment Power Loss of Life Payment Power Family Leave of Absence Payment Power Involuntary Unemployment Power Surge

 

Miscellaneous Forms
HIPAA Authorization to Release Information	New York residents only HIPAA Authorization to Release Information

 

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