Turn your PDF into an API-fillable template in seconds. No signup required.
Try it now
Turn your PDF into an
API-fillable template in
seconds
Upload any PDF to see Anvil's Document AI in action. No signup required.
Products
Workflows
Automate complex document processes
Etch E-sign
Embed white-labeled e-signatures
PDF Services
Fill PDFs with collected or stored data
Webforms
Collect data with mobile-friendly webforms
Document AI
Faster way to build workflows
Document SDK
All you need to automate documents
Industries
Insurance
Rate, quote, and bind faster
Human resources
Automate onboarding documents
Real estate
Secure workflows for buying, selling, renting
Healthcare
Launch HIPAA compliant document workflows
Finance
Automate documents for financial products
Case studies
Learn how businesses have grown with Anvil
Resources
Form library
Ship faster with pre-made form templates
Blog
New features, industry news, customer stories
Help center
Step-by-step guides for using Anvil
Product updates
New features & app improvements
PDF Costs Calculator
Calculate your company's document costs
Features
Overview of all Anvil features
Developers
Get started
A quick introduction to building with Anvil
Documentation
Learn how to build Anvil into your product
API reference
GraphQL types, queries, & more
Open source
Pre-written clients to simplify development
Engineering blog
Technical topics, how-tos, & more
Pricing
Try it free
Get a demo
Products
Industries
Resources
Developers
Pricing
Login
Try it free
Death Claim Discharge Form
One API call is all it takes. Free to use.
Fill it over API
Download fillable PDF
AI-generated
4.8 Stars
A discharge form for claiming death benefits from SBI Life Insurance Company, documenting claim details and financial settlement.
Fill over API
Get it e-signed
Build document flow
Fill out your PDF over API
Send JSON, fill PDF
. It's that simple.
Fast and scalable PDF filling.
Quick
AI-assisted
template setup.
Get started for free
Get your PDF filled and signed
Request e-signatures over
API
.
Save time (& sanity) with
Document AI
.
Style
&
embed
e-sign into your application.
Get started for free
Automate your document flows
Generate
production-ready Webforms
from PDFs in seconds.
Collect reusable, structured data.
Customize document workflows without code.
Get started for free
See other insurance forms
Explore other production-ready form templates
here
.
Master Services Agreement
PDF template
A master agreement between Chartis International and MMR Information Systems for providing electronic medical record storage services to insurance customers.
See template
See template
Warranty Claim Form
PDF template
A detailed form for submitting warranty claims for equipment, specifically focused on compressor warranties from Portland Winair Company.
See template
See template
McVeigh V. UnumProvident Corporation And Provident Life Accident Insurance Company
PDF template
A federal court order addressing diversity jurisdiction in a disability benefits lawsuit filed by Michael C. McVeigh against insurance companies.
See template
See template
NO SURPRISE BILLING PROTECTION FORM
PDF template
A document explaining patient protections from unexpected medical bills and out-of-network care costs, with options to waive those protections.
See template
See template
Mutual Of Omaha Claim Form Fill Able
PDF template
A detailed claim form for reporting accidents and injuries for insurance purposes.
See template
See template
Loss Claim Form
PDF template
Guide for fish harvesters and processors to claim compensation for gear and vessel damage or oil spills related to the Hebron project.
See template
See template
Chapter 100 Sales Of Cemetery Merchandise, Funeral Merchandise And Funeral Services
PDF template
Administrative rules defining regulations for sales of cemetery and funeral merchandise and services in Iowa.
See template
See template
Sales Of Cemetery Merchandise, Funeral Merchandise And Funeral Services Rules
PDF template
Regulatory rules implementing Iowa Code chapter 523A for the sale of cemetery, funeral merchandise, and services.
See template
See template
DFC Discharge Form
PDF template
A comprehensive medical discharge form documenting client's final medical status, assessment details, and follow-up planning.
See template
See template
Driver Monitoring And Contract Amendment
PDF template
Documents related to driver record monitoring services and a contract amendment for Mason County's health services.
See template
See template
Policy Loan Agreement Form
PDF template
A comprehensive form for requesting a loan against a life insurance policy with personal and banking details collection
See template
See template
Initial Disability Claim Form
PDF template
A comprehensive form for filing an initial disability insurance claim, collecting patient and policyholder information, and documenting disability details.
See template
See template
Amicus Curiae Brief Auto Owners Insurance Company V. Pozzi Window Company
PDF template
Amicus curiae brief filed by construction industry associations in support of Pozzi Window Company in an insurance coverage dispute
See template
See template
Livestock Risk Protection (LRP) Handbook
PDF template
Comprehensive guide for livestock risk protection insurance application and claims process for agricultural producers.
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for submitting vision care reimbursement claims for out-of-network services and eyewear expenses
See template
See template
HEALTH CENTER MEDICAL HISTORY FORM
PDF template
Comprehensive medical history form for collecting personal health information, emergency contacts, and current medical status for students.
See template
See template
Emergency Medical Release Form
PDF template
A comprehensive medical information form used to collect personal health details and emergency contact information.
See template
See template
LWC WC 1008
PDF template
A form for filing a workers' compensation dispute with the Louisiana Office of Workers' Compensation.
See template
See template
Certificates Of Discharge Or Release From Active Duty
PDF template
An Illinois state law governing the recording and copying of military discharge certificates by county recorders with specific provisions for population over 500,000.
See template
See template
Prescription Drug Reimbursement Form
PDF template
A form for members to request reimbursement for prescription medication expenses through their health plan.
See template
See template
LWC WC 1025.EE Employee Certificate Of Compliance
PDF template
A legal document detailing employee obligations and restrictions while receiving workers' compensation benefits.
See template
See template
Employer Certificate Of Compliance
PDF template
A mandatory certification form for employers to verify compliance with Louisiana workers' compensation insurance requirements.
See template
See template
STATE COMPENSATION INSURANCE FUND CORPORATION WAIVER FORM
PDF template
A form for corporate officers/directors to elect exclusion from workers' compensation insurance coverage under specific California legal conditions.
See template
See template
KK Incident Report
PDF template
A comprehensive form for documenting accidents, injuries, or property damage during events or activities.
See template
See template
MetLife Disability Insurance Absence Reporting Guide
PDF template
Comprehensive guide for reporting disability and medical leave claims through MetLife, including FMLA and other absence types.
See template
See template
Proposal Form Export Insurance Policy (EXIP)
PDF template
A form for applying for export insurance cover for single or multiple export contracts with specific eligibility requirements and compliance guidelines.
See template
See template
ARIASU.S. 2017 Spring Conference Request For Proposals Submission Guidelines And Application
PDF template
Request for proposal guidelines for the ARIASU.S. 2017 Spring Conference seeking presentations on insurance and reinsurance industry topics.
See template
See template
Report Of Claim Form
PDF template
Official government form for reporting claims against the City of Pittsburgh, documenting incidents, damages, or property-related issues.
See template
See template
10 Day Agreement Review Cancellation
PDF template
A form for subscribers to request cancellation of a health insurance policy within 10 days of coverage effective date.
See template
See template
PAYMENT INSURANCE FORM NFCA SURF CITY SHOWCASE RECRUITING CAMP
PDF template
Registration and payment form for athletes interested in participating in a sports recruiting camp, with payment and medical information collection.
See template
See template
Section 1115 Demonstration Proposal For Act 421 ChildrenS Medicaid Option
PDF template
A proposal for a Section 1115 demonstration program related to children's Medicaid coverage and services.
See template
See template
Medical Claim Form
PDF template
A form used to request payment for eligible healthcare services already received from UnitedHealthcare.
See template
See template
Certificates Of Insurance Model Act
PDF template
A model legislative act providing guidelines for the preparation, issuance, and regulation of insurance certificates in property and casualty insurance.
See template
See template
Uniform Standards For Riders, Endorsements Or Amendments Used To Effect Group Term Life Insurance Po
PDF template
Detailed guidelines for creating and filing riders, endorsements, and amendments for group term life insurance policy changes.
See template
See template
Student International Travel Form
PDF template
Comprehensive form for students seeking international travel credit, detailing pre-trip requirements and professionalism expectations.
See template
See template
Motor Vehicle Accident Report
PDF template
Official form for reporting motor vehicle accidents in Missouri where an uninsured party is involved, used to determine insurance and fault compliance.
See template
See template
Privileged Assets Service Request
PDF template
A form for changing address and/or name for RiverSource Life Insurance contract owners
See template
See template
Evaluating Outcomes Understanding Reports And Improvement
PDF template
A guide for Continuum of Care (CoC) organizations to improve data quality and performance reporting for discharge destinations.
See template
See template
Prevention Counseling Teen Intervene CompletionDischarge Form
PDF template
A form used to document the completion or discharge of counseling and intervention services for teens, tracking session details and participant outcomes.
See template
See template
Certificate Of Insurance For Services
PDF template
Official document for certifying insurance coverage for services with Texas Department of Transportation (TxDOT)
See template
See template
EMPLOYEE PERSONAL PROPERTY DECLARATION FORM
PDF template
Form for employees to declare personal property used at work and outline claim procedures in case of loss or damage
See template
See template
Form 1560 CS Professional Provider Insurance
PDF template
Insurance form for professional service providers working with the Texas Department of Transportation (TxDOT)
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims for roof or deck issues with detailed documentation requirements by Holcim Solutions and Products US, LLC.
See template
See template
MOTOR VEHICLE ACCIDENT REPORT FORM
PDF template
A comprehensive insurance form for documenting details of a motor vehicle accident in Mauritius.
See template
See template
Request For Copy Of Military Discharge Form
PDF template
A form used to request a copy of a veteran's military discharge document from a county office.
See template
See template
Dental And Eye Care Insurance Enrollment Form
PDF template
A comprehensive form for enrolling in dental and eye care insurance coverage, capturing employee and dependent information.
See template
See template
Insurance Cert. Sample C
PDF template
Detailed guidelines for insurance coverage requirements for contractors in Cook County, Illinois
See template
See template
Section 355 Property Damage Report Form
PDF template
A form for reporting property damage incidents to local government authorities.
See template
See template
Notice Of Hearing On CollabHealth Plan Services, Inc.S Application For Approval Of Proposed Acquisit
PDF template
Official notice of a hearing regarding the proposed acquisition of SoundPath Health, Inc. by CollabHealth Plan Services, Inc.
See template
See template
GENERAL CONSENT TO TREAT PATIENT AUTHORIZATIONACKNOWLEDEMENT FO BENEFITS RELEASE
PDF template
Comprehensive dental patient consent form covering treatment authorization, medical information release, insurance benefits, and privacy practices acknowledgement.
See template
See template
CHG 8 Chapter 5 Real Property Acquisition
PDF template
Policies and guidance for acquiring real property for HUD-funded programs under the Uniform Relocation Assistance and Real Property Acquisition Policies Act (URA).
See template
See template
General Information For Authorization
PDF template
A form for requesting and documenting healthcare service authorization with medical and provider details.
See template
See template
Life Insurance Enrollment Form
PDF template
A form for employees to enroll in or modify life insurance coverage options through the Texas A&M University System.
See template
See template
Proof Of Insurance And Emergency Contact Form
PDF template
A form collecting student health insurance details and emergency contact information for record-keeping and safety purposes.
See template
See template
Notice Of Hearing
PDF template
Official notice regarding the revocation of Earl C. Dennis's Washington State insurance producer license due to alleged client misconduct.
See template
See template
Vision Group Insurance Form
PDF template
Insurance claim form for submitting vision care expenses and patient information to Standard Insurance Company.
See template
See template
Procedures In Case Of Accidents On Diocesan Property
PDF template
Detailed instructions for handling and reporting accidents that occur on diocesan property, including steps for immediate response and documentation.
See template
See template
4 H 869 W Animal Lease Agreement
PDF template
A comprehensive lease agreement for temporarily transferring an animal's care and responsibility between a lessor and lessee with specific health and insurance requirements.
See template
See template
Visit Submission Form
PDF template
A form for tracking fitness center visits to earn health program rewards when online tracking is not available.
See template
See template
Retiree Basic Life Insurance Form
PDF template
Form for retirees to elect or decline basic life insurance coverage and designate beneficiaries.
See template
See template
MetLife Enrollment Form
PDF template
Insurance enrollment form for employees to request coverage through their employer's group insurance plan.
See template
See template
PINS Transport Insurance Claim
PDF template
Insurance claim form for transport damage to products purchased from Verkkokauppa.com, covering purchases within Finland for up to 3000 euros.
See template
See template
FH Liability Insurance Form
PDF template
A form for child care providers to declare their liability insurance status for family home child care operations.
See template
See template
Form A Application For Proposed Acquisition Of Control Of Northwest Dentists Insurance Company
PDF template
Legal document detailing a Form A filing for the proposed acquisition of Northwest Dentists Insurance Company by The Dentists Insurance Company.
See template
See template
Home Inventory Form
PDF template
A form for documenting personal property details including item description, manufacturer, serial number, and current value for insurance or record-keeping purposes.
See template
See template
Blue Cross Of Idaho Care Plus, Inc. Health Assessment
PDF template
Form for collecting health information from newly enrolled Medicare Advantage members to develop individual care plans.
See template
See template
Claim Form
PDF template
Comprehensive form for submitting flexible spending account (FSA) and health reimbursement claims with multiple benefit code options.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims for vehicle parts and labor to Buyers Products Co.
See template
See template
Honorable Discharge Form
PDF template
Official membership documentation form for documenting service and discharge details for members of the Daughters of Union Veterans of the Civil War organization.
See template
See template
Form M Medical And Health Insurance Information And Consent For Medical Or Dental Care Of A Minor
PDF template
A medical consent and health insurance information form for minors attending ORU Early College program, authorizing emergency medical treatment.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims to an insurance provider, detailing member information and pharmacy details.
See template
See template
Form 1751a Benefits Enrollment
PDF template
A form for employees to enroll or modify health and welfare benefits at Los Alamos National Laboratory.
See template
See template
Part B Discharge Description
PDF template
A detailed form for reporting physical, biological, and chemical parameters of intake water and discharge for environmental monitoring.
See template
See template
Death Certificate Request Form
PDF template
Oklahoma state form for requesting a death certificate with search fee and copy options.
See template
See template
Application For Group Term Insurance
PDF template
Insurance application form for group term life insurance policy from Insular Life Assurance Company
See template
See template
Authorization For Cremation And Disposition
PDF template
Official New York State document providing guidelines and requirements for authorizing cremation and disposition of human remains.
See template
See template
Certificate Of Insurance
PDF template
A form for insurance certification for residential rental properties in the City of Oshawa, Ontario, requiring minimum $2,000,000 coverage.
See template
See template
Union Benefits Cancellation Form
PDF template
Form for union members to cancel or modify their existing insurance and benefits coverage across multiple carriers.
See template
See template
American Arbitration Association Award Of Dispute Resolution Professional
PDF template
Arbitration award related to a medical necessity dispute involving an MRI claim from an auto accident
See template
See template
Property And Casualty Insurance Regulations
PDF template
Regulations governing insurance rate and form submissions for property and casualty insurers in Iowa, including electronic filing requirements and hearing procedures.
See template
See template
Employee Enrollment Form
PDF template
A comprehensive form for employees to enroll in health insurance coverage with options for individual and family plans.
See template
See template
NU SHIP Cancellation Form 2019 2020
PDF template
Form for students to terminate their university-provided health insurance coverage at Northwestern University
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims for appliance repairs or parts replacement for RV Products.
See template
See template
VEHICLE REGISTRATION FORM
PDF template
A form for reporting vehicle registration details to K&K Insurance for multiple vehicles across multiple states.
See template
See template
Union Benefits Cancellation Form
PDF template
A form for union members to cancel various insurance and supplemental benefits from multiple carriers
See template
See template
Uniform Certificate Of Authority Application (UCAA) Primary Application Checklist
PDF template
A comprehensive checklist for insurers applying for a primary uniform certificate of authority, detailing required documentation and filing requirements.
See template
See template
Group Disability Claim Filing Instructions
PDF template
Instructions and form for filing a disability claim with American Fidelity Assurance Company for disability benefits.
See template
See template
Guide For Completing A Damage Report
PDF template
A comprehensive guide for reporting damage and filing claims under a fisheries compensation program for vessel and gear damage related to oil spills.
See template
See template
Workers Compensation Payroll Audit
PDF template
Annual form for reporting employee payroll details for workers' compensation insurance purposes across different job classifications.
See template
See template
Short Term Disability Claim Form
PDF template
A comprehensive form for filing a short-term disability claim, capturing personal, medical, and employment details for disability benefits.
See template
See template
TRAVEL RISK ASSESSMENT FORM
PDF template
A comprehensive form for travelers to provide personal and medical information before international travel, assessing potential health risks.
See template
See template
SEBB Electronic Debit Service Agreement
PDF template
Form for authorizing automatic monthly payments for SEBB insurance coverage through electronic bank account deductions
See template
See template
Your LegalCare Plan University Of California Legal Expense Insurance Plan
PDF template
A comprehensive legal services insurance plan offering preventive legal services and attorney consultations for University of California members.
See template
See template
IAIABC Electronic Partnering Agreement
PDF template
A document establishing guidelines for electronic data exchange between trading partners in industrial accident claims reporting.
See template
See template
The ARAG Legal Plan
PDF template
Comprehensive legal plan booklet detailing benefits, eligibility, and services for University of California employees and retirees.
See template
See template
Livestock Risk Protection (LRP) Handbook
PDF template
Comprehensive guide for Livestock Risk Protection insurance program covering form standards, entries, and completion requirements.
See template
See template
Medical Insurance Information
PDF template
A form for collecting medical insurance details for a child's admission to Spaulding Academy & Family Services
See template
See template
Form 14135 Application For Certificate Of Discharge Of Property From Federal Tax Lien
PDF template
IRS form for requesting discharge of property from a federal tax lien, used by taxpayers seeking to clear property encumbrances.
See template
See template
The ARAG Legal Plan
PDF template
A comprehensive legal insurance plan document detailing benefits, eligibility, and services for University of California employees and retirees.
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for requesting reimbursement for vision care services from providers outside the Davis Vision network.
See template
See template
ATHLETICS MEDICAL RELEASE FORM
PDF template
A medical release and information form for student-athletes, authorizing medical treatment and collecting important health details.
See template
See template
Request For Certificate Of Insurance
PDF template
A form used to request an insurance certificate for a scouting activity or event with details about coverage and additional insured status.
See template
See template
Insurance Requirements For GoodsServices, BidsRequests For Proposals, AwardsContracts
PDF template
Detailed guidelines for insurance coverage requirements for contractors and awardees doing business with the City of Tampa
See template
See template
EAP Billing Form
PDF template
Medical billing form for submitting claims to BPA Health for employee assistance program services.
See template
See template
Pre Authorized Debit Agreement
PDF template
A pre-authorized debit form for University of Victoria Graduate Students' Society health and dental insurance plan payments
See template
See template
Student Chromebook Insurance Form
PDF template
Optional repair plan for student Chromebooks at Penn-Harris-Madison School Corporation, covering up to two repairs for $25 per year.
See template
See template
Emergency Contact Form
PDF template
A form for collecting student emergency contact, medical, and insurance information for campus housing purposes.
