Get Application For Reinstatement - Dearborn National

This guide provides a clear and user-friendly approach to completing the APPLICATION FOR REINSTATEMENT from Dearborn National. By following the outlined steps, users can accurately fill out the form and ensure a smooth reinstatement process.

Follow the steps to properly complete the form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editing interface.
2. Fill out your policy number and participant number in the designated fields at the top of the form.
3. Record the date through which your premium is paid in the 'Paid-to-Date' field, and indicate the total amount due.
4. Provide the insured's full name and Social Security Number (SSN) in the appropriate fields.
5. Enter the street address, date of birth, and physical details such as height and weight.
6. Input your home phone number and occupation, as well as your work phone number.
7. Complete the beneficiary section, detailing their name, SSN, and relationship to the insured.
8. Respond to the health questions by checking 'Yes' or 'No' and providing any additional details for 'Yes' answers on the following page.
9. Document information related to any affirmative answers, including dates, duration, and healthcare provider details.
10. Sign and date the application at the end, confirming the accuracy of the information provided.
11. Review the completed form for any errors, then save your changes. You can choose to download, print, or share the filled application as needed.

Start completing your APPLICATION FOR REINSTATEMENT online today to ensure your coverage is reinstated promptly.