Get Short Term Disability Print Form

Filling out the Short Term Disability Print Form online can seem daunting, but with the right guidance, you can complete it smoothly. This guide provides detailed instructions for each section of the form to assist you through the process, ensuring that you provide all necessary information accurately.

Follow the steps to fill out the Short Term Disability Print Form with ease.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Identify the type of activity you are applying for by selecting one of the options: New, Change, or Reinstatement.
3. Enter the Policy Number associated with your application.
4. Fill out the personal information section, including last name, first name, middle initial, sex, birth date (MM/DD/YYYY), Social Security number, height, and weight for each proposed insured person.
5. Provide the resident address, including street, city, state, and ZIP code, along with email address and home/business phone numbers.
6. Indicate the name of your full-time employer, your job title, and a brief description of your job duties.
7. If you are adding a spouse to an existing policy, complete the respective fields, including the reason for addition and desired effective date.
8. For billing purposes, select your preferred method of payment (payroll deduction or direct payment) and specify the frequency.
9. Complete the Policy Information section, indicating the type of coverage desired and other selections such as the occupation class and accident elimination period.
10. Fill in the Disability Coverage Information sections per the instructions, ensuring that all questions, especially regarding existing coverage and health history, are answered accurately.
11. Review any applicable medical questions and provide accurate responses, as this information may affect the approval of your policy.
12. Finally, sign the proposed policyowner's agreement confirming that all information is accurate and complete, and ensure to provide the date, time, and location of the signing.
13. After completing the form, save your changes, then download, print, or share the document as necessary.

Start filling out your Short Term Disability Print Form online today to ensure timely processing of your application.