See template
See template
VISA CHECKLIST
PDF template
Comprehensive guide for applicants seeking a visa to enter Germany, detailing required documents and application process.
See template
See template
Annual Report Form Multi Sector General Permit For Storm Water Discharges
PDF template
Annual reporting form for industrial facilities documenting storm water discharge inspections and compliance activities.
See template
See template
Transfer Request Form
PDF template
A form for tenants to request a transfer to a different housing unit within a development or housing authority.
See template
See template
VERIFICATION OF TRUST FORM
PDF template
A comprehensive form for verifying trust details, ownership, and beneficiary information for insurance policy purposes.
See template
See template
Crystal Lake School 5th And 6th Grade ChromebookInsurance Form 2019 2020
PDF template
A form for parents to select insurance options for school-issued Chromebook devices for 5th and 6th grade students
See template
See template
Discharge Form
PDF template
A comprehensive form for documenting patient discharge details and reasons from a mental health program or clinic.
See template
See template
Requisition Form
PDF template
Comprehensive medical form for patient demographics, insurance information, and diagnostic specimen collection details.
See template
See template
Name And Ownership Changes Request Form
PDF template
A form for requesting changes to policy ownership, contact information, and personal details for American Heritage Life Insurance Company policies.
See template
See template
Youth Sports Camps Clinics Audit Form Addition Of Camps
PDF template
Insurance form for auditing or adding youth sports camp sessions with liability and medical payment coverage options.
See template
See template
Homeowner Warranty Claim Form For Georgia Pacific Vinyl Siding
PDF template
A comprehensive form for homeowners to submit warranty claims for Georgia-Pacific vinyl siding installations, documenting product details and areas of concern.
See template
See template
Maine Revenue Services Certificate Of Discharge Of Estate Tax Lien
PDF template
Official state document used to certify discharge of estate tax liens for decedents owning property in Maine.
See template
See template
USAV YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
Medical release and consent form for youth and junior volleyball players participating in USAV sanctioned competitions and practices.
See template
See template
2019 2020 Short Term Disability Information
PDF template
Policy detailing disability income benefits and eligibility for Yavapai College employees, including benefit calculation and claim process.
See template
See template
ATSG FitBit Activity Tracker Program Purchase Form
PDF template
Form for employees to purchase FitBit activity trackers through corporate wellness program with payroll deduction options.
See template
See template
2020 2021 Flu And Pneumo Insurance Information Form
PDF template
A form for collecting patient information and insurance details for flu and pneumococcal vaccines.
See template
See template
2020 Employee Authorization For Payroll Deduction To HSA
PDF template
Form for employees to start, change, or stop payroll deductions for Health Savings Account (HSA) contributions.
See template
See template
Seed Insurance Waiver Form
PDF template
A waiver form for seed owners to confirm they maintain their own insurance coverage for seeds stored at Ioka Farms facilities.
See template
See template
Physical Therapy Of Boulder Patient Intake Form
PDF template
Comprehensive medical intake form for physical therapy patients covering personal information, insurance details, and consent for treatment.
See template
See template
USAV YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
Medical release and consent form for youth and junior volleyball players participating in USAV sanctioned competitions and practices.
See template
See template
USAV YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
Medical release and emergency contact form for youth and junior volleyball players participating in USAV sanctioned competitions and practices.
See template
See template
UABHSF Office Of Risk Management User Guide
PDF template
A comprehensive guide detailing the practices, procedures, and guidelines for the UAB Office of Risk Management and Insurance.
See template
See template
Boletn De Oportunidades De Cooperacin TIC
PDF template
A bulletin highlighting international technology cooperation opportunities and partnership requests across various technological domains.
See template
See template
Patient Protection And Affordable Care Act Patient Protection Notice
PDF template
Federal document outlining requirements for group health plans and insurers regarding primary care provider designations for participants and children.
See template
See template
POGS Sickness Benefit Application Form
PDF template
Application form for members of the Philippine Obstetrical and Gynecological Society to claim sickness benefits
See template
See template
Warranty Claim Form
PDF template
Form for submitting warranty claims for prosthetic products and detailing product and patient information.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for furniture products, including damaged item details and required documentation.
See template
See template
Brisker V. Ohio Dept. Of Ins., 2021 Ohio 3141
PDF template
Legal case involving Frederick Brisker's appeal of his insurance license revocation by the Ohio Department of Insurance.
See template
See template
TRS Medicare Eligible Health Plan (MEHP) Prescription Drug Benefit Guide
PDF template
Detailed guide for Teachers' Retirement System of Kentucky Medicare Part D prescription benefit plan managed by Know Your Rx Coalition through Express Scripts
See template
See template
YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
A medical release form for youth and junior volleyball players to document health information and parental consent for participation.
See template
See template
Volunteer Excess Liability Insurance Form
PDF template
Insurance form for occasional volunteers providing liability coverage for park and community service volunteers
See template
See template
Warranty Claim Form
PDF template
A form for customers to submit warranty claims for agricultural products or equipment with detailed failure and product information.
See template
See template
AC Pro Warranty Claim Form
PDF template
A form for submitting warranty claims for air conditioning units, parts, and equipment by technicians or contractors.
See template
See template
KEY CONTACT INFORMATION QUESTIONNAIRE
PDF template
A comprehensive form for collecting key contact details for various risk management roles within an agency
See template
See template
Claim Form
PDF template
A comprehensive claim form for medical reimbursement from GlobeMed Qatar/SEIB insurance network covering various healthcare services.
See template
See template
POGS MAP Sickness Benefit Application Form
PDF template
A form for members of the Philippine Obstetrical and Gynecological Society to apply for sickness benefits for medical and COVID-related conditions.
See template
See template
2022 IAG AGM Resources FAQs
PDF template
Document providing resources and information for shareholders attending IAG's 2022 Annual General Meeting on 21 October 2022.
See template
See template
Long Term Disability Claim Form Statement Of Employee
PDF template
A comprehensive form for employees to file a long-term disability claim with Lincoln Financial Group, detailing personal, employment, and medical information.
See template
See template
Marine Warranty Claim Form
PDF template
Claim form for marine equipment warranty service and reimbursement for repairs and replacements.
See template
See template
PATIENTS INTAKE FORM
PDF template
Comprehensive medical intake form for patient registration and insurance information at a podiatry medical practice.
See template
See template
RENTAL AGREEMENT 2022
PDF template
Comprehensive rental policies and requirements for booking event spaces at the Mahogany Beach Club, detailing deposit, cancellation, and facility usage terms.
See template
See template
Medical Release Form
PDF template
Medical consent and emergency contact form for minors attending music camp programs at Sam Houston State University
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for equipment to Coe Orchard Equipment Inc.
See template
See template
USI Vehicle Accident Reporting Form
PDF template
A comprehensive form for documenting details of a vehicle accident involving USI employees or vehicles.
See template
See template
Chromebook Insurance
PDF template
Insurance policy for Chromebook devices issued to students in grades 5-12, covering accidental damage and device protection.
See template
See template
2023 2024 Student Emergency Form
PDF template
A comprehensive form for collecting student emergency contact details, health insurance information, and parental contact information for school records.
See template
See template
Cooma Show 2023 Ground Space Booking Form
PDF template
A booking form for vendors and stallholders wanting to secure a site at the 2023 Cooma Show with specific terms and conditions.
See template
See template
AgentAgency Agreement
PDF template
A legal agreement defining the terms of engagement between DENCAP Dental Plans and an independent insurance agent for soliciting dental service agreements.
See template
See template
DNRC General Clauses To Emergency Equipment Rental Agreement
PDF template
Standard rental agreement for emergency equipment with detailed clauses covering equipment requirements, liability, and operational conditions.
See template
See template
Facility Use And Indemnification Agreement Between The City Of Othello And The Greater Othello Chamb
PDF template
Agreement for the Greater Othello Chamber of Commerce to use city parks for the 4th of July Celebration event, including facility use terms and insurance requirements.
See template
See template
Flexible Spending Account Reimbursement Form
PDF template
A form for submitting out-of-pocket healthcare expenses for reimbursement through a Flexible Spending Account (FSA)
See template
See template
Marine Warranty Claim Form
PDF template
Form for submitting warranty claims for marine equipment and services with detailed repair and service information.
See template
See template
Student Medical Information
PDF template
A comprehensive medical form for collecting student health details, emergency contacts, and insurance information for educational program participation.
See template
See template
New Hire Active Employee Enrollment Form
PDF template
A comprehensive form for new employees to enroll in health, dental, vision, and life insurance benefits with Fulton County, Georgia.
See template
See template
FORM XI INSURANCE FORM
PDF template
Official insurance form for filing a death claim with details of the deceased, insurance policy, and compensation calculation.
See template
See template
Pre Authorization Request Form
PDF template
A medical pre-authorization form for healthcare providers to request service approval from UHSM, detailing patient and provider information.
See template
See template
Pre Authorization Request Form
PDF template
A form for healthcare providers to request pre-authorization for medical services from UHSM with detailed documentation requirements.
See template
See template
Insurance Renewal Memo
PDF template
Memo discussing the option to waive statutory tort limits and purchase excess liability insurance for the City of Sunfish Lake.
See template
See template
Property Damage Personal Injury Claim Form (Other Than Vehicle)
PDF template
A municipal claim form for reporting property damage or personal injury within the Town of Innisfil's jurisdiction, excluding vehicle-related incidents.
See template
See template
LIC Operations Committee Meeting
PDF template
Two-day conference hosted by Baltimore Life focusing on operational innovation and strategic improvement in the insurance industry.
See template
See template
2024 2025 Benefits Enrollment Form
PDF template
Form for employees to select health benefit plans, add or remove dependents, and update personal information for the upcoming benefits year.
See template
See template
Group Medical Plan Waiver Form
PDF template
A form for employees to waive medical plan coverage by certifying alternative health insurance coverage and understanding ACA requirements.
See template
See template
TASBO Membership And Professional Liability Insurance Form
PDF template
Membership registration form for Texas Association of School Business Officials with optional professional liability insurance coverage
See template
See template
Preliminary Accident Report
PDF template
A comprehensive form documenting details of a vehicle accident, including driver, vehicle, and third-party information for insurance and risk management purposes.
See template
See template
Cooma Show 2024 Ground Space Booking Form
PDF template
Booking form for stallholders and vendors to reserve space at the 2024 Cooma Show with detailed terms and conditions.
See template
See template
Notification Of Intent To Use Exhibitor Appointed Contractor
PDF template
Form for exhibitors to declare non-official contractors for The Aesthetic Meeting 2024 event and provide required insurance details.
See template
See template
Patient Demographic Form
PDF template
A comprehensive form for collecting patient personal, contact, and insurance information for medical services.
See template
See template
2024 Guardian Dental Cancellation Form
PDF template
A form to request cancellation of Guardian Dental insurance coverage by an employee.
See template
See template
HSA Payroll Deduction Form 2024
PDF template
A form for employees to authorize payroll deductions for Health Savings Account contributions with IRS contribution limits and University contribution details.
See template
See template
Eugene Metro Futbol Club Medical Release Release Of Liability Form
PDF template
Medical and liability consent form for youth soccer player registration and participation in soccer programs.
See template
See template
2024 Direct Member Reimbursement Request Form
PDF template
A form for Medicare plan members to request reimbursement for dental, eyewear, and hearing aid services.
See template
See template
PLAN YEAR 2024 ENROLLMENTCHANGE FORM MEDICAL SPENDING CONVERSION (MSC) HEALTH BENEFITS BUY OUT WAIVE
PDF template
Enrollment form for New York City employees to participate in or terminate health benefits buy-out waiver program for plan year 2024.
See template
See template
Group Medicare Enrollment Form Kaiser Permanente Medicare AdvantageSenior Advantage (HMO)
PDF template
Enrollment form for individuals seeking to join Kaiser Permanente's Medicare Advantage/Senior Advantage health plan through a group plan.
See template
See template
20232024 Season
PDF template
Registration and medical information form for volleyball team participants, including contact details, medical history, and insurance information
See template
See template
Stone X Spade, Inc. Blanket Rental Agreement
PDF template
Comprehensive rental agreement for equipment rental services with detailed payment, insurance, and service terms.
See template
See template
Disability Insurance Claim Packet Instructions
PDF template
Instructions for filing a disability insurance claim with Standard Insurance Company, detailing the application process and required documentation.
See template
See template
Credentials Check List For Tournament Teams
PDF template
Detailed guidelines for tournament team documentation and eligibility verification for Dixie Boys Baseball (DBB) tournaments.
See template
See template
VADA Termination Or Voluntary Cancellation Form
PDF template
Form for employees to cancel or terminate their employment benefits including medical, dental, vision, disability, and life insurance.
See template
See template
2025 Provider Referral Form
PDF template
A medical referral form for patients seeking enrollment in weight management or diabetes management programs through the Florida Department of Management Services.
See template
See template
Benefits Cancellation Form
PDF template
Form for employees to remove dependents from their healthcare or insurance benefits plan.
See template
See template
Group AdministratorS Member Transactions
PDF template
Form for group administrators to manage member insurance coverage changes, cancellations, and reinstatements
See template
See template
Disability Insurance Claim Packet Instructions
PDF template
Comprehensive guide for applying for disability insurance benefits through Standard Insurance Company, detailing claim submission process and requirements.
See template
See template
SoonerCareInsure Oklahoma Referral Form
PDF template
A referral form for healthcare providers to refer patients for medical services within the SoonerCare/Insure Oklahoma program.
See template
See template
Road Service Reimbursement Request
PDF template
Form for AAA members to request reimbursement for roadside assistance services in specific states and territories.
See template
See template
Property Loss And Damage Report Form
PDF template
A document for reporting property loss and damage incidents, used for documenting financial transactions and potential insurance claims.
See template
See template
Form 216 F Health Carrier External Review Annual Report Form
PDF template
Annual reporting form for health carriers to provide aggregate information about external review requests in Virginia
See template
See template
Apricus Referral Form
PDF template
A comprehensive medical referral form for patient discharge planning and facility care management services.
See template
See template
MyFitRx And Kids On The Move Reimbursement Form
PDF template
A reimbursement form for members participating in MyFitRx or Kids on the Move fitness programs, offering up to $50 per benefit year.
See template
See template
USA Volleyball Incident Report Form
PDF template
Comprehensive form for documenting injuries or property damage during USA Volleyball events
See template
See template
USA Volleyball Incident Report Form
PDF template
Official form for documenting injuries or property damage incidents during USA Volleyball events
See template
See template
Final Expense Frequently Asked Questions
PDF template
Comprehensive guide detailing payment methods, billing options, and administrative procedures for final expense insurance policies.
See template
See template
Hanford Employee Welfare Trust Short And Long Term Disability Plan And Disability Equalizer Benefit
PDF template
Summary plan description detailing short and long term disability benefits for Hanford employees
See template
See template
Claim Form
PDF template
Official form for submitting property damage or injury claims to the City of Mobile municipal government
See template
See template
Request For Proposal Package
PDF template
Guidelines and instructions for submitting a proposal to the Rhode Island Public Transit Authority for insurance broker services.
See template
See template
Retiree Benefits Enrollment Form
PDF template
Form for retirees or surviving spouses to enroll or modify health and dental benefits coverage options.
See template
See template
Group Whole Life Enrollment Forms And Statement Of Insurability Forms
PDF template
Regulatory standards for enrollment forms related to group whole life insurance policies, defining requirements for form submission and usage.
See template
See template
Claim Form
PDF template
Official form for submitting claims for injuries or property damage within the City of Mobile, Alabama.
See template
See template
Public Official Bond Surety Application And Indemnity Agreement
PDF template
A surety application and indemnity agreement for public officials seeking bond coverage through a municipal insurance fund.
See template
See template
Uniform Standards For Group Term Life Insurance Enrollment Forms And Statement Of Insurability Forms
PDF template
Regulatory guidelines for group term life insurance enrollment forms, establishing uniform standards for form content, submission, and usage across insurance providers.
See template
See template
Emergency Contact Form
PDF template
A comprehensive emergency contact and medical information form for high school band and dance students in Fort Bend Independent School District.
See template
See template
Request For Certificate Of Insurance
PDF template
A form used to request a certificate of insurance from Purdue University's Risk Management department.
See template
See template
Certificate Of Compliance Workers Compensation Law
PDF template
A form documenting workers' compensation insurance compliance for Minnesota State Fair licensees, required by state law.
See template
See template
Personal Property Inventory Form
PDF template
Insurance claim form for documenting personal property damage and losses with comprehensive item tracking details.
See template
See template
Registration For Risk Purchasing Group (RPG)
PDF template
Official form for registering a risk purchasing group to conduct insurance activities in Wisconsin, as required by state statute.
See template
See template
Town Of Hurley Requirements For Building Permit
PDF template
Comprehensive guide detailing documentation and requirements for obtaining a building permit in the Town of Hurley, New York.
See template
See template
Universal Provider Request For Claim Review Form
PDF template
A standardized form for healthcare providers to submit claim review requests to multiple health plans and MassHealth in Massachusetts.
See template
See template
Southern Michigan Insurance Company V State Farm Insurance Company
PDF template
A court of appeals case involving automobile no-fault insurance coverage and personal injury protection benefits for a spouse during ongoing divorce proceedings.
See template
See template
Non UH Event Or Activity Participant Consent, Waiver, Release And Indemnity Agreement
PDF template
Legal document outlining participant consent, risk acknowledgment, and liability release for non-University of Hawaii events or activities.
See template
See template
Participant Consent, Waiver, Release And Indemnity Agreement Non UH Event Or Activity
PDF template
A legal consent and release form for participants in non-University of Hawaii events, outlining health representations, risk assumptions, and liability waivers.
See template
See template
Claim Process For Swasthya Ratna Policy
PDF template
Detailed guide explaining cashless and reimbursement claim processes for insurance policy, covering planned and emergency hospitalizations.
See template
See template
CLAIM FORM FOR HEALTH DEPENDENT CARE EXPENSES
PDF template
A form for employees to request reimbursement for health and dependent care expenses through their Flexible Spending Account (FSA)
See template
See template
Enrollment Form
PDF template
An enrollment form for collecting personal and dependent information for insurance or benefits enrollment with Lincoln Financial Group.
See template
See template
Loss Claim Form
PDF template
A guide for fish harvesters and processors to claim compensation for gear, vessel damage, or oil spills related to the Hibernia project.
See template
See template
Personal Automobile Rate And Rule Manual And Underwriting And Procedures Manual
PDF template
Comprehensive manual for personal automobile insurance rates, rules, underwriting guidelines, and procedures for Capitol Insurance Company.
See template
See template
Warranty Claim Form
PDF template
Form for documenting equipment failure, repair details, and warranty claim submission for Klein Products equipment.
See template
See template
ACORD 35 Cancellation Request Policy Release
PDF template
A standardized form for requesting cancellation or release of an insurance policy, providing clear details and minimal room for miscommunication.
See template
See template
PIP Checklist
PDF template
A comprehensive checklist for healthcare providers to ensure complete documentation and submission of required forms for personal injury protection insurance claims.
See template
See template
Pre Authorization Form
PDF template
A pre-authorization form for requesting cashless hospitalization through a medical insurance policy, requiring details from the patient, treating doctor, and insurance provider.
