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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
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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