Perspecta Universal Life insurance


To order quantities of printed forms, please contact your sales office. Sales offices can complete Request for Forms (PC BIL 3340) and fax it to us toll-free at 1 877 536-4666.


Name
Loan Repayment Form 1581
Claim Note Form 2004
Client Identification Supplementary Information
(effective June 23, 2008)		 PC 6330
Life Insurance and Critical Illness Insurance -
Express Application Form		 5072
Life Insurance and Critical Illness Insurance -
Express Application fillable Form

Fillable application Instructions - Life Insurance and Critical Illness Insurance - Express Application 		5072 –
Fillable

5072 –
Instructions
Life Insurance and Critical Illness Insurance -
Comprehensive Application Form		 5071
Your guide to underwriting with Standard Life 5664
Life Insurance Policy Delivery Receipt 5113
Fax order form for Underwriting Requirements PC BIL 3186
Application for Payment of Fund Benefit at
First Death for Joint Last to Die Coverage in a Perspecta policy		 PC 3226
Life Profiles – Reference Chart 5137
Life Profiles Questionnaire PC 3521
Financial Underwriting 5586
Underwriting Requirements -
Protecta, Perspecta, Term 10/20, Whole Life		 PC 4439
Application for Change XPS 2638
Declaration of Insurability 2761
Declaration of Continued Insurability PC 6065
Perspecta Investment Instructions 5388
Pre-Authorized Debit (PAD) Agreement PC 2010-Fillable
Know Your Client PC 6168
Third Party Determination 5097
Application for Policy Loan or Dividend PC BIL 2053
Life Insurance Needs Analysis Form 6549
Client Identification by paramedical examiner 6559
Gradual Inheritance Concept (Flyer and application form) 6544-fillable

Supplementary Questionnaires (as required)

Name
Nervous condition questionnaire PC BIL 5829
Mountaineering questionnaire PC BIL 5830
Activities of daily living (ADL’s) PC BIL 5832
Alcohol Usage PC BIL 2149
Request for Non-smoker Rate upon attaining the age of 18 - Perspecta policies only PC 4143
Asthma XPS BIL 541
Diabetes PC BIL 260
Drug Usage PC BIL 2148
Confidential Financial Questionnaire PC 2863
Hazardous & Aviation Activities 659
Loss of Consciousness PC BIL 2150
Foreign Residence/Travel 3965

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