See template
See template
Senate Bill No. 320
PDF template
New Jersey legislative bill that restricts and regulates access to motor vehicle accident reports for specific parties.
See template
See template
Pension Application Form
PDF template
Comprehensive application form for pension insurance covering employer and employee details for individual or group policies.
See template
See template
Commercial Sewer Discharge Form
PDF template
A form for industrial and commercial users to provide details about their facility's sewer discharge and operational characteristics for NPDES permit compliance.
See template
See template
Administrative Procedure 3810 Claims Against The District
PDF template
Outlines the MiraCosta Community College District's responsibilities and procedures for handling claims involving injuries, property damage, and liability.
See template
See template
GENERAL PERMIT 3 9004 DISCHARGES FROM PETROLEUM RELATED REMEDIATION ACTIVITIES
PDF template
State of Vermont general permit governing discharges from petroleum-related remediation activities in Class B waters within the state.
See template
See template
Medco Health Prescription Order Form
PDF template
A form for ordering prescription medications through Medco Health, with options for refills, new prescriptions, and payment methods.
See template
See template
ATHLETIC INSURANCE CERTIFICATION FORM
PDF template
A form certifying student insurance coverage for athletic participation at Gateway Middle School
See template
See template
3M Window Film Warranty Claim Form
PDF template
Form for submitting warranty claims for 3M window film products, covering window breakage and seal failure scenarios.
See template
See template
Official Form 410 Proof Of Claim
PDF template
A standardized form used to file a claim for payment in a bankruptcy case, detailing creditor information and claim specifics.
See template
See template
HUD Handbook 4240.4 REV 2
PDF template
Guidelines for HUD mortgage endorsement process, focusing on rehabilitation loan procedures and insurance requirements.
See template
See template
Electronic Debit Service Agreement
PDF template
Agreement for automatic monthly payments from a bank account for PEBB insurance coverage.
See template
See template
NY Medicaid Provider Enrollment Form For Practitioners
PDF template
A form for healthcare providers to enroll in the New York State Medicaid Program, detailing privacy requirements and enrollment process.
See template
See template
New York State Medicaid Enrollment Form
PDF template
Form for healthcare practitioners to enroll as Medicaid providers in New York State, covering ordering, referring, and managed care network providers.
See template
See template
Medicare Reimbursement Account (MRA) Claim Form Instructions
PDF template
Detailed instructions for submitting Medicare Part B premium reimbursement claims through a Medicare Reimbursement Account.
See template
See template
Broker Agreement
PDF template
Document detailing requirements for brokers to initiate appointment process with AmWINS Program Underwriters
See template
See template
Medical Service Request Form
PDF template
A form for healthcare providers to request medical services for South Country Health Alliance members with detailed service and patient information.
See template
See template
MCPS Form 450 2 Optional Dependent Term Life Insurance EnrollmentCancellation Form
PDF template
Form for enrolling or canceling optional dependent term life insurance for Montgomery County Public Schools employees and retirees.
See template
See template
Chapter 6 Final Endorsement
PDF template
Detailed guidelines for final endorsement procedures for mortgage insurance transactions involving construction loans.
See template
See template
HUD Handbook 4700.1 REV 1
PDF template
HUD handbook providing guidelines for lending institutions on credit application, investigation, and approval processes for insurance-backed loans.
See template
See template
Request For Proposal For Third Party Administrator For Self Insured Workers Compensation And Employe
PDF template
Request for proposal document for selecting a third-party administrator for workers' compensation and employers' liability insurance coverage for Boone County, Missouri.
See template
See template
Incident Or Injury ReportingInsurance
PDF template
A comprehensive procedure for reporting and documenting incidents, injuries, and equipment damage at Piedmont Technical College.
See template
See template
SI 2047 Your Disability Benefit Claim
PDF template
Comprehensive guide and forms for applying for disability insurance benefits, including instructions for claim submission and potential benefit reductions.
See template
See template
Product Standards For Service Contracts
PDF template
Regulatory guidelines for service contract providers in Oregon, defining filing requirements and contract standards for service agreements.
See template
See template
Shareholders Agreement Western Professional Insurance Company
PDF template
A legal agreement defining the terms of share ownership, board composition, and share transfer restrictions among insurance company shareholders.
See template
See template
Out Of Network Reimbursement Form
PDF template
A form for employees to submit out-of-network healthcare service reimbursement claims with detailed patient and service information.
See template
See template
NC Medicaid Enrollment Form
PDF template
Form for choosing or changing Medicaid health plans and primary care providers in North Carolina.
See template
See template
DEALERS OPEN LOT GARAGE KEEPERS LEGAL LIABILITY PROPOSAL FORM
PDF template
Insurance proposal form for automotive dealers, parking lots, and related businesses seeking garage keepers legal liability and dealers open lot coverage.
See template
See template
Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, medical, insurance, and contact information for healthcare providers.
See template
See template
M TIBA OUTPATIENT CLAIM AND PRE AUTHORIZATION FORM
PDF template
A comprehensive healthcare claim form for submitting outpatient medical treatment details and seeking pre-authorization for medical services.
See template
See template
Virginia Service Request Form
PDF template
Official form for insurance agents to request name changes, license updates, and address modifications in Virginia.
See template
See template
CMS 1500 Claim FormAmerican National Standards Institute (ANSI) Crosswalk For PaperElectronic Claims
PDF template
A comprehensive guide explaining how to file Medicare claims electronically or via paper form, detailing the correspondence between paper and electronic claim elements.
See template
See template
Weekly Disability Claim Form
PDF template
A comprehensive form for reporting disability status and medical information for the Greater St. Louis Construction Laborers' Welfare Fund.
See template
See template
INSURANCE COMPLAINT FORM
PDF template
Official form for consumers to file insurance-related complaints with the Office of the Commissioner of Insurance in Wisconsin.
See template
See template
Sample Letter For Insurance Claim Property Damage
PDF template
A template document for filing insurance claims related to property damage, covering motor vehicle and other property damage scenarios.
See template
See template
Direct Deposit Authorization Form
PDF template
Form for authorizing direct deposit of flexible spending account (FSA) or health reimbursement account (HRA) reimbursements.
See template
See template
Disability Claim Application Forms
PDF template
Comprehensive documentation requirements for submitting a disability insurance claim with multiple form and document submission instructions.
See template
See template
Appellate Division Court Document Daniel F. Imrie II V. Andrew R. Ratto Et Al.
PDF template
A court document detailing appeals from judgments and orders in a legal case involving multiple parties and insurance claims.
See template
See template
Fitness Reimbursement Request
PDF template
Form for members to request reimbursement for qualified fitness expenses through Blue Cross Blue Shield of Massachusetts.
See template
See template
Blue MedicareRx (PDP) 2024 ENROLLMENT FORM
PDF template
Enrollment form for Medicare beneficiaries who want to join a Medicare Prescription Drug Plan in Connecticut, Massachusetts, Rhode Island, and Vermont.
See template
See template
PROOF OF CLAIM FORM
PDF template
A claim form for potential claimants of a company being liquidated by the Florida Department of Financial Services as Receiver.
See template
See template
Aflac Continuing Disability Claim Form
PDF template
A form for submitting continuing disability claims with Aflac insurance, providing instructions for online form completion and submission.
See template
See template
Warranty Claim Form
PDF template
A form for customers to submit warranty claims for Katun products with detailed instructions for processing.
See template
See template
Goodman Warranty Claim Form
PDF template
A document detailing the process for submitting warranty claims for Goodman HVAC equipment and participating in promotional drawing.
See template
See template
CONSUMER WARRANTY CLAIM FORM
PDF template
A form for consumers to submit warranty claims for defective Alpine Corporation products with specific submission requirements and instructions.
See template
See template
Medical Form
PDF template
A medical form for applicants to Notre Dame Seminary's Graduate School of Theology Priestly Formation Program, collecting health and insurance information.
See template
See template
Proof Of Death ClaimantS Statement
PDF template
Insurance claim form for reporting and documenting the death of a policyholder, used to initiate a life insurance death benefit claim.
See template
See template
Universal Request For Change Form
PDF template
A form used to update or change beneficiary designations for a life insurance policy.
See template
See template
NYS Medicaid InstitutionalRate Based Provider Change Of Address Form
PDF template
A form for New York State Medicaid providers to update their correspondence, pay to, and corporate addresses.
See template
See template
Interactive Registration For Policyholders
PDF template
A confidentiality agreement and registration form for accessing LWCC's online policy and claims information system for policyholders.
See template
See template
Data Processing Agreement
PDF template
Legal agreement outlining data processing terms between Jasper AI and its customers for handling personal data.
See template
See template
Proof Of Claim And Release
PDF template
Legal claim form for participants in a class action lawsuit involving Regions Morgan Keegan closed-end funds.
See template
See template
Citizens 4 Point Inspection Form
PDF template
A comprehensive inspection form for evaluating property risks and eligibility for insurance purposes, with updated requirements for inspectors.
See template
See template
Certificate Of Liability Insurance Form Florida
PDF template
A comprehensive overview of ACORD insurance certificates, explaining their purpose and importance for business risk management.
See template
See template
Acord 27 Form
PDF template
A standard insurance document used to provide proof of property coverage in the insurance industry.
See template
See template
ACORD 35 Cancellation Form
PDF template
A standardized document used to request and document the cancellation of an insurance policy with essential policyholder and policy details.
See template
See template
Tier 2 Retirement Checklist
PDF template
Comprehensive checklist for Tier 2 retirement application process, detailing required forms and documentation for pension and benefits
See template
See template
Allegany College Of Maryland Athletics Emergency ContactInsurance Form
PDF template
Form for collecting athletic student emergency contact details and health insurance information at Allegany College of Maryland.
See template
See template
Application For Group Insurance CHEIBA Trust
PDF template
A comprehensive insurance application form for employee group insurance coverage with options for various types of insurance benefits.
See template
See template
FirstChoice Personal Super Withdrawal Form
PDF template
A form for withdrawing units from a superannuation fund, either as a rollover to another fund or as a cash withdrawal with specific conditions.
See template
See template
Workers Compensation Third Party Administrators (TPA) Licensing Packet
PDF template
Licensing documentation for third party administrators handling workers' compensation self-insurance for employers and pools in Tennessee.
See template
See template
Optional Life Insurance Enrollment Form
PDF template
Insurance enrollment form for optional life insurance coverage for employees, spouses, and children with various coverage options.
See template
See template
Senate Bill No. 768
PDF template
Legislation modifying access rules for motor vehicle accident reports in New Jersey
See template
See template
Pradhan Mantri Jeevan Jyoti Bima Yojana Claim Form
PDF template
Official claim form for the Pradhan Mantri Jeevan Jyoti Bima Yojana life insurance scheme for processing death benefit claims.
See template
See template
Notice Of Injury Or Occupational Disease
PDF template
A form used to report workplace injuries or occupational diseases in Nevada, documenting details of the incident and potential worker's compensation claim.
See template
See template
Form 80 006C Instructions For Warranty Claim Form 80 226C
PDF template
Detailed guidelines for completing and submitting a warranty claim form for Allied Systems Company.
See template
See template
GROUP PLANS ENROLLMENT FORM
PDF template
Comprehensive form for employees to select and enroll in group insurance and benefit plans covering life, disability, medical, and supplemental insurance options.
See template
See template
Express Scripts PharmacySM Home Delivery Form
PDF template
A form for submitting prescription medication orders through Express Scripts' home delivery pharmacy service, including member and patient information, payment options, and shipping details.
See template
See template
HSMV 83392 Insurance Request Form
PDF template
Form for requesting insurance information on a vehicle involved in a crash in Florida, used by individuals or attorneys.
See template
See template
SSU Admission And Discharge Form
PDF template
Medical intake and release document for detainees in immigration health services facilities, tracking health status and disposition.
See template
See template
Questions And Answers From Early Intervention Insurance Assessment Webinar
PDF template
A comprehensive document addressing questions about insurance processes in early intervention services and related forms.
See template
See template
Proof Of Claim Form
PDF template
A form for filing claims against Freestone Insurance Company, which is in liquidation, with a deadline of December 31, 2015.
See template
See template
Community Use Of School District Buildings Sites Equipment Facility Request And Agreement Form
PDF template
A form for requesting use of school district facilities and equipment, with liability and insurance requirements.
See template
See template
Refund Request Section 232
PDF template
A U.S. Department of Housing and Urban Development form for requesting refunds related to Section 232 Healthcare Facility Insurance Program.
See template
See template
Conditional Commitment Direct Endorsement Statement Of Appraised Value
PDF template
Official HUD document outlining conditions and terms for mortgage insurance and property commitment
See template
See template
REMICADE And Infliximab Mastercard Patient Information Form
PDF template
Form for patients to provide personal information and insurance details for medication rebate program for REMICADE and Infliximab.
See template
See template
Group Benefits EnrolmentChange Form
PDF template
A comprehensive form for enrolling or changing group benefit plan details for employees, including personal information, coverage selection, and benefit options.
See template
See template
City Of Goshen Commercial Sewer Discharge Form
PDF template
Form for industrial and commercial users to provide details about their facility's sewer system discharge and operational characteristics for NPDES permit compliance.
See template
See template
Advancing Access Patient Information Form
PDF template
Comprehensive form for collecting patient personal information, contact preferences, and insurance details for medical services.
See template
See template
Subscriber Claim Form
PDF template
A comprehensive insurance claim form for submitting medical service reimbursements to Blue Cross Blue Shield of Massachusetts.
See template
See template
Benefits Administration Letter 99 101
PDF template
Official guidance from the Office of Personnel Management addressing common documentation problems in Federal Employees Retirement System (FERS) applications and retirement claims.
See template
See template
U.S. Coast Guard Auxiliary 9CR Claim For Reimbursement Travel Form
PDF template
Official form for Coast Guard Auxiliary members to claim out-of-pocket travel expenses for reimbursement.
See template
See template
Certification Of Trust
PDF template
A form for certifying trust details when a trust is the owner of an Eagle Life insurance annuity contract.
See template
See template
Insurance Office Quick Reference Guide 2017
PDF template
Comprehensive reference for filing insurance claims, emergency contacts, and reporting procedures for various types of incidents.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims to Redmond/Williams Distributing for product repairs or replacements.
See template
See template
Accident Report Form
PDF template
A comprehensive form for documenting details of a traffic accident, designed for drivers to record witness information and accident circumstances.
See template
See template
Damage Report Form
PDF template
Form for reporting vehicle damage during AAA service, requiring detailed documentation and supporting evidence.
See template
See template
Damage Report Form
PDF template
A comprehensive form for reporting vehicle damage during AAA automotive services, requiring detailed incident documentation.
See template
See template
Booking Form For Tours Cruises
PDF template
A comprehensive booking form for travel tours and cruises, capturing personal details, trip preferences, and payment information.
See template
See template
Veterans Administration Aid And Attendance Claim Checklist
PDF template
Comprehensive checklist of required documentation for filing a Veterans Administration Aid and Attendance benefit claim, including personal, financial, and military records.
See template
See template
Alberta Accident Benefits Initial Claims Process
PDF template
A comprehensive guide for filing insurance claims and accessing medical benefits after an automobile accident in Alberta, Canada.
See template
See template
AB CFCPAS 907 SLTC 158 Unable To AdmitDischarge Form
PDF template
Policy and form guiding the process for provider agencies when unable to admit or discharging a member from personal assistance services.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims for equipment parts with detailed instructions for completion and return.
See template
See template
ABT Claim Form
PDF template
A claim form for asylum applicants seeking review under the ABT Settlement Agreement regarding employment authorization documents.
See template
See template
Treatment Service Request Form
PDF template
A form for healthcare providers to request and authorize prescription of Nuplazid medication, including patient and insurance information.
See template
See template
Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, medical, insurance, and contact information for healthcare services.
See template
See template
Group Insurance Accelerated Benefit Option Claim Form
PDF template
A form for employees or members to claim an accelerated benefit option for terminal illness life insurance claims.
See template
See template
Group Accident Insurance Claim Form
PDF template
A comprehensive claim form for reporting and documenting accident-related insurance claims with detailed instructions and submission guidelines.
See template
See template
Accidental Injury Claim Form
PDF template
Insurance claim form for documenting details of an accidental injury and related medical information for potential insurance coverage.
See template
See template
Vehicle CrashDamage Notice
PDF template
Official form for reporting vehicle accidents, damage, or crashes involving state-owned or managed vehicles in Minnesota.
See template
See template
Auto Accident Report Form
PDF template
Comprehensive form for documenting details of an auto accident, including vehicle, driver, and damage information
See template
See template
NORTHWESTERN UNIVERSITY ACCIDENT REPORT FORM
PDF template
A form for documenting accidents involving university vehicles, detailing damage, driver information, and incident specifics.
See template
See template
ACCIDENT REPORT FORM
PDF template
A document used to record details of an accident, including parties involved, location, circumstances, and witnesses.
See template
See template
Maritime General Insurance Co. Ltd. Claim Form
PDF template
Comprehensive insurance claim document for documenting vehicle and driver details in case of an insurance claim or occurrence.
See template
See template
Accident Report Form
PDF template
A bilingual form for documenting details of an accident, including location, date, injured person's information, and incident specifics.
See template
See template
DRIVERS ACCIDENT REPORT
PDF template
Official form for documenting details of a vehicle accident involving county personnel, to be completed at the accident scene and submitted to supervisor.
See template
See template
Rideshare AccidentDamage Report Form
PDF template
A comprehensive form for documenting details of an accident or damage involving a rideshare vehicle and other parties.
See template
See template
GoTriangle Vanpool Accident Report Form
PDF template
A comprehensive form for documenting details of an accident involving a GoTriangle vanpool vehicle, including driver and insurance information.
See template
See template
Accident Wellness Benefit Claim Form
PDF template
Insurance claim form for submitting wellness screening benefits and personal health information to Guardian Life Insurance.
See template
See template
Consumer Warranty Claim
PDF template
A form used by customers to submit warranty claims for ACCO UK products with details about the product and fault.
See template
See template
Insurance Certificate Issuer Contractors
PDF template
Instructions for insurance certificate issuers on how to complete and submit insurance certificates for University of Nebraska contractors.
See template
See template
CLAIM FORM
PDF template
A comprehensive insurance claim form for collecting detailed policyholder and incident information for processing an insurance claim.
See template
See template
ACORD 66 MA
PDF template
Insurance application form for property coverage with detailed submission instructions and legal notices.
See template
See template
ACORD 126
PDF template
Insurance form for capturing details about employee benefits liability coverage and business insurance details.
See template
See template
ACORD 131
PDF template
Standard insurance policy application form for capturing liability and policy details across multiple insurance categories.
See template
See template
Insurance Application Form
PDF template
Comprehensive insurance application form for property coverage with multiple sections for property details, coverage options, and risk assessment.
See template
See template
Certificates Of Insurance And Lenders
PDF template
Analysis of changes to ACORD insurance certificate forms and their impact on Freddie Mac and lenders' acceptance policies.
See template
See template
ACORD 35 Cancellation Request Policy Release
PDF template
A standardized form for requesting cancellation of an insurance policy and documenting release details.
