Tampa-Administered Forms for Louisiana

Forms are separated in three categories:

  • Pre-Sale Forms—Licensing, Master Applications, Statement of Insurability, etc.
  • Post-Sale Forms—Enrollment, Individual Applications, Refusal of Insurance, Reporting Summary etc.
  • Post-Policy Forms—Claim, Change of Beneficiary, Reinstatement, etc.
Pre-Sale Back To Top

. 06670220-2000LA Master Application for Employee Benefits LA
. 06673571-1005LA Statement of Insurability for Group Programs LA
. 06673571-1098LA Application for Group Voluntary Programs All LA
. 06673571-1496LA Application for Group Voluntary Programs Life & AD&D LA
. AGLC101519LA Application for Life Insurance LA

The above are the only state-specific forms. Additional forms can be found on the the General Forms page.

Post-Sale Back To Top

. 06673571-1003LA Individual Application for Group Critical Illness Insurance LA
. 06673571-1005LA Statement of Insurability for Group Programs LA
. 06673571-1098LA Application for Group Voluntary Programs All LA
. 06673571-1496LA Application for Group Voluntary Programs Life & AD&D LA

The above are the only state-specific forms. Additional forms can be found on the the General Forms page.

Post-Policy Back To Top

There are no state-specific forms. Use forms located on the General Forms page.