See template
See template
ACORD 855 NY Construction Certificate Addendum
PDF template
Detailed addendum summarizing insurance policy provisions for construction-related general liability coverage
See template
See template
Acord Lost Policy Release Form
PDF template
A form for releasing or managing insurance policy documentation when original policy documents are missing or need to be replaced.
See template
See template
Acord Policy Change Request Form
PDF template
A fillable form for requesting changes to an existing insurance policy with various coverage options.
See template
See template
Quick Reference Guide MedicalBehavioral Health Providers
PDF template
A comprehensive guide for medical and behavioral health providers on claims submission, pre-authorization, and service procedures for Amida Care health plan.
See template
See template
Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, contact, medical, and insurance information for chiropractic services.
See template
See template
Acute Inpatient Hospital Assessment Form
PDF template
Form for requesting authorization for hospital admissions and stay extensions for Blue Cross and Blue Care Network commercial plans
See template
See template
Ukrpozyka Assignment Agreement
PDF template
A legal document outlining the terms and conditions for transferring a loan claim between a loan originator and an assignee.
See template
See template
LOCAL 22 HEALTH PLAN DEPENDENT FORM
PDF template
Form for adding a spouse or dependent to the Local 22 Health Plan, requiring personal information and supporting documentation.
See template
See template
Pre Authorization Form Instructions
PDF template
Detailed instructions for completing a medical pre-authorization request form, including required documentation and submission process.
See template
See template
Indemnification Agreements And Additional Insureds Under Pennsylvania Law
PDF template
A comprehensive legal document examining indemnification agreements, insurance procurement, and additional insured provisions under Pennsylvania law.
See template
See template
UWS B1242 Accidental Death Dismemberment Insurance
PDF template
Comprehensive employer manual for Accidental Death and Dismemberment insurance policy for University of Wisconsin System employees.
See template
See template
Private Hospitals Discharge Form (ADF96)
PDF template
A comprehensive form for collecting detailed patient discharge data from private hospitals for statistical reporting purposes.
See template
See template
Security Incident Report And Self Insurance Form
PDF template
A comprehensive form for reporting and documenting security incidents in Prince George's County Public Schools.
See template
See template
ADULT FOSTER HOME ADMISSIONDISCHARGE STATEMENT
PDF template
Official form for documenting admission or discharge of clients into or from an adult foster home care facility.
See template
See template
Adobe Generative AI Additional Terms
PDF template
Supplemental legal terms governing the use of Adobe's generative AI features, including guidelines for content input and output.
See template
See template
Emergency Medical Form ADULT
PDF template
Comprehensive medical authorization and emergency contact form for adult participants in MUMC trips.
See template
See template
Adult Confidential Medical Information And Emergency Notification Form
PDF template
Comprehensive medical information and emergency contact form for participants in the 2007 Big Sky Regional Science Bowl
See template
See template
Adult Medical Release Form
PDF template
Medical and liability release form for participants in Diocese of Little Rock youth ministry events
See template
See template
Adult Registration Form
PDF template
Comprehensive form for collecting patient personal and insurance information for healthcare purposes.
See template
See template
Provider Appeal Request
PDF template
A form for healthcare providers to submit appeals for denied claims or authorizations with Advanced Health.
See template
See template
Provider Appeal Request
PDF template
A form for healthcare providers to request an appeal of a denied claim or authorization with Advanced Health.
See template
See template
Advanced Illness Benefit Application Form
PDF template
Application form for palliative care through the Advanced Illness Benefit for advanced cancer/oncology care by Anglovaal Group Medical Scheme.
See template
See template
Advantage Plus Enrollment Form
PDF template
Enrollment form for Kaiser Permanente Medicare Advantage optional supplemental benefits package in the Mid-Atlantic States Region.
See template
See template
Commercial Prescription Drug Claim Form
PDF template
A form for submitting prescription drug claims to Aetna Pharmacy Management for reimbursement or processing.
See template
See template
Prescription Drug Claim Form
PDF template
A comprehensive form for submitting prescription drug claims to Aetna Pharmacy Management for reimbursement or processing.
See template
See template
AETNA STUDENT HEALTH CLAIM FORM
PDF template
Insurance claim form for Aetna Student Health covering medical and accident-related expenses for university students.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for E-Z Climber and Electric Utility Vehicles, detailing product failure and repair information.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form used by dealers to submit warranty claims for electronic equipment to Hindley Electronics, Inc.
See template
See template
Affidavit Of Domestic Partner Status And Tax Dependency Status
PDF template
A form for employees to declare domestic partner and dependent status for health and welfare benefits eligibility
See template
See template
Insurance Form For County Affiliates
PDF template
Insurance documentation form for county-level cattle industry affiliate events in Missouri.
See template
See template
Accidental Injury Claim Form
PDF template
Insurance claim form for documenting details of an accidental injury for potential insurance benefits and reimbursement.
See template
See template
Continuing Disability Claim Form
PDF template
A claim form for filing a continuing disability insurance claim with Aflac, requiring detailed patient and policyholder information.
See template
See template
Initial Disability Claim Form
PDF template
Insurance claim form for reporting disability due to sickness or injury, used by Aflac for processing disability claims.
See template
See template
M0272B Flexible Spending Account Claim Form
PDF template
Form for requesting reimbursement from a Flexible Spending Account for medical and dependent care expenses.
See template
See template
Initial Disability Claim Form
PDF template
Comprehensive form for filing a disability insurance claim covering various types of disability including accidents, sickness, pregnancy, and cancer.
See template
See template
AFLAC Optional Insurance
PDF template
Document detailing optional insurance offerings from AFLAC for the Housing Authority of the City of Los Angeles (HACLA)
See template
See template
Sickness Claim Form
PDF template
A comprehensive form for filing insurance claims related to sickness, disability, hospitalization, and other health events with Aflac.
See template
See template
AFSCME Local 127 PPO Benefits Matrix
PDF template
Comprehensive dental insurance plan detailing coverage levels for various dental treatments and services.
See template
See template
Reed Insurance Agency Bill Invoice Form
PDF template
A form used by Reed Insurance to document policy transaction details, billing information, and payment verification.
See template
See template
52675 (0820) Checklist
PDF template
A comprehensive checklist for insurance agents applying to contract with Americo, outlining required documentation and process steps.
See template
See template
AgentS Report
PDF template
A form for agents to report and settle surety bond transactions with details about bond execution and premiums.
See template
See template
Services Agreement
PDF template
Agreement for individuals to perform data collection tasks for Datoid's AI research and development, involving text, speech, and media labeling and processing.
See template
See template
Medical Reimbursement Form
PDF template
Form for members to request reimbursement for medical services covered under their health plan
See template
See template
AIM Issuing Orphan Endorsements
PDF template
Instructions for issuing an orphan endorsement to a policy issued outside the AIM+ environment.
See template
See template
Individual Family Life Insurance Form (Policy 32871 G)
PDF template
A form allowing employees to enroll in or increase life insurance coverage for themselves, spouse/domestic partner, and children during an annual enrollment period.
See template
See template
AIR TOUR BOOKING FORM
PDF template
A comprehensive travel booking form for reserving holidays with Woods Holidays Limited, covering passenger details and travel arrangements.
See template
See template
Allied, Therapeutic And Psychology Extender Benefit Application Form For 2024
PDF template
Application form for healthcare benefit coverage under the Retail Medical Scheme's Essential Plus Option for allied, therapeutic, and psychology services.
See template
See template
Allowable Discharge To Water Resources Form
PDF template
Form for obtaining approval to discharge water into City of Vancouver's water resources, requiring detailed information about water characteristics and source.
See template
See template
Pre Authorization Checklist For Acute LymphocyticLymphoblastic Leukemia
PDF template
A medical form used by healthcare providers to pre-authorize treatment for pediatric leukemia patients through the Philippine Health Insurance Corporation.
See template
See template
Accident Coverage Claim Form
PDF template
Insurance claim form for reporting accidental injuries and seeking coverage benefits from American Heritage Life Insurance Company.
See template
See template
What To Do In Case Of An Accident
PDF template
A step-by-step guide for handling an automobile accident and reporting a claim to Allstate Insurance.
See template
See template
Participant Accident WaiverRelease Of Liability Form
PDF template
A comprehensive liability waiver for participants in motorcycle events, covering risks, personal fitness, and legal responsibilities.
See template
See template
Blue Cross Medical Travel Benefit Claim
PDF template
A claim form for medical travel expenses for members of the Arrow Lakes Teachers' Association submitted to Pacific Blue Cross.
See template
See template
Transfer Or Discharge Form
PDF template
A form used to document and record the transfer or discharge of a resident from a healthcare facility, including essential transfer details and accompanying documentation.
See template
See template
Enrollment Form
PDF template
A comprehensive enrollment form for dental and vision insurance coverage through an employer's benefit plan.
See template
See template
Enrollment Form
PDF template
A comprehensive form for enrolling in dental insurance coverage, including subscriber and dependent information, coverage options, and coordination of benefits.
See template
See template
ENROLLMENT FORM VISION ONLY
PDF template
A comprehensive enrollment form for vision insurance coverage, allowing employees to add or modify vision insurance benefits.
See template
See template
Dental Claim Form
PDF template
A comprehensive form for submitting dental insurance claims, requiring patient and employee information, treatment details, and authorization signatures.
See template
See template
Enrollment Change Waiver Group Insurance Form
PDF template
Insurance form for enrolling, changing, or waiving group dental insurance coverage for employees and their dependents.
See template
See template
COBRA Eye Care Insurance Form
PDF template
Form for documenting employee and dependent eye care insurance coverage under COBRA regulations.
See template
See template
Hearing Insurance Enrollment Form
PDF template
A comprehensive form for employees to enroll in or modify hearing insurance coverage for themselves and dependents.
See template
See template
Group Insurance Form Eye Care
PDF template
Insurance enrollment form for group eye care coverage, allowing employees to enroll, change, or waive insurance benefits
See template
See template
AMI Insurance Application
PDF template
A comprehensive insurance application form for personal health coverage with options for individual or family plans.
See template
See template
Change Of Beneficiary Form Privileged Assets
PDF template
A form for changing beneficiary designations on a deferred annuity contract with RiverSource Life Insurance Co. of New York.
See template
See template
Indiana DowngradePolicy Change Form
PDF template
A form for making changes to an individual Anthem Blue Cross and Blue Shield insurance policy, excluding certain types of modifications.
See template
See template
Annual Controlled Substance Inventory Form
PDF template
Form for documenting annual inventory of controlled substances at Michigan State University locations.
See template
See template
Ohio DowngradePolicy Change Form
PDF template
A form for making changes to an individual insurance policy with Anthem Blue Cross and Blue Shield, excluding certain types of modifications.
See template
See template
Member Claim Form
PDF template
Insurance claim form for submitting medical expenses and service details to Anthem Blue Cross health insurance.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for patients to submit claims for prescription medication reimbursement from their insurance provider.
See template
See template
Medical Insurance Claim Form
PDF template
A standard medical insurance claim form for submitting patient information and medical service details to an insurance provider.
See template
See template
Medical Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare service details and patient information to Anthem Blue Cross insurance.
See template
See template
Dental Claim Form
PDF template
Official form for submitting dental insurance claims and treatment documentation to dental benefit plans.
See template
See template
Medical Claim Form
PDF template
A comprehensive form for submitting medical insurance claims, collecting patient, subscriber, and medical service information.
See template
See template
Medical Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare service reimbursement claims to Anthem Blue Cross and Blue Shield insurance.
See template
See template
PPO Dental Blue Complete
PDF template
Comprehensive dental insurance plan offering flexible network options and preventive care coverage for active and retired police association members.
See template
See template
Short Term Disability Claim Form
PDF template
A form for employees to file a claim for short-term disability benefits with insurance details and authorization.
See template
See template
Medical Claim Form
PDF template
A standard medical insurance form for submitting healthcare service claims and patient information to an insurance provider.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
A claim form for submitting vision care expenses to Blue View Vision when receiving services from out-of-network providers.
See template
See template
ANZ Discharge And Variation Authority Form
PDF template
A comprehensive form for managing loan releases, property sales, and loan modifications with ANZ banking services.
See template
See template
COVID 19 Assumption Of The Risk Forms
PDF template
Proposal for risk mitigation forms to address COVID-19 exposure in fraternity settings, covering various participant types.
See template
See template
Texas Department Of Insurance, Division Of Workers Compensation Adopted Amendments To Chapter 133
PDF template
Amendments to medical billing forms and procedures for the Texas workers' compensation system, specifically updating electronic billing and pharmacy claim forms.
See template
See template
PARTICIPANT MEDICAL HISTORY FORM
PDF template
Confidential medical history form for collecting participant health information for trips and activities by APEX
See template
See template
Administrative Form AP F002 STAFF TRAVEL EXPENSE CLAIM FORM
PDF template
A form for employees to document and request reimbursement for travel-related expenses including meals, transportation, and other costs.
See template
See template
Essex County Fairgrounds Task Force Application Checklist
PDF template
Comprehensive checklist for rental application and requirements for using Essex County Fairgrounds facilities.
See template
See template
JOB APPLICATION FORM (STUDENT WORKER)
PDF template
An application form for students seeking on-campus employment at North South University's Central Library
See template
See template
Application For Policy Changes (High Net Worth Products Except Signature Wealth)
PDF template
Insurance policy modification form for making various changes to an existing life insurance policy, including smoking class adjustments and other policy updates.
See template
See template
Texas Tech University System Camp And Conference Non Sports And Sport Camps Insurance Application
PDF template
Insurance application for Texas Tech University System camps covering participant and staff insurance details
See template
See template
Direct AgentAgency Electronic Appointment Onboarding Process
PDF template
Detailed guide for agents and agencies to electronically complete their appointment process with Scott and White Health Plan and FirstCare Health Plans.
See template
See template
Resident Insurance ProducerInsurance AdjusterReal Estate Appraiser Background Check Consent Form
PDF template
A consent form for criminal history record checks required for licensing insurance producers, adjusters, and real estate appraisers in Minnesota.
See template
See template
Albuquerque Public Schools Domestic Partners Policy
PDF template
Policy outlining benefits eligibility for employees with domestic partners, including medical, dental, and insurance coverage.
See template
See template
Guidelines For Filing Applications For Dry Cleaning Facilities
PDF template
Official guidelines from Westchester County Department of Health for submitting permit applications for dry cleaning facilities, including requirements and documentation needed.
See template
See template
Arkansas Motor Vehicle Accident Report (SR 1)
PDF template
Official form for reporting motor vehicle accidents involving property damage over $1,000 or bodily injury/death.
See template
See template
Application For Architects And Engineers Professional Liability Insurance
PDF template
Insurance application for architecture and engineering firms seeking professional liability coverage with detailed firm information and financial reporting requirements.
See template
See template
Architects And Engineers Professional Liability Insurance Application
PDF template
An insurance application for architects and engineers to evaluate professional liability coverage eligibility.
See template
See template
Arizona SPDSCLUE Waiver Form
PDF template
A form allowing buyers and sellers to waive property disclosure statement and insurance claims history report in a real estate transaction.
See template
See template
Recommended Finish Floor Elevation Affidavit
PDF template
A document for property owners acknowledging flood risk information and recommended floor elevation based on FEMA Base Level Engineering data.
See template
See template
Accident Report Form
PDF template
A form for reporting accidents during ART teaching activities, used to comply with public liability insurance requirements.
See template
See template
Prospective Member Insurance Qualification Information
PDF template
Insurance qualification form for prospective pilots seeking membership in Artisan Aviation Inc., collecting personal and flight history information.
See template
See template
MMB Insurance Form
PDF template
A form for documenting artwork details and insurance values for an art exhibition by the Madison Arts Commission.
See template
See template
Referral Form
PDF template
Medical referral form for new patient intake and treatment evaluation at Ascend Health Center, focusing on mental health services.
See template
See template
Student Accident Report Form
PDF template
Comprehensive form documenting details of student accidents and injuries within a school district setting.
See template
See template
ASNC Payer Policy Feedback Form
PDF template
A form for physicians to report issues and provide feedback about health plan and insurance carrier interactions related to medical imaging services.
See template
See template
MEDICALVISION CLAIM FORM
PDF template
A comprehensive claim form for submitting medical and vision insurance claims, requiring detailed employee and patient information.
See template
See template
COVID 19 Assumption Of The Risk Forms
PDF template
Comprehensive guidance for creating risk assumption forms to address COVID-19 exposure in fraternity settings, with five different versions for various participant types.
See template
See template
Warranty Claim Form
PDF template
Official form for submitting warranty repair claims for AQUASPORT boats with detailed guidelines for claim submission and processing.
See template
See template
ANNUAL ATHLETIC FACILITES AGREEMENT
PDF template
An agreement between an Athletic Association and North Lebanon Township detailing terms of facility usage, responsibilities, and liability requirements.
See template
See template
TMU Athletics Secondary Insurance Disclosure Form
PDF template
Detailed explanation of athletic injury insurance coverage for student athletes at The Master's University, outlining insurance policy terms and student responsibilities.
See template
See template
Melba Schools Activity Policy
PDF template
Comprehensive policy document covering insurance waiver, drug testing consent, and activity participation guidelines for Melba School District students.
See template
See template
ATTACHMENT B VENDOR PROFILE
PDF template
A vendor document detailing insurance requirements and company profile information for a municipal contract in Duluth, Minnesota.
See template
See template
FINAL PERMIT AKG523000 Annual Report
PDF template
Annual reporting form for vessels discharging pollutants to Alaska waters under General Permit AKG523000, tracking seafood processing waste and discharge details.
See template
See template
Long Term Disability Claim Form
PDF template
A comprehensive medical form for documenting a patient's disability claim, including medical history, diagnosis, treatment, and current condition.
See template
See template
Patient Intake Form
PDF template
Comprehensive patient intake form for collecting personal, contact, and medical insurance information at Auburn University Clinical Health Services clinics.
See template
See template
Authorization Form For Insurance Complaint
PDF template
A form authorizing a representative to discuss and access medical information related to an insurance complaint or appeal.
See template
See template
DriverS Accident Report Form
PDF template
A comprehensive form for documenting details of a vehicle accident, including driver, vehicle, and accident information.
See template
See template
Auto Accident Report Form
PDF template
A comprehensive form for documenting details following a motor vehicle accident, including vehicle, driver, and injury information.
See template
See template
Automobile Accident Report
PDF template
Comprehensive form for reporting vehicle accidents involving University of Delaware vehicles or employees
See template
See template
Auto Accident Report Form
PDF template
A comprehensive form for documenting details of a vehicle accident involving Oregon State University personnel, vehicles, or property.
See template
See template
New PIP Patient Form
PDF template
Detailed form for documenting vehicle accident details and patient information for insurance or medical purposes.
See template
See template
Auto Incident Report Form
PDF template
A comprehensive form for documenting details of an auto collision involving a nonprofit organization's vehicle.
See template
See template
Client Interview Form Auto Accidents
PDF template
Comprehensive form for collecting client information related to an auto accident insurance or legal claim.
See template
See template
Colony Specialty Automobile Vehicle Inspection Form
PDF template
Comprehensive inspection form for evaluating the condition of vehicles and trailers, assessing various mechanical and safety components.
See template
See template
Vehicle Accident Report Form
PDF template
A comprehensive form for documenting details of a vehicle accident, including driver, vehicle, damage, and witness information.
See template
See template
Arbitration Award Certas Direct Insurance Company V. Allstate Insurance Company Of Canada
PDF template
Arbitration award resolving an insurance priority dispute between two insurers following a motor vehicle accident in 2018.
See template
See template
Award Agreement (Agreement To Pay Benefits)
PDF template
Official form documenting workers' compensation benefits agreement between an injured worker and employer/insurance carrier.
See template
See template
Premium And Billing Change Request
PDF template
A form for changing insurance premium payment methods, including pre-authorized check plan and billing modifications for American Heritage Life Insurance Company policies.
See template
See template
Medical Expense Claim Form
PDF template
A form for employees to claim medical expenses through a Flexible Spending Account with detailed submission instructions.
See template
See template
Alfond Youth Community Center New England Sports Camps Medical History Form 2023
PDF template
Comprehensive medical history and emergency contact form for children attending various sports camps in Maine.
See template
See template
Member Request For Medical Reimbursement Form
PDF template
A form used by UnitedHealthcare Community Plan members to request reimbursement for medical services, co-payments, coinsurance, and deductibles.
See template
See template
Warranty Claim Form
PDF template
Official form and policy for submitting warranty claims for Aztec product repairs or returns.
See template
See template
Securing Waivers Of Liability From Volunteers Of Nonprofit Organizations
PDF template
A comprehensive guide for nonprofit organizations on obtaining and using liability waivers to protect against potential legal claims from volunteers.
See template
See template
Benefit Application Form (BA1)
PDF template
Application form for members of the New Zealand Firefighters Welfare Society to claim benefits and reimbursements.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims for product defects or replacement parts.
See template
See template
My Choice Wisconsin BadgerCare Plus Authorization Form
PDF template
A comprehensive form for requesting healthcare service authorizations under the BadgerCare Plus program in Wisconsin.
See template
See template
Ballast Water Discharge Form
PDF template
Official form for reporting ballast water discharge details for vessels entering Alaska waters, required by state environmental regulations.
See template
See template
Chronic Appliance Benefit Application Form
PDF template
Medical application form for patients seeking insurance coverage for chronic medical appliances and equipment through Bankmed.
See template
See template
Medical History Form
PDF template
Comprehensive medical history form for patients seeking weight loss treatment, collecting personal, medical, and insurance information.
See template
See template
Health Is Wealth Patient Intake Form
PDF template
Comprehensive medical intake form collecting patient personal, employment, emergency contact, and insurance information.
See template
See template
WARRANTY CLAIM PROCEDURES
PDF template
Detailed instructions for customers seeking warranty service for Barreto manufactured equipment and components.
See template
See template
BASIC CARE AND ASSISTED LIVING GUIDE FOR IMPLEMENTATION OF TRANSFER OR DISCHARGE REQUIREMENTS
PDF template
Guidelines for developing and completing transfer or discharge notices for basic care and assisted living facilities.
See template
See template
Patient Insurance Information Form
PDF template
Comprehensive form for collecting patient medical insurance and health coverage details for claims processing.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive insurance claim form for documenting medical treatment, injury, or preventive care for reimbursement purposes.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient details, treatment information, and other coverage details.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive insurance claim form for submitting medical treatment claims with detailed patient and treatment information.
See template
See template
Member Reimbursement
PDF template
A form for members to request reimbursement for healthcare expenses paid out-of-pocket directly to providers.
See template
See template
SNFAcute IPR Assessment Form
PDF template
Prior authorization form for skilled nursing facility and inpatient rehabilitation services for Blue Cross Blue Shield of Michigan and Blue Care Network providers.
See template
See template
Member Reimbursement
PDF template
A form for Blue Cross Blue Shield members to request reimbursement for healthcare expenses paid out of pocket.
See template
See template
Medical Expense Claim
PDF template
A claim form for submitting medical expenses to Blue Cross and Blue Shield of Alabama for reimbursement.
See template
See template
Member Reimbursement
PDF template
Form for members to request reimbursement for healthcare expenses paid out-of-pocket.
See template
See template
Member Claim Form
PDF template
A form for filing healthcare claims with Blue Cross Blue Shield of North Carolina, detailing patient and insurance information for reimbursement of medical services.
See template
See template
Prescription Drug Claim Form
PDF template
A form for submitting prescription drug claims, allowing members to request reimbursement for pharmacy expenses.
See template
See template
Change Of Address Form
PDF template
Form for updating a customer's address with Blue Cross Blue Shield of Mississippi to ensure proper mail delivery.
See template
See template
My Benefit Plan Summary
PDF template
Comprehensive healthcare benefit plan summary for SEIU Clerical Employees detailing coverage limits and medical benefits.
See template
See template
My Benefit Plan Summary
PDF template
Comprehensive health benefits summary for full-time employees of Brant Community Healthcare System through Green Shield Canada.
See template
See template
Member Billing Form
PDF template
A form for submitting medical bills from non-participating healthcare providers for reimbursement or claim processing.
See template
See template
Member Reimbursement Form
PDF template
A form for healthcare members to request reimbursement for out-of-pocket medical expenses they have paid directly.
See template
See template
Mental HealthSubstance Use Treatment Claim Form
PDF template
A claim form for submitting mental health and substance use treatment services to Beacon Health Options for reimbursement.
See template
See template
Beazley Financial Institutions Directors Officers Proposal Form
PDF template
A comprehensive proposal form for financial institutions seeking Directors & Officers liability insurance coverage, requiring detailed company information and ownership details.
See template
See template
MEDICAL HISTORY FORM
PDF template
Comprehensive form for collecting patient personal information, medical history, insurance details, and current health status.
See template
See template
DESIGNATION OF BENEFICIARY FOR LIFE INSURANCE KANSAS BOARD OF REGENTS MEMBERS
PDF template
A form for Kansas Board of Regents members to designate life insurance beneficiaries for basic and optional group life insurance benefits.
See template
See template
Beneficiary Designation
PDF template
A form for designating beneficiaries for an insurance or retirement plan, allowing members to specify beneficiary allocation and revocability.
See template
See template
M NCPPC BENEFITS ENROLLMENTCHANGE FORM
PDF template
Form for employees to enroll or change benefits, covering medical, dental, and prescription plans for new hires or those experiencing qualifying life events.
See template
See template
Health Sector Occupational Pension Scheme (DEATH BENEFIT APPLICATION FORM)
PDF template
A form for claiming death benefits for deceased health sector workers in Ghana, to be completed by beneficiaries.
See template
See template
Benefits Billing Form
PDF template
A form for employees to elect benefits continuation options during FMLA or general leave of absence
See template
See template
Benefits Cancellation Form
PDF template
Form used to remove dependents from an employee's benefits plan and modify coverage options.
See template
See template
Benefits Cancellation Form
PDF template
Form for employees to cancel or modify health, dental, and life insurance benefits with Haverhill Public Schools.
See template
See template
Dental Insurance Plan
PDF template
Insurance plan detailing dental coverage eligibility for employees and their dependents at the University of Nebraska.
See template
See template
Benefits Enrollment Form
PDF template
A comprehensive form for employees to select and enroll in medical, dental, and optional insurance benefits
See template
See template
Discharge Form
PDF template
A form used to document and track patient discharge details for behavioral health clinical services.
See template
See template
Controlled Substances Biennial Inventory Form
PDF template
A mandatory federal form for documenting the inventory of controlled substances in a research or medical facility.
See template
See template
Billing 101 What You Need To Know
PDF template
A comprehensive guide addressing billing, reimbursement, and professional practice considerations for athletic trainers seeking third-party payor reimbursement.
See template
See template
We CanT Wait Act Of 2023
PDF template
A bill to allow disabled individuals to elect to receive disability insurance benefits during the mandatory waiting period.
See template
See template
We CanT Wait Act Of 2024
PDF template
A bill to permit disabled individuals to elect to receive disability insurance benefits during the waiting period.
See template
See template
Patient Intake Form
PDF template
Comprehensive medical form for collecting patient personal, contact, medical, and insurance information with consent authorization.
See template
See template
Release And Assumption Of Risk Form
PDF template
Legal document releasing the Bermuda Institute of Ocean Sciences from liability during scientific, research, or recreational activities.
See template
See template
New York State ComptrollerS Office Office Of Unclaimed Funds Claim Form
PDF template
A form for claiming unclaimed funds held by the New York State Office of Unclaimed Funds, requiring claimant and owner information.
See template
See template
Driver Agreement Form
PDF template
A form documenting driver responsibilities and information for university club sports team vehicle transportation.
See template
See template
Health Insurance Claim Form
PDF template
Comprehensive form for collecting patient medical insurance information, health coverage details, and claim submission details.
See template
See template
Blue Cross Blue Shield Insurance Claim Form
PDF template
A comprehensive medical insurance claim form for collecting patient and insurance information for medical service reimbursement.
See template
See template
Blue Cross Blue Shield Change Of Address Form
PDF template
A form for Blue Cross Blue Shield members to update their contact information and address details.
See template
See template
Member Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare service expenses to Anthem Blue Cross insurance.
See template
See template
Discharge Authority Form
PDF template
A form for processing loan discharge requests with detailed instructions and conditions for Bluestone Mortgages customers.
See template
See template
Blue View VisionSM Reimbursement Form
PDF template
A form for submitting out-of-network vision care service reimbursement claims to Blue View Vision insurance.
See template
See template
Exhibitor Appointed Contractor Form
PDF template
A form authorizing a non-official contractor to design, set up, and/or dismantle an exhibit at a trade show event with specific insurance requirements.
See template
See template
Exhibitor Appointed Contractor Form
PDF template
Form authorizing a non-official contractor to design, set up, or dismantle an exhibit at BOMA 2022 trade show event.
See template
See template
Bond Application (For Corporation Partnership)
PDF template
Application form for corporations and partnerships to request a surety bond from Pacific Union Insurance Company
See template
See template
Fidelity Bond Purchase Agreement
PDF template
A document for purchasing fidelity bond packages to assist ex-offenders and at-risk job applicants in securing employment through insurance coverage.
See template
See template
Termination Of Membership Form
PDF template
A form for members to officially resign from the Bonitas Medical Fund and terminate their medical scheme membership.
See template
See template
Booking Terms And Conditions
PDF template
Comprehensive booking terms and conditions for travel services outlining customer rights, obligations, and important travel guidelines.
See template
See template
BOOKING FORM
PDF template
Comprehensive booking form for travel expedition including personal, medical, and payment details
See template
See template
BOOKING CONTRACT FORM AAPI JAPAN AND SOUTH KOREA TOUR APRIL 07 20, 2024
PDF template
A comprehensive travel booking contract for a tour to Japan and South Korea with detailed traveler and insurance information.
See template
See template
Booking Form
PDF template
A comprehensive travel booking form and travel guidance document providing instructions for booking trips and essential travel preparation information
See template
See template
Booking Form
PDF template
A comprehensive guide for booking travel, including login instructions, passport requirements, and travel protection recommendations.
See template
See template
Pension Plan Benefit Application Form
PDF template
A comprehensive form for union members to apply for pension benefits, covering member information, reason for benefit request, and required certifications.
See template
See template
Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for equipment repair, documenting failure details, labor, and parts.
See template
See template
Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for replacement engine parts and related repair expenses.
See template
See template
Consent To Treat Form
PDF template
A medical form authorizing treatment, information release, and benefit assignment for medical services at a healthcare facility.
See template
See template
Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for Breckwell stove products, requiring detailed information about the stove, owner, and defective part.
See template
See template
Medi Cal To Healthy Families Bridging Consent Form
PDF template
A consent form allowing transfer of Medi-Cal case file information to the Healthy Families Program for low-cost health coverage for children.
See template
See template
Sales Order Form
PDF template
Order form for BIBA (British Insurance Brokers' Association) Broker Assess system license, capturing company and contact details for membership registration.
See template
See template
Sales Order Form
PDF template
Sales order form for purchasing BIBA Broker Assess licensing with staff pricing and contact details.
See template
See template
BTEC 255 Medical Billing Uniform Course Syllabus
PDF template
A comprehensive course syllabus for medical billing, covering procedures, professional skills, and insurance claim processing.
See template
See template
Building Rental Agreement
PDF template
Comprehensive rental agreement for utilizing the Nashville Dog Training Club facility, detailing rental fees, insurance requirements, and liability terms.
See template
See template
OVERSEAS TAVEL RISK ASSESSMENT FORM
PDF template
A comprehensive form for staff and students to assess risks associated with international travel to high-risk areas.
See template
See template
Aflac Dental Claim Form
PDF template
A claim form for submitting dental insurance details and patient information to Aflac.
See template
See template
Burglary Insurance Proposal Form
PDF template
An insurance proposal form detailing coverage, exceptions, and terms for burglary insurance by M & C General Insurance Company Ltd.
See template
See template
Business Entity Affiliation Cancellation Form 202C
PDF template
Official form for cancelling business entity licensee affiliations in New Mexico, used to notify the Office of Superintendent of Insurance about licensee terminations.
See template
See template
Standard Claim Form
PDF template
A formal document for filing claims for personal or property damages related to incidents involving the Boston Water and Sewer Commission.
See template
See template
Feedback Form
PDF template
A bilingual survey assessing individuals' understanding and intentions regarding health insurance coverage and preventive care services.
See template
See template
Property And Casualty Certificate Of Insurance Act
PDF template
Legal code defining rules and definitions for property and casualty insurance certificates in Utah, including scope, applicability, and key terms.
See template
See template
Accident Report Form
PDF template
A form for collecting comprehensive details about a vehicle accident for insurance claim purposes.
See template
See template
WEST VIRGINIA WESLEYAN COLLEGE CAFETERIA PLAN MEDICAL CARE EXPENSE CLAIM FORM
PDF template
A form for submitting medical expense reimbursement claims under a cafeteria plan with detailed certification and documentation requirements.
See template
See template
CAHC Provider Accreditation Application
PDF template
Application document outlining requirements for provider accreditation by CAHC, including legal authority, business registration, and compliance verification.
See template
See template
Service Request Form
PDF template
A comprehensive form for making changes to an insurance policy, including beneficiary updates, name changes, address changes, and coverage cancellation.
See template
See template
Member Reimbursement Claim Form
PDF template
Detailed instructions for submitting a medical reimbursement claim to an insurance provider with guidelines for documentation and submission process.
See template
See template
DIVER BOOKING FORM
PDF template
Comprehensive form for collecting diver personal information, experience details, travel insurance, and equipment rental preferences for a diving trip.
See template
See template
Cal OMS Administrative Discharge Form
PDF template
Administrative form for documenting client discharge from substance abuse treatment program with details on discharge status, drug use, and client information.
See template
See template
CalOMS Standard Discharge Form
PDF template
Standardized discharge documentation form for tracking substance use disorder treatment progression and referral status.
See template
See template
PatientS Information Form
PDF template
Comprehensive medical form for collecting patient personal, contact, insurance, and healthcare provider information.
See template
See template
Camp Dora Golding Medical Form
PDF template
A comprehensive medical form for parents to provide health and emergency contact information for children attending Camp Dora Golding.
See template
See template
University Of Arkansas Camps Insurance Form
PDF template
Form for calculating insurance charges for university camps based on participants and duration
See template
See template
Jewelry Warranty Claim Form
PDF template
A form for submitting warranty claims for jewelry items, including personal details, school information, and payment instructions.
See template
See template
Program Coverage Cancellation Request Form
PDF template
A form for requesting cancellation of various vehicle protection and service programs with refund details and contract termination acknowledgment.
See template
See template
Request To Cancel Coverage Form
PDF template
A form detailing reasons and documentation required for canceling health insurance coverage with specific qualifying events.
See template
See template
Miscellaneous Deductions And Insurances Cancellation Form
PDF template
Form for cancelling optional insurance plans and miscellaneous deductions not subject to pre-tax restrictions.
See template
See template
Cancer Claim Form
PDF template
Claim form for filing a cancer-related insurance claim with Aflac New York, requiring policyholder and patient details along with medical documentation.
See template
See template
CLAIM FORM AND INSTRUCTIONS
PDF template
A comprehensive insurance claim form for filing wellness exam benefits with instructions for submission and processing.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for customers to submit warranty claims for potential manufacturing defects of Candock products.
See template
See template
Prescription Drug Claim Form
PDF template
A comprehensive form for submitting prescription drug claims, including standard, compound, and Medicare-related prescriptions and test kits.
See template
See template
Billing Inquiry Form
PDF template
A form for patients to request fee waivers, reductions, or contest billing issues for healthcare services at CAPS (Counseling and Psychological Services).
See template
See template
Pre Authorisation Form Care
PDF template
A detailed medical insurance form for patients seeking cashless hospitalization, capturing personal, medical, and insurance details.
See template
See template
Mail Service Order Form
PDF template
A form for ordering prescriptions through mail service with health history and participant information collection.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims with detailed patient and insurance information requirements.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims to an insurance provider or healthcare plan.
See template
See template
Warranty Claim Form
PDF template
A comprehensive form for submitting product warranty claims for Carlisle Fluid Technologies equipment, detailing product failure and repair information.
See template
See template
Carrier Contact Form
PDF template
Form for collecting contact details and information for workers' compensation insurance carriers in Utah.
See template
See template
Adobe Customer Story Unum
PDF template
Case study highlighting how Unum improved customer service and document processing speed using electronic signatures and digital document management.
See template
See template
Instructions For Application To Sell UnitedHealthcare Products
PDF template
Comprehensive guide for agents and agencies seeking authorization to sell UnitedHealthcare insurance products and complete the appointment process.
See template
See template
WAIVER FORM
PDF template
A legal form allowing corporate officers, directors, general partners, and LLC managing members to opt out of workers' compensation insurance coverage in California.
See template
See template
Harford Mutual Insurance Group Agency Portal Terms Of Use
PDF template
Legal terms governing access and use of Harford Mutual Insurance Group's agency web portal for agents and users.
See template
See template
Medicare Advantage Plan Enrollment Form
PDF template
Enrollment form for MassHealth Standard members over 65 to join a Medicare Advantage Plan
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims detailing product information, customer details, and repair specifics.
See template
See template
Certificate Of Insurance
PDF template
Insurance documentation for residential contractors and remodelers in Minnesota, certifying general liability and property damage coverage.
See template
See template
Certificate Of Insurance Covering General Liability And Property Damage Liability Insurance Coverage
PDF template
Official document certifying insurance coverage for construction contractors in Minnesota, meeting state statutory requirements for liability insurance.
See template
See template
Covered California For Small Business Change Request Form For Employers
PDF template
A form for employers to request changes to their Covered California small business health insurance coverage, including ownership, address, and plan modifications.
See template
See template
Cottonwood Crossing Summer Institute Health Information Form
PDF template
A comprehensive medical form for student participation in summer institute activities, collecting health insurance, medical history, and emergency treatment authorization.
See template
See template
Personal Vehicle Travel Liability And Insurance Form
PDF template
A liability release form for students using personal vehicles for university-sponsored off-campus activities
See template
See template
CDPHP Co Pay Reimbursement Form
PDF template
Form for employees to submit medical co-pay expenses for reimbursement through Hudson Valley Community College's healthcare program.
See template
See template
Exhibitor Appointed Contractor Form
PDF template
Form for exhibitors to authorize independent contractors for services at Calgary Expo 2024, with specific requirements and restrictions.
See template
See template
PATIENT REGISTRATION MEDICAL HISTORY FORM
PDF template
Comprehensive medical registration form for patient intake, collecting personal, contact, and insurance information for medical services.
See template
See template
2017 SAFETY INCENTIVE PROGRAM
PDF template
A comprehensive safety program guide for insurance fund members focusing on workplace safety, health, and wellness efforts.
See template
See template
APPLICATION FOR DISABILITY BENEFIT
PDF template
Application form for disability benefits from the Central States, Southeast and Southwest Areas Pension Fund for eligible participants.
See template
See template
Certificate Of Insurance
PDF template
Insurance certification document required for obtaining a pesticide operator licence in Newfoundland and Labrador.
See template
See template
ContractorS, ArchitectS AndOr EngineerS Certificate Of Insurance Form
PDF template
A formal document certifying insurance coverage details for a construction or design project with multiple insurance companies.
See template
See template
Certificate Of Insurance Form For ContractorS Architects AndOr EngineerS
PDF template
A certificate of insurance detailing coverage for contractors, architects, and engineers for a specific project.
See template
See template
YOUR GROUP VOLUNTARY TERM LIFE BENEFITS
PDF template
Certificate describing voluntary term life insurance benefits for employees of University of the Incarnate Word
See template
See template
Certificate Of Liability Insurance
PDF template
A standard insurance document that provides information about liability insurance coverage without conferring specific rights to the certificate holder.
See template
See template
ContractorS Certificate Of Workers Compensation Insurance (Form 61A)
PDF template
A form for contractors to provide details about their workers' compensation insurance status and business information for compliance purposes in Virginia.
See template
See template
Vehicle Accident Report
PDF template
A comprehensive form for documenting details of a vehicle accident involving non-state-owned vehicles used in cooperative extension service activities.
See template
See template
Incident Report Form
PDF template
A comprehensive form for documenting injuries and incidents at CrossFit facilities, used for risk management and insurance purposes.
See template
See template
CG 20 40 12 19 Commercial General Liability Endorsement
PDF template
Insurance endorsement that automatically adds additional insureds for parties involved in construction contracts, specifically for completed operations liability.
See template
See template
Amendment Of Insured Contract Definition
PDF template
Insurance policy endorsement modifying the definition of 'insured contract' in a commercial general liability coverage part.
See template
See template
ElitePac General Liability Extension Endorsement
PDF template
A comprehensive summary of additional coverages and modifications for a commercial general liability insurance policy.
See template
See template
GROUP POLICY CHANGE FORM
PDF template
A form for employees to request changes to their group insurance policy details and dependent status.
See template
See template
Change Of Contractor Form
PDF template
Instructions and form for changing contractors on a building permit in Southwest Ranches, Florida, with requirements for licensing, insurance, and notification.
See template
See template
Checklist For Business Visa
PDF template
A comprehensive checklist of documents and requirements for obtaining a business visa for travel to Schengen countries.
See template
See template
Cherry Hill Counseling New Client Information Packet
PDF template
Comprehensive new client forms for mental health counseling services, including medical history, insurance, and privacy documentation.
See template
See template
Child Registration Form
PDF template
A comprehensive form for registering a child, collecting personal and insurance information for medical or childcare purposes.
See template
See template
Insurance FAQ
PDF template
Comprehensive overview of liability insurance coverage provided by the Sports Field Management Association (SFMA) for chapter officers, directors, and events.
See template
See template
Chromebook Optional Insurance Plan
PDF template
Optional insurance plan for Chromebooks at Dexter Community Schools, covering repair or replacement costs for students
See template
See template
Chronic Illness Benefit Application Form 2022
PDF template
Application form for Bankmed members on Essential and Basic Plans to apply for Chronic Illness Benefit coverage.
See template
See template
Chronic Illness Benefit Application Form
PDF template
An application form for patients seeking chronic illness benefits through the Glencore Medical Scheme, detailing submission requirements and contact information.
See template
See template
Remedi Medical Aid Scheme Application Form
PDF template
Application form for patients seeking medical aid coverage through Remedi Medical Aid Scheme, requiring patient and medical professional details.
See template
See template
Malcor Medical Aid Scheme Application Form
PDF template
An application form for joining the Malcor Medical Aid Scheme, requiring patient and medical details.
See template
See template
GreenlandAntarctica Travel Affidavit And Questionaire
PDF template
A comprehensive travel risk assessment and insurance document for individuals traveling to Greenland or Antarctica, requiring detailed travel and health information.
See template
See template
Non Employee IncidentAccident Report
PDF template
A form used to document details of non-employee incidents or accidents, capturing key information about the event, parties involved, and potential damages.
See template
See template
Cigna Claim Form (Rev. 72015)
PDF template
A comprehensive form for submitting healthcare service reimbursement claims with patient, provider, and payment information.
See template
See template
Cigna Dental Specialty Referral Form
PDF template
A referral form for specialty dental services under Cigna Dental Care, outlining payment guidelines and patient responsibilities.
See template
See template
Medical Claim Form
PDF template
Form for submitting medical claims for fellows, trainees, and patients seeking international health insurance reimbursement.
See template
See template
CIMERLI Solutions Enrollment Form
PDF template
Comprehensive enrollment form for healthcare services, insurance verification, and patient assistance programs offered by CIMERLI Solutions
See template
See template
PHILHEALTH CIRCULAR No. 2018 XXX
PDF template
Official guidelines for PhilHealth Accredited Collecting Agents on using the Electronic Collection Reporting System for premium contribution reporting and remittance.
See template
See template
Citizen Complaint Illicit Discharge Reporting Form
PDF template
A citizen-submitted form to report and document potential environmental contamination or unauthorized water discharge incidents.
See template
See template
Claim For Money Or Damages Against The City Of Moreno Valley
PDF template
A legal form for filing monetary claims or damages against the City of Moreno Valley, California.
See template
See template
Employability Assessment Form (PA 1663)
PDF template
A comprehensive guide for healthcare providers on completing the Pennsylvania Medicaid Employability Assessment Form to verify patient health conditions and disability status.
See template
See template
BENEFICIARY CONTACT FORM
PDF template
A comprehensive form for collecting contact and demographic information about Medicare beneficiaries and their representatives.
See template
See template
MEDICAL EXPENSE CLAIM
PDF template
Form for filing medical expense claims with Blue Cross and Blue Shield of Alabama when a healthcare provider does not file a claim directly.
See template
See template
Claims Adjustments And Project Form
PDF template
A form for healthcare providers to request claims adjustments, retractions, or resolution of billing issues with WellSense Health Plan.
See template
See template
ClaimantS Affidavit Form
PDF template
Affidavit for claiming life insurance benefits, used to collect claimant and insured information for processing a life insurance claim.
See template
See template
Death Claim Discharge Form
PDF template
A discharge form for claiming death benefits from SBI Life Insurance Company, documenting claim details and financial settlement.
See template
See template
Virginia Workers Compensation Commission Claim Form
PDF template
Official form for filing a workers' compensation claim in Virginia, documenting workplace injury details and requesting benefits.
See template
See template
City Of Lawrence Claim Form
PDF template
A legal form for submitting claims for property damage or personal injury against the City of Lawrence, Kansas.
See template
See template
Claim Form
PDF template
Official form for filing a claim against a public entity, detailing incident, damages, and claimant information.
See template
See template
CIEE Claim Form
PDF template
A comprehensive medical claim form for student health insurance reimbursement and documentation of medical conditions or treatments.
See template
See template
Claim Form
PDF template
Official form for claiming abandoned property through the Mississippi State Treasurer's Office Unclaimed Property Division.
See template
See template
Prescription Claim Form
PDF template
A form for submitting prescription reimbursement claims under a Medicare Part D manufacturer patient assistance program
See template
See template
Dental Insurance Claim Form
PDF template
Insurance claim form for submitting dental treatment and patient information for reimbursement or coverage verification.
See template
See template
Frame Replacement Claim Form
PDF template
Claim form for Toyota vehicle owners who paid out-of-pocket for frame replacement on specific Toyota models between 2005-2010 due to rust perforation.
See template
See template
Student Insurance Claim Form
PDF template
Insurance claim form for students to report medical examinations, illnesses, prescriptions, or injuries for insurance coverage.
See template
See template
Claim Form Finder And User Guide
PDF template
Comprehensive guide to help healthcare providers select the appropriate claim form for various submission scenarios and corrections.
See template
See template
Claim Form Finder
PDF template
Comprehensive guide for healthcare providers detailing claim modification forms and processes for Neighborhood Health Plan of Rhode Island.
See template
See template
Details Of Hospital Claim Form Part B
PDF template
A comprehensive medical claim form for documenting patient hospital admission, treatment, and insurance claim details.
See template
See template
National Grid Claim Form
PDF template
Claims form for reporting property damage or personal injury related to National Grid services.
See template
See template
Claim Form ICS Non Medical Expenses
PDF template
A comprehensive claim form for reporting non-medical insurance damages across multiple insurance types including household contents, travel/baggage, liability, and extra costs.
See template
See template
PRADHAN MANTRI SURAKSHA BIMA YOJANA (PMSBY) CLAIM CUM DISCHARGE FORM
PDF template
Official claim form for submitting accidental disability or death claims under the Pradhan Mantri Suraksha Bima Yojana insurance scheme.
See template
See template
Claim Form
PDF template
Official document for filing property damage or personal injury claims with the City of Waterbury municipal government.
See template
See template
VSP Member Reimbursement Form
PDF template
A form for VSP vision care members to request reimbursement for vision-related services and expenses.
See template
See template
Claim Inquiry Form
PDF template
A form for healthcare providers to submit claim-related inquiries to Carelon Behavioral Health regarding claim status, denials, or clarifications.
See template
See template
Retiree Claim For Reimbursement
PDF template
A form for retirees to submit healthcare expense reimbursement claims through their health reimbursement arrangement (HRA)
See template
See template
MVP Health Care Claim Reimbursement Form
PDF template
Detailed instructions for MVP Health Care members to submit medical and dental expense reimbursement claims with required documentation.
See template
See template
Claims Reporting Reference Guide
PDF template
A comprehensive guide for reporting and managing various types of insurance claims across different coverage areas.
See template
See template
Certificate Of Insurance And Claims History FAQ
PDF template
Frequently asked questions about obtaining certificates of insurance and claims history from Rush, covering procedures, requirements, and limitations.
See template
See template
CLAIM FORM
PDF template
A comprehensive form for reporting property damage or personal injury claims related to National Grid services or incidents.
See template
See template
Member Reimbursement Form For Medical Claims
PDF template
A form for patients to submit medical claims for reimbursement, detailing patient, subscriber, and provider information.
See template
See template
MOTOR WINDSCREEN AND WINDOW GLASS DAMAGE REPORT FORM
PDF template
Insurance claim form for reporting windscreen and window glass damage to a vehicle under Lion of Kenya Insurance Company's policy.
See template
See template
Revised Claims Inquiry Form Process
PDF template
Guidelines for healthcare providers to submit and resolve claim payment disputes with Partnership HealthPlan of California.
See template
See template
Claim Procedure Note
PDF template
A detailed guide explaining the process for obtaining cashless medical insurance claims through a network hospital and third-party administrator.
See template
See template
Claims Reimbursement Form
PDF template
A comprehensive form for submitting medical claims for reimbursement, used by patients or healthcare providers to request payment for medical services.
See template
See template
Claims Reporting Reference Guide
PDF template
A comprehensive guide for reporting insurance claims across multiple coverage types and managing workplace incidents
See template
See template
County Of Ventura Claim For Damages Form
PDF template
Detailed instructions for filing a claim for damages with Ventura County, outlining the required steps and information for submission.
See template
See template
MDHS CLAIM SUPPORT FORM (COST REIMBURSEMENT) PAYMENT TYPE
PDF template
A form used by subgrantees to report monthly costs incurred and request funds on a cost reimbursement basis.
See template
See template
PacificSource Enrollment Application
PDF template
A comprehensive group health insurance enrollment form for employees and their dependents to select medical and dental coverage.
See template
See template
Patient Information Form
PDF template
Comprehensive patient intake form collecting personal, contact, medical, and insurance information for dermatology services.
See template
See template
Cancer Claim Form
PDF template
Comprehensive form for filing cancer-related insurance claims, detailing required documentation and submission instructions.
See template
See template
BENEFICIARY CONTACT FORM
PDF template
A form for collecting contact and demographic information for Medicare beneficiaries and their representatives during counseling sessions.
See template
See template
Client Insurance Form
PDF template
Insurance form for collecting client insurance information and authorizing claims submission and payment
See template
See template
Client Endorsement Request Form
PDF template
A form for customers to request changes to their existing insurance policy with Colwood Insurance Services.
See template
See template
Behavioral Health Discharge Clinical Form
PDF template
A clinical form for documenting patient discharge details from behavioral health treatment, including care level, residence, and follow-up appointments.
See template
See template
PATIENT DISCHARGE PROTOCOL
PDF template
Comprehensive protocol for veterinary patient discharge, covering communication with client, medical record review, medication instructions, and post-surgical care guidance.
See template
See template
CLAIM FOR INJURY OR DEATH
PDF template
A legal form for filing claims related to personal injury or death involving federal agencies, specifically for the Camp Lejeune Claims Unit.
See template
See template
Club Sports Informed Consent Form
PDF template
A legal consent and liability release form for students participating in club sports at Connecticut College, acknowledging risks and insurance responsibilities.
See template
See template
Funeral Home Claim Form
PDF template
A claim form for processing funeral service insurance benefits with detailed documentation requirements.
See template
See template
CM 600 WEB Claim Form
PDF template
Insurance claim form for processing death benefits from American Memorial Life Insurance Company or Union Security Insurance Company.
See template
See template
HEALTH INSURANCE CLAIM FORM
PDF template
Standard medical insurance form for submitting healthcare claims and patient information for reimbursement purposes.
See template
See template
Health Insurance Claim Form
PDF template
Official form for submitting medical insurance claims and capturing patient and insured party information.
See template
See template
Medicare Redetermination Request Form 1st Level Of Appeal
PDF template
Official form for Medicare beneficiaries to request a first-level appeal of a Medicare claim determination.
See template
See template
Medicare Reconsideration Request Form 2nd Level Of Appeal
PDF template
A form for Medicare beneficiaries or providers to request a second-level appeal of a Medicare claim determination.
See template
See template
Privacy Impact Assessment Benefits Coordination And Recovery Center
PDF template
Privacy impact assessment documenting the data collection and processing system for Medicare benefits coordination and recovery processes.
See template
See template
Form CMS L564R297 (0923) Request For Employment Information
PDF template
A form used to verify group health plan coverage for Medicare special enrollment based on current employment.
See template
See template
CMS Model Consent Form For Marketplace Agents And Brokers
PDF template
A model consent form for documenting consumer permission for health insurance agents or brokers to assist with marketplace coverage enrollment.
See template
See template
CMS Model Consent Form For Marketplace Agents And Brokers
PDF template
A model consent form for documenting consumer permission for health insurance agents or brokers to assist with Marketplace coverage enrollment.
See template
See template
HIRER COLLISION Or DAMAGE REPORT FORM
PDF template
A comprehensive form for documenting details of a vehicle rental accident, including renter, driver, vehicle, and incident information.
See template
See template
BOOKING FORM
PDF template
Travel booking form for collecting passenger details and holiday reservation information
See template
See template
COBRADirect Billing Participant Use ONLY ACH Agreement Form
PDF template
Form for authorizing automatic health insurance premium payments via bank account deduction.
See template
See template
Referral Form
PDF template
A form for healthcare providers to request patient referrals and provide medical background information.
See template
See template
Election To Fellowship Application Form
PDF template
Application form for professionals seeking fellowship status with the Chartered Insurance Institute (CII)
See template
See template
Employee Flexible Spending Account (FSA) Enrollment Form
PDF template
Form for employees to enroll in Flexible Spending Account (FSA) options for healthcare and dependent care expenses.
See template
See template
Account Information Tax Advantage Wellness Programs
PDF template
Form for establishing a new account for Tax Advantage Wellness Programs with Colonial Life insurance services.
See template
See template
Insurance Claim Processing Instructions
PDF template
Instructions for submitting an insurance claim, including required documentation and processing details for Colonial Life & Accident Insurance Company.
See template
See template
General Service Provider Data Sharing And Confidentiality Agreement
PDF template
Agreement establishing terms for data sharing and confidentiality between Colonial Life Insurance and a service provider for insurance administration services.
See template
See template
Application For Policy Changes Part 1
PDF template
Insurance policy form for requesting changes such as cash surrender, partial withdrawal, and policy modifications.
See template
See template
AFI PRE AUTHORIZATION FORM FOR HOSPITALIZATION FROM PANEL NON PANEL HOSPITALS
PDF template
A form for obtaining pre-authorization for hospitalization from panel and non-panel hospitals for insurance coverage.
See template
See template
NEW PATIENT REGISTRATION FORM
PDF template
Comprehensive form for new patient medical registration, including personal information, medical history, insurance details, and a physician-patient arbitration agreement.
See template
See template
WARRANTY CLAIM FORM
PDF template
Form for submitting warranty claims for Comet products with details about product failure and parts replacement.
See template
See template
ComfortStar Warranty Claim Form
PDF template
A detailed warranty claim form for reporting and requesting compensation for defective HVAC equipment and parts.
See template
See template
Notice Of Proposed Information Collection Requests Discharge Application Total And Permanent Disab
PDF template
National Consumer Law Center's commentary on proposed changes to student loan total and permanent disability discharge application form
See template
See template
CGL CERTIFICATE OF INSURANCE
PDF template
Official insurance certificate documenting commercial general liability coverage for an insured party with the City of Vancouver
See template
See template
Loss Or Damage Report Form Commercial
PDF template
Insurance claim form for reporting commercial property loss or damage incidents with comprehensive details about the incident and policyholder.
See template
See template
Commercial Surety Bond Application
PDF template
A comprehensive application form for obtaining a commercial surety bond from Lexington National Insurance Corporation, collecting business and personal financial information.
See template
See template
Commission Inquiry Form
PDF template
Form for agents to submit inquiries about commission payments for L.A. Care Covered health insurance policies.
See template
See template
NAIC Enterprise Risk Report (Form F) Implementation Guide
PDF template
A guide for preparing and reviewing annual enterprise risk reports for insurance holding company systems as part of NAIC accreditation requirements.
See template
See template
COMPANY MOTOR PROPOSAL FORM
PDF template
Insurance proposal form for company vehicle coverage detailing vehicle ownership, use, and driver information.
See template
See template
Comparable Coverage Premium Certification
PDF template
Certification document for insurers offering renewal policies to Texas Windstorm Insurance Association policyholders, detailing coverage and premium requirements.
See template
See template
Compatriot Death Report Form
PDF template
A form used to report the death of members in a society or organization, with space for multiple death reports.
See template
See template
Complaint Form
PDF template
A detailed form for submitting complaints about insurance companies and policy-related issues in Washington state.
See template
See template
Consumer Complaint Form
PDF template
Official form for filing insurance-related complaints with the Nevada Division of Insurance
See template
See template
ComplaintInquiry Form
PDF template
Official form for filing insurance-related complaints or inquiries with the State of Hawaii Insurance Division.
See template
See template
COMPLAINT RESOLUTION FORM
PDF template
A form for customers to submit and document complaints or service issues with Takaful Emarat.
See template
See template
Affordable Care Act ACA Compliance Form Filing Submission Worksheet
PDF template
A comprehensive worksheet for insurance providers to submit compliance documentation for ACA-related insurance products and services.
See template
See template
IEEE AP SUSNC URSI 2024 EXHIBITORS COMPULSORY INSURANCE FORM
PDF template
Mandatory insurance form for exhibitors at the IEEE AP-S/USNC URSI 2024 conference, detailing insurance coverage requirements and policies.
See template
See template
CONSENT INSURANCE FORM
PDF template
A comprehensive form for collecting medical insurance and consent information for a cadet or applicant, including parent/guardian details and insurance policy information.
See template
See template
Parental Consent Form
PDF template
Parental consent and liability waiver form for participation in hockey school activities, including insurance and concussion acknowledgment.
See template
See template
Authorization For Medical Treatment Of Child
PDF template
A form allowing school representatives to consent to medical treatment for a student when parents cannot be reached during an emergency.
See template
See template
Authorization For Medical Treatment Agreement
PDF template
A legal document authorizing medical treatment and insurance payment for elder care services at Horizon Internal Medicine.
See template
See template
USA Hockey National Championships Consent To TreatMedical History Form
PDF template
A comprehensive medical history and consent to treat form for USA Hockey participants, covering emergency contact, medical history, and insurance information.
See template
See template
Authorization Informed Consent
PDF template
Consent form for behavioral health services covering patient authorization, medical record release, and payment agreements.
See template
See template
Consentimiento Para Recibir Tratamiento, Cesin De Beneficios Y Garanta De Pago
PDF template
A Spanish-language medical consent and insurance benefits assignment form for Northwell Health Dental Medicine patients.
See template
See template
USA Hockey National Championships Consent To TreatMedical History Form
PDF template
Medical consent and history form for USA Hockey participants, allowing medical treatment and collecting health information for emergency purposes.
See template
See template
Consent To Treat Form
PDF template
A legal document allowing medical treatment for patients, including consent for minors and adults, insurance filing, and patient rights.
See template
See template
Consent To Treat Form
PDF template
A medical consent form allowing treatment authorization and insurance filing by a healthcare provider.
See template
See template
Amendment Proposal Form
PDF template
A form for proposing amendments to VM-00 Exposure Draft related to principle-based valuation reserve requirements.
See template
See template
Individual Products Independent Contractor Form
PDF template
Form for adding or updating independent insurance agents as 1099 contractors for a contracted agency
See template
See template
NAIC Funded Consumer Representative Travel Expense Reimbursement Policy
PDF template
Policy detailing travel expense reimbursement procedures for NAIC consumer representatives attending national and interim meetings.
See template
See template
2024 NAIC Funded Consumer Representative Travel Expense Reimbursement Policy
PDF template
Guidelines for reimbursing NAIC consumer representatives' travel expenses for national and interim meetings, with up to $5,500 allocated per representative in 2024.
See template
See template
Contact Information And Medical Form
PDF template
A comprehensive medical form collecting participant's personal information, emergency contacts, medical history, and health conditions for University of Maine at Presque Isle program participation.
See template
See template
What Forms Are Required To Process A Contract
PDF template
Comprehensive guide detailing documentation and procedural requirements for contract processing based on contract value thresholds.
See template
See template
Contracted Agreement
PDF template
A contractual agreement outlining patient responsibilities, payment terms, and cancellation policies for healthcare services.
See template
See template
Contractor Frequently Asked Questions
PDF template
Comprehensive overview of contractor licensing requirements and regulations in Hawaii, covering license application process, exemptions, and legal guidelines.
See template
See template
Building Permit Application
PDF template
A document for contractors to apply for a building permit, detailing contractor information and workers' compensation insurance requirements.
See template
See template
Diversity Management System (DMS) Submission Documentation
PDF template
A detailed tracking document for contractor submissions, insurance requirements, and project documentation across federal and state projects.
See template
See template
Contract Request Form (CRF)
PDF template
Form for healthcare providers to request a contract and credentialing with Molina Healthcare
See template
See template
Contract Types And Required Documents
PDF template
Comprehensive guide outlining document requirements for different types of consultant agreements and contracts.
See template
See template
Annual Controlled Substance Inventory Form
PDF template
A form for tracking and documenting annual physical inventory of controlled substances as required by state and federal regulations.
See template
See template
CONTROLLED SUBSTANCES INITIALBIENNIAL INVENTORY FORM
PDF template
Official form for documenting physical inventory of controlled substances as required by DEA regulations every two years.
See template
See template
Request For Group Life Conversion Materials
PDF template
Form for obtaining individual life insurance policy after group coverage cessation or reduction
See template
See template
ING Premier Disability Cancellation Form
PDF template
A form for employees to cancel their ING Premier Short Term Disability insurance policy and associated payroll premium deduction.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty repair claims for ice machine repairs and refrigeration services.
See template
See template
Certificate Of Trust
PDF template
A document used to establish or update trust insurance and annuity policy ownership with Pacific Guardian Life insurance company.
See template
See template
Unclaimed Property Holder Claim Form
PDF template
Form for holders to claim and return unclaimed property to rightful owners in Maryland.
See template
See template
Request For Court Ordered Discharge
PDF template
Instructions for defendants seeking a court-ordered discharge of a small claims judgment lien in New Hampshire.
See template
See template
COVID 19 OTC Test Reimbursement Form
PDF template
Form for submitting reimbursement claims for personally purchased FDA-approved COVID-19 over-the-counter tests.
See template
See template
COVID Vaccine Patient Intake Form 2021
PDF template
Patient intake form for COVID-19 vaccination at Stauffer's Drug Store and Stauffer's LTC Pharmacy, collecting patient information and insurance details.
See template
See template
Work Comp MVA Patient Intake Form
PDF template
Comprehensive medical intake form for documenting patient information, injury details, and insurance details for workers' compensation and motor vehicle accident claims.
See template
See template
Driver Proof Of Insurance Form
PDF template
Form for volunteer drivers to document and verify current automobile insurance coverage for Catholic Pro-Life Committee activities.
See template
See template
Special Application For Search Of Military Discharge Form (DD214)
PDF template
A specialized application for obtaining military discharge documents with strict eligibility and privacy requirements.
See template
See template
Credit Card Authorization Form
PDF template
A form allowing Tranquility Psychiatry and Counseling Services to keep a credit card on file for service payments and outstanding balances.
See template
See template
Optional Credit Insurance Form
PDF template
Insurance disclosure document explaining optional credit life and accident insurance options for loan borrowers.
See template
See template
Instructions For Credit Life And Health Insurance Experience Reports
PDF template
Detailed instructions for insurance carriers to submit statistical reports on credit life and health insurance cases in Maryland.
See template
See template
CRESEMBA Support Solutions Enrollment Form
PDF template
A comprehensive enrollment form for patients seeking support and prescription assistance for CRESEMBA medication through Astellas Patient Assistance Program.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for machinery purchased from Crommelins Machinery, detailing product information and repair details.
See template
See template
WARRANTY CLAIM FORM
PDF template
A product warranty claim form for submitting repair and replacement details for machinery purchased from Crommelins.
See template
See template
WARRANTY CLAIM FORM V19r1
PDF template
Official form for submitting warranty claims for Cruz products, requiring personal and product information for processing.
See template
See template
Initial Controlled Substances Inventory Form
PDF template
A form for documenting initial physical inventory of controlled substances in compliance with DEA regulations.
See template
See template
CSA DISCHARGE FORM
PDF template
Form for documenting the discharge of a client from CSA-funded services, including service outcomes and last date of service.
See template
See template
CSI Warranty Claim Form
PDF template
A form for documenting and submitting warranty claims for equipment repairs and service
See template
See template
Controlled Substances Procedure
PDF template
Procedure for managing and handling controlled substances at Boise State University in compliance with state and federal regulations.
See template
See template
Certificate (Policy) Service Request Form
PDF template
A form for requesting various insurance contract services such as withdrawal, surrender, ownership assignment, or duplicate contract issuance.
See template
See template
Flight Attendant Optional Short Term Disability (OSTD)
PDF template
An optional short-term disability insurance program for flight attendants that provides income protection during periods of disability between paid sick time and long-term disability benefits.
See template
See template
Grace Period Extension Agreement
PDF template
An agreement allowing insurance customers additional time to pay premiums during the COVID-19 pandemic without plan termination.
See template
See template
SHORT TERM DISABILITY CLAIM FORM
PDF template
Form for employees to file a claim for short-term disability benefits, including personal and employment details.
See template
See template
Certification Course CMBP Designation
PDF template
A comprehensive training program covering medical billing fundamentals, insurance types, claims processing, and medical office forms.
See template
See template
Custom EnrollmentApplication Certification Instructions
PDF template
A compliance checklist for customized enrollment forms to ensure regulatory requirements are met before submission.
See template
See template
Custom EnrollmentApplication Certification Instructions
PDF template
Instructions and checklist for ensuring compliance of customized enrollment forms prior to submission to regulatory authorities.
See template
See template
Customer Accessibility Feedback Form
PDF template
A form designed to collect customer feedback about service accessibility and satisfaction at Heartland Farm Mutual Insurance Inc.
See template
See template
Prescription Claim Form
PDF template
A form for submitting prescription reimbursement claims under a Medicare Part D manufacturer patient assistance program.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims, including patient and pharmacy information, insurance details, and claim reasons.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims, used to process pharmacy expense reimbursements.
See template
See template
CVS Caremark Prescription Benefits Guide
PDF template
A guide providing six strategies for saving money and time on prescription medications through CVS Caremark's pharmacy benefits program.
See template
See template
Careworks TX HCN Formal Complaint Form
PDF template
A formal complaint submission form for issues related to healthcare network services or claims.
See template
See template
Patient Registration Form
PDF template
A comprehensive medical intake form for collecting patient personal and insurance details for healthcare services.
See template
See template
General Consent For Treatment
PDF template
A consent form allowing medical treatment for minor patients at The C. W. Williams Community Health Center, including medical and dental procedures.
See template
See template
MODEL INDIVIDUAL ENROLLMENT REQUEST FORM TO ENROLL IN A MEDICARE ADVANTAGE PLAN (PART C)
PDF template
Official form for individuals with Medicare who want to enroll in a Medicare Advantage Plan, outlining eligibility and enrollment periods.
See template
See template
MOTOR ACCIDENT REPORT FORM
PDF template
Comprehensive form for reporting motor vehicle accidents, documenting incident details, vehicle information, and driver statements.
See template
See template
STATE OF LOUISIANA DRIVER AUTHORIZATION FORM
PDF template
Official form for authorizing state employees to drive vehicles on state business and documenting driving credentials and insurance compliance.
See template
See template
Levant Warranty Claim Form
PDF template
Warranty claim documentation for Levant product installation, allowing customers to submit details about product issues and project information.
See template
See template
MEMBER REIMBURSEMENT DENTAL CLAIM FORM
PDF template
A form for members to request reimbursement for out-of-network dental services from their insurance provider.
See template
See template
Claim Form
PDF template
A formal document for filing claims against Desert Community College District for damages, injuries, or property losses
See template
See template
Damage Report Form
PDF template
A form for reporting and documenting insurance damage claims with contact and incident details.
See template
See template
Damage Report Form
PDF template
A detailed form documenting damage incidents at a cemetery, including damage details, witnesses, police reports, and potential insurance claims.
See template
See template
Damage Report Form
PDF template
A form documenting damage to cemetery property, stones, or monuments, including details of the incident and potential repair process.
See template
See template
DocuSign Analyzer Datasheet
PDF template
An AI-driven tool that helps organizations analyze, negotiate, and review incoming agreements more efficiently by extracting key terms and generating risk scorecards.
See template
See template
DaVan Co. 1 Year Limited Warranty Claim
PDF template
A form for customers to submit warranty claims for DaVan Co. products within the 1-year limited warranty period.
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for requesting reimbursement from Davis Vision for out-of-network vision services and eyewear expenses.
See template
See template
Order Davis V. State Farm Life Insurance Company
PDF template
Legal document detailing a court ruling on a motion for judgment regarding a life insurance policy ownership and beneficiary dispute between Debra J. Davis and State Farm Life Insurance Company.
See template
See template
DB 450 Notice And Proof Of Claim For Disability Benefits
PDF template
Instructions for filing a disability benefits claim in New York State, detailing submission requirements and process for employees and recently unemployed individuals.
See template
See template
Client Interview Form Defense Base Act
PDF template
A comprehensive form for collecting client information related to workplace injuries under the Defense Base Act
See template
See template
New York State Disability Benefits Rights Statement
PDF template
Informational document outlining disability benefits rights for employees in New York State under Section 229 of the Disability and Paid Family Leave Benefits Law.
See template
See template
DC 54 Complaint Form
PDF template
Instructional guide for filing a complaint related to Temporary Disability Insurance or Prepaid Healthcare issues in Hawaii.
See template
See template
WARRANTY CLAIM FORM
PDF template
A comprehensive form for customers to submit warranty claims for Diamond C trailers, detailing issues and requesting repair approvals.
See template
See template
APPLICATION FOR CERTIFIED COPY OF MILITARY DISCHARGE (FORM DD 214)
PDF template
Application form for obtaining a certified copy of a military discharge document (DD-214) by authorized individuals.
See template
See template
DD FORM 2876 3, TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM
PDF template
Official Department of Defense form for enrolling, disenrolling, or changing primary care managers in the TRICARE Prime healthcare program.
See template
See template
DD FORM 2876 TRICARE PRIME ENROLLMENT, DISENROLLMENT, AND PRIMARY CARE MANAGER (PCM) CHANGE FORM
PDF template
A Department of Defense form for enrolling, disenrolling, or changing primary care managers in the TRICARE Prime healthcare program.
See template
See template
Delta Dental Of Colorado Enrollment Form
PDF template
Form for enrolling in Delta Dental insurance coverage, including employee and dependent information.
See template
See template
Delta Dental Enrollment Form
PDF template
Enrollment form for obtaining dental insurance coverage through Delta Dental of Massachusetts
See template
See template
Claim For Disability Insurance (DI) Benefits
PDF template
Authorization form for releasing medical information to process a disability insurance claim with the California Employment Development Department (EDD).
See template
See template
DEA Order Form 222
PDF template
Official form for ordering Schedule I and II controlled substances from authorized suppliers, requiring detailed tracking and record-keeping.
See template
See template
DEA Biennial Controlled Substance Inventory Form
PDF template
Official DEA form for documenting and tracking controlled substances used in research settings, requiring detailed inventory information.
See template
See template
DEA Controlled Substance Inventory Form
PDF template
Form for documenting and tracking controlled substance inventory as required by DEA regulations for licensed facilities.
See template
See template
Application For Life AndOr Critical Illness Insurance
PDF template
Notification about a new insurance application form version and submission requirements for Equitable Life insurance advisors.
See template
See template
Power Of Attorney Form
PDF template
Legal document authorizing an attorney-in-fact to execute controlled substance order forms and electronic orders under federal regulations.
See template
See template
DEATH BENEFIT APPLICATION FORM
PDF template
A form for processing retirement and terminal benefits for deceased retirement savings account (RSA) holders and their next of kin.
See template
See template
Death Benefit Application Form
PDF template
A form for Fiji Bank & Finance Sector Employees Union members to apply for death benefits for themselves or eligible family members.
See template
See template
Claim Form For Life Insurance Proceeds
PDF template
A claim form for beneficiaries to submit after the death of an insured individual to receive life insurance proceeds from New York Life Insurance Company.
See template
See template
DECA ICDC 2023 Registration Guide
PDF template
Official registration and permission form for DECA conference attendance, including medical authorization and conduct agreement.
See template
See template
Decrease Election Form For Supplemental Life Insurance
PDF template
A form for active state employees to reduce their supplemental life insurance coverage in prescribed increments.
See template
See template
Payroll Deduction Cancellation Form
PDF template
Form for employees to cancel various payroll deductions for insurance, benefits, and voluntary contributions.
See template
See template
Specialty Care Referral Form
PDF template
A form for referring patients to dental specialists with patient, enrollee, and referral details.
See template
See template
Dental Claim Form
PDF template
A standardized form for submitting dental treatment and insurance claim information to Delta Dental of Illinois.
See template
See template
Dental Claim Form
PDF template
A standardized form for submitting dental insurance claims, tracking patient treatment, and requesting predetermination or preauthorization.
See template
See template
Delta Dental EnrollmentChange Form
PDF template
A comprehensive form for enrolling in or modifying dental insurance coverage with Delta Dental plans
See template
See template
Delta Dental Of Minnesota Membership Enrollment Form
PDF template
Membership enrollment form for Delta Dental insurance coverage, allowing employees to select dental plan options and enroll dependents.
See template
See template
ENROLLMENT FORM
PDF template
Dental insurance enrollment form for University of Tennessee Health Science Center (UTHSC) student plan.
See template
See template
Demand For Documents Letter
PDF template
A letter requesting legal documentation, potentially related to debt collection or insurance matters, with guidance on proper letter composition and legal considerations.
See template
See template
Patient Intake Form
PDF template
Comprehensive patient registration form collecting personal, contact, and insurance information for medical practice.
See template
See template
Demographics And Insurance Form Surgery Registration
PDF template
Comprehensive patient intake form for surgical procedures, collecting patient demographics, insurance, and medical contact information.
See template
See template
Dental Claim Form
PDF template
Standard form for submitting dental treatment and insurance claim details for reimbursement or predetermination.
See template
See template
ADA Dental Claim Form Instructions
PDF template
Comprehensive instructions for completing the ADA Dental Claim Form, including general instructions, coordination of benefits, and National Provider Identifier requirements.
See template
See template
Delta Dental Of Wisconsin EnrollmentChangeWaiver Form Dental
PDF template
A form for enrolling in, changing, or waiving dental insurance coverage through an employer's group plan with Delta Dental of Wisconsin.
See template
See template
COBRA Dental Insurance EnrollmentWaiver Form
PDF template
A form for employees to enroll in or waive dental insurance coverage, with options for adding or dropping dependent coverage under COBRA.
See template
See template
Dental Insurance EnrollmentWaiver Form
PDF template
A comprehensive form for employees to enroll or waive dental insurance coverage, including personal and dependent information.
See template
See template
Employee Enrollment Form
PDF template
Comprehensive form for employee insurance enrollment with personal information and coverage details.
See template
See template
Dental Examination Waiver Form
PDF template
A form for parents/guardians to request a waiver from required dental examination for school-enrolled children in Illinois.
See template
See template
Dental Insurance EnrollmentChange Form
PDF template
A form for employees to enroll in or modify dental insurance coverage, including dependent information and policy details.
See template
See template
Dental Insurance Form
PDF template
A comprehensive form for collecting patient and insurance details for dental insurance claims.
See template
See template
Dental Waiver Form
PDF template
A form allowing civil service staff to waive enrollment in Genesee Community College's group dental insurance plan.
See template
See template
Dental Claim Form
PDF template
A comprehensive form for filing dental insurance claims, collecting patient and insurance information.
See template
See template
DentalVision Enrollment Form
PDF template
Detailed guide for completing a dental and vision insurance enrollment form with step-by-step instructions.
See template
See template
Patient Referral Form
PDF template
A comprehensive medical and dental referral form for patient intake and specialist consultation at Boston Children's Hospital dental services.
See template
See template
DepartureTransfer Out CHECKLIST
PDF template
A comprehensive checklist for international students preparing to leave their current location, covering health insurance, student accounts, housing, and financial matters.
See template
See template
DependantS Pension Application Form
PDF template
A form for Nestl European Pension Fund members to nominate a financial dependent to receive pension benefits in the event of the member's death.
See template
See template
Dependent Audit Form
PDF template
A form for employees to verify and update dependent insurance coverage information and personal details.
See template
See template
Designation Of Beneficiary And Emergency Contact Form
PDF template
A form for designating beneficiaries and emergency contacts for funds owed by the International Atomic Energy Agency (IAEA)
See template
See template
2022 Construction General Permit Dewatering Inspection Report
PDF template
A detailed inspection report for documenting dewatering discharges and environmental compliance under the Construction General Permit.
See template
See template
Warranty Claim Form
PDF template
A form for customers to submit warranty claims for Dexter Axle trailer components, documenting product details and service issues.
See template
See template
Residential Child Care Discharge Form
PDF template
A form used by residential child care providers to request removal of a child from a current placement with Child Protective Services.
See template
See template
FEMME PHYSIOCARE PATIENT INTAKE FORM
PDF template
Comprehensive patient intake form for physiotherapy services with personal information, insurance, and consent sections.
See template
See template
UDENYCA Solutions Enrollment Form
PDF template
Enrollment form for patients seeking information about UDENYCA medication and insurance verification services.
See template
See template
Liability And Insurance Form Instructions
PDF template
Comprehensive instructions for electronically filling out and submitting a liability and insurance form across different devices and platforms.
See template
See template
Molina Healthcare Of California Direct Referral To Specialist
PDF template
A referral form for Molina Healthcare members to receive specialized medical services within their network of contracted specialists.
See template
See template
DIS 101C V7 EMPLOYEE STATEMENT DISABILITY CLAIM FORM
PDF template
A comprehensive form for employees to file a disability claim for short-term or long-term disability benefits.
See template
See template
SUPPLEMENTAL DISABILITY CLAIM FORM
PDF template
Claim form for submitting a disability benefit request for IUOE Local 132 Health and Welfare Fund participants
See template
See template
Group Disability Claim Filing Instructions
PDF template
Instructions for filing a disability insurance claim with American Fidelity Assurance Company, detailing the required steps and documentation.
See template
See template
Disability Health Welfare Hours Claim Form
PDF template
A form for carpenters to claim disability health and welfare hours due to illness or injury, requiring participant and physician statements.
See template
See template
Disability Coverage Claim Form
PDF template
Insurance claim form for filing a disability coverage claim with American Heritage Life Insurance Company.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for submitting a disability insurance claim, detailing the policyholder's medical condition and disability status.
See template
See template
Delta Pilots Mutual Aid Disability Claim Form
PDF template
Disability claim form for Delta pilots to request benefits and authorize medical information release and payment processing.
See template
See template
Short Term Disability Claim Form
PDF template
A comprehensive form for employees to file a claim for short-term disability benefits, requiring input from the employee, employer, and attending physician.
See template
See template
Disability Claim Form Instructions
PDF template
Comprehensive instructions for filing a disability insurance claim with sections for physician, claimant, and employer statements.
See template
See template
New York State NOTICE AND PROOF OF CLAIM FOR DISABILITY BENEFITS
PDF template
Official New York State form for filing a disability benefits claim, to be used by employees who became disabled while employed or within four weeks of employment termination.
See template
See template
MetLife Disability Insurance Guide
PDF template
A comprehensive guide for reporting disability claims and absence procedures through MetLife insurance.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for filing a disability claim with medical and employment details for Teamsters Joint Council No. 83 members.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for filing a disability claim through the Teamsters Joint Council No. 83 of Virginia Health & Welfare and Pension Funds.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for filing a disability claim with the Teamsters Joint Council No. 83 of Virginia Health & Welfare and Pension Funds.
See template
See template
Continuing Disability Claim Form
PDF template
A comprehensive form for filing a disability insurance claim covering various types of disability and patient information
See template
See template
Disability Application Glossary Of Terms
PDF template
A comprehensive guide defining key terms and requirements for disability retirement applications for public employees in Massachusetts.
See template
See template
Supplementary Disability Claim Form
PDF template
A form used to submit disability claims, requiring details from both the claimant and attending physician about an employee's inability to work.
See template
See template
SI 11268 Your Disability Benefit Claim
PDF template
Application packet for submitting a long-term disability benefits claim, including instructions for completing required forms.
See template
See template
Disabled Dependent Authorization Form
PDF template
Insurance form for documenting dependent status, eligibility, and coverage details for a disabled dependent under 26 years old.
See template
See template
How To File A Claim For Weekly Disability Benefits
PDF template
Comprehensive guide for filing a disability benefits claim, including required documentation and medical certification requirements.
See template
See template
EMPLOYER CERTIFICATION OF COMPLIANCE DISCHARGEDEMOTION PROCEDURES
PDF template
A certification form documenting compliance with discharge and demotion procedures for state university employees in Illinois.
See template
See template
One Page Discharge Form
PDF template
A standardized form for documenting client discharge from mental health services, capturing key details about the discharge reason and service status.
See template
See template
National Cadet Corps Discharge Certificate
PDF template
Official document certifying the discharge of a cadet from the National Cadet Corps, detailing service record and performance.
See template
See template
Discharge Form
PDF template
A comprehensive discharge form for tracking patient discharge details and referral information from Marin Behavioral Health and Recovery Services.
See template
See template
Discharge Form
PDF template
A form used to document patient discharge from a healthcare facility with multiple completion options.
See template
See template
Discharge Form S117 PRO FORMA
PDF template
Official form for discharging a patient from Section 117 Mental Health Act 1983 aftercare services.
See template
See template
Discharge Of Mortgages
PDF template
Comprehensive guide explaining the process, circumstances, and legal requirements for discharging mortgages under the Registration of Titles Act in Jamaica.
See template
See template
Discharge And Follow Up Recommendations
PDF template
Guidelines for healthcare personnel on discharge and follow-up care for patients who have experienced assault, including medical and mental health considerations.
See template
See template
DISCHARGE PLANNING INPATIENT STANDARDS
PDF template
A comprehensive protocol detailing the procedures and responsibilities for patient discharge from an inpatient healthcare facility.
See template
See template
Discharge Report Form Instructions
PDF template
Instructions for reporting oil spills, hazardous substance releases, and environmental contamination incidents to appropriate authorities.
See template
See template
What Are My Discharge Rights From A 24 Hour Mental Health Facility
PDF template
A guide explaining discharge rights for voluntary patients in mental health facilities, including treatment plan participation and release processes.
See template
See template
Pediatric Discharge Summary Template
PDF template
A comprehensive template and instructions for creating a pediatric patient discharge summary with detailed guidelines for documentation.
See template
See template
International Medical History Form
PDF template
Comprehensive medical form for collecting personal health information, emergency contacts, and medical history for international travel purposes.
See template
See template
International Medical History Form
PDF template
Comprehensive medical history and emergency contact form for international travelers to ensure safety and medical preparedness.
See template
See template
Distinctive Americas Holiday Booking Form
PDF template
A comprehensive travel booking form for reserving holidays with Distinctive Americas, including personal details, travel insurance, and payment information.
See template
See template
CLAIM FOR REIMBURSEMENT TRAVEL FORM
PDF template
A form for Coast Guard Auxiliary Division 5 members to claim travel-related expenses and reimbursements.
See template
See template
UM Diver Proof Of Insurance Form
PDF template
Form requiring proof of medical insurance coverage for potential scuba diving accidents and hyperbaric oxygen therapy
See template
See template
UM Diver Proof Of Insurance Form
PDF template
A form requiring divers to prove they have medical insurance coverage for potential scuba diving accidents involving hyperbaric oxygen therapy.
See template
See template
Guidelines For Maintaining An Equipment Inventory
PDF template
Comprehensive guidelines for managing and tracking equipment owned by a PEF Division, including insurance coverage, custodianship, and inventory tracking.
See template
See template
Guidelines For Maintaining An Equipment Inventory
PDF template
Comprehensive guidelines for managing and tracking equipment owned by a PEF Division, including insurance coverage, custodianship, and inventory tracking.
See template
See template
Claims Reporting Procedure Manual
PDF template
Comprehensive guide for reporting and managing various types of claims for state-owned property, vehicles, and liability incidents in Alaska.
See template
See template
Retirement Scheme Divorce Benefit Information Form
PDF template
A form for collecting member information related to potential benefit distribution in the context of a divorce order
See template
See template
DIY Docs
PDF template
An online legal document creation and storage tool provided by ARAG for employees to generate and manage legal documents independently.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for customers to submit warranty claims for products or services from DMI Homes.
See template
See template
Organizational Hold Harmless And Indemnity Agreement
PDF template
Legal document that provides liability protection for Boy Scouts of America against claims from non-BSA scouting groups and organizations.
See template
See template
Domestic Maid (Lite) Proposal Form
PDF template
Insurance proposal form for domestic maid coverage in Singapore, detailing proposer and maid particulars.
See template
See template
Good Fit Domestic Partner Affidavit
PDF template
A form for active and retired employees to add or terminate domestic partner and dependent coverage for various insurance plans.
See template
See template
Do Not File Insurance Waiver Form
PDF template
A document allowing patients to request that Oklahoma State University Medicine not file an insurance claim for a specific date of service.
See template
See template
Driver Services Release Form
PDF template
A legal document for releasing liability related to a vehicular accident, allowing a releasor to waive claims against a released party.
See template
See template
Job Displacement Insurance A Policy Typology
PDF template
A research paper examining policy approaches for insuring workers against earnings losses from unemployment and job displacement.
See template
See template
Disability Benefit Application Instructions
PDF template
Comprehensive instructions for submitting a disability benefit application, including eligibility requirements and submission guidelines.
See template
See template
Motor Vehicle Accident Report Form
PDF template
Confidential report form for documenting details of a motor vehicle accident involving injury, death, or property damage over $1,000.
See template
See template
Chapter 133 General Medical Provisions Health Care Provider Billing Procedures
PDF template
Regulatory document outlining electronic and paper billing procedures for health care providers in workers' compensation and insurance contexts.
See template
See template
Chapter 133. General Medical Provisions Subchapter B. Health Care Provider Billing Procedures
PDF template
Regulatory document specifying required electronic and paper billing formats for healthcare providers in workers' compensation and insurance contexts.
See template
See template
Indemnity Data CallReporting Contact Form
PDF template
Form for insurance affiliates to designate primary data reporting contacts for NCCI Group Codes.
See template
See template
Driver Insurance Form Field Trips And Athletics
PDF template
A form for parents/guardians to complete insurance and driving history information for school-related transportation and field trips.
See template
See template
DriverForm Rev12.2016 VOLUNTEEREMPLOYEE DRIVER FORM
PDF template
A form for collecting driver information, vehicle details, insurance coverage, and driving history for volunteers and employees who drive vehicles.
See template
See template
New Drivers Of University Vehicles
PDF template
Form for collecting driver information and authorization for new drivers of university vehicles, specifically for golf carts or low-speed electric vehicles.
See template
See template
DriverS Accident Reporting Packet
PDF template
Comprehensive guide for handling vehicle accidents involving University of California vehicles, providing step-by-step instructions for reporting and managing post-accident procedures.
See template
See template
CIBC Insurance DriveSmart Program Terms And Conditions
PDF template
Policy terms and conditions for CIBC Insurance DriveSmart telematics driving program with Certas Direct Insurance Company.
See template
See template
Warranty Claim Form
PDF template
A form for consumers to submit warranty claims for DRiV products, including part replacement and purchase details.
See template
See template
Installment Agreement
PDF template
Official form for resolving driver's license reinstatement through an installment payment plan with specific procedural requirements.
See template
See template
Student Insurance Claim Form
PDF template
A comprehensive insurance claim form for students to report medical examinations, illnesses, prescriptions, or injuries for insurance coverage.
See template
See template
Direct Deposit Enrollment Authorization Form
PDF template
Authorization form for electronic benefit payments through direct deposit for Social Services programs in North Carolina.
See template
See template
Change Of Information Form
PDF template
A form for patients to update their personal, contact, insurance, and payment information with Double Talk Therapy, PLLC.
See template
See template
Durable Power Of Attorney
PDF template
A form allowing employees to designate an attorney-in-fact to conduct insurance-related transactions with the Employees Group Insurance Division (EGID).
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for HVAC equipment, requiring detailed information about failed parts and replacement components.
See template
See template
Workers Compensation Complaint Form
PDF template
Official form for filing a complaint related to workers' compensation violations in Texas, detailing alleged system participant infractions.
See template
See template
Warranty Claim Form
PDF template
A warranty claim document for Delstar HD Brushless Alternators used in various vehicle and industrial applications.
See template
See template
Employee Benefit Enrollment Form
PDF template
A comprehensive form for employees to select and enroll in medical, dental, and vision benefit plans.
See template
See template
Certification Of Trust
PDF template
A form for certifying trust details when a trust is the owner of an American Equity annuity contract.
See template
See template
Declaration For Testamentary Deposit (Multiple Grantors), Form 720009
PDF template
Federal document detailing FDIC forms used to collect information about depositors and deposit ownership for failed financial institutions.
See template
See template
Workers Compensation Commission Self Insurance Program Application
PDF template
Comprehensive application guide for employers seeking self-insurance status for workers' compensation in Maryland.
See template
See template
Exhibitor Appointed Contractor Form
PDF template
Form detailing requirements and guidelines for third-party contractors working at Gulf Coast Conference (GCC) event.
See template
See template
Loan Discharge Application School Closure
PDF template
Application for loan discharge for borrowers affected by school closure under federal student loan programs.
See template
See template
EASA PROGRAM DISCHARGE FORM
PDF template
A form used to document client discharge details from the EASA program, including reasons for discharge and transition information.
See template
See template
INITIAL DISABILITY CLAIM FORM
PDF template
A comprehensive form for filing disability insurance claims covering various types of disability scenarios with patient and policyholder information.
See template
See template
DENTAL APPLICATION AND POLICY CHANGE
PDF template
A comprehensive form for enrolling in or modifying dental insurance coverage, including options for new employees, open enrollment, COBRA, and membership changes.
See template
See template
PELHAM SCHOOL DISTRICT POLICY EBBB ACCIDENT REPORTS
PDF template
Comprehensive policy detailing requirements for reporting accidents involving students or employees in school settings, including notification procedures and documentation guidelines.
See template
See template
Accident Reporting
PDF template
Policy outlining procedures for reporting accidents involving students or employees at school or school-sponsored activities.
See template
See template
Claim Form
PDF template
A comprehensive form for submitting claims for various flexible spending and healthcare reimbursement accounts.
See template
See template
North Carolina Workers Compensation Electronic Billing And Payment Companion Guide
PDF template
A companion guide for electronic billing and payment processes in North Carolina's workers' compensation system, based on national electronic billing standards.
See template
See template
Term Life And Disability Income Administration Manual
PDF template
Administration manual for term life and disability insurance benefits for North American Division of Seventh-day Adventists employees.
See template
See template
EasyCare Cancellation Form
PDF template
Form for cancelling vehicle protection or GAP coverage contract with specific documentation requirements.
See template
See template
Elk County Catholic High School Building Usage Form
PDF template
A form for external groups to request use of school facilities, including details about event, facilities, and insurance requirements.
See template
See template
Claims Submission Form
PDF template
A form authorizing healthcare providers to submit and exchange personal information for insurance claims processing and benefits administration.
See template
See template
Electronic Transmission Authorization And Consent Form
PDF template
A form authorizing electronic submission and exchange of personal health information for insurance claims processing and administration.
See template
See template
ECU Leased Equipment Policy Change Form
PDF template
A form for documenting changes to leased equipment at East Carolina University, including equipment details, location, and lease information.
See template
See template
ECU Leased Equipment Policy Change Form
PDF template
A form for documenting changes to leased equipment at East Carolina University, including equipment details, location, and lease information.
See template
See template
Traveler Health And Medical Information
PDF template
A comprehensive guide for group leaders to collect and manage travelers' medical information and health considerations during travel programs.
See template
See template
Extended Health Care Claim Form
PDF template
A comprehensive form for submitting medical and health care expense claims to an insurance provider, requiring detailed personal and coverage information.
See template
See template
Electronic Communications Requirements
PDF template
Document outlining electronic communication services and requirements between Western National Insurance Group and its agencies for policy information transmission and business communications.
See template
See template
EFT And ERA Electronic Funds Transfer And Electronic Remittance Advice Transactions Basics
PDF template
A comprehensive overview of Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) transactions in healthcare payment systems.
See template
See template
IAIABC Electronic Partnering Agreement
PDF template
A document establishing guidelines and expectations for electronic data exchange between trading partners in industrial accident and workers' compensation domains.
See template
See template
Emergency Contact Form
PDF template
A comprehensive form for collecting student emergency contact details, medical information, and guardian contact information for school records.
See template
See template
Health Office Emergency Contact Form
PDF template
A comprehensive form collecting student contact, medical, and insurance information for school emergency purposes.
See template
See template
Emergency Contact Form
PDF template
A comprehensive form for recording family contacts, medical care providers, and insurance details for emergency reference.
See template
See template
Emergency Information
PDF template
A comprehensive emergency contact and medical information form for students participating in university activities.
See template
See template
Emergency Medical Form
PDF template
Form for updating student emergency contact, insurance, and athletic participation information for school records.
See template
See template
Emeriti Reimbursement Benefit Claim Form
PDF template
Instructions for submitting healthcare reimbursement claims through Rx debit card, online portal, or paper submission.
See template
See template
EMFG Venue Check List
PDF template
Comprehensive checklist of required documents and steps for preparing an event venue at a fairgrounds facility.
See template
See template
Health Insurance Claim Form
PDF template
Standard health insurance claim form for submitting patient and insurance information for medical reimbursement and processing.
See template
See template
Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for product defects, missing parts, or damage by dealers and customers.
See template
See template
ENROLLMENT, CHANGE, CANCELLATION, OR OPT OUT EMPLOYEES ONLY HEALTH AND WELFARE PLANS
PDF template
A form for Lawrence Livermore National Security employees to enroll, change, cancel, or opt out of health and welfare benefit plans.
See template
See template
ENROLLMENT FORM FOR GROUP INSURANCE
PDF template
A comprehensive form for enrolling in group insurance benefits, capturing employee and dependent information, coverage selections, and authorization.
See template
See template
Group Term Life Employee Enrollment Form
PDF template
Insurance enrollment form for employees to select group term life coverage options and designate beneficiaries.
See template
See template
Eye Care Insurance Enrollment Form
PDF template
A comprehensive form for employees to enroll in or modify eye care insurance coverage for themselves and dependents.
See template
See template
Employer Error Institution Process
PDF template
Guidelines for handling employer errors in employee insurance enrollment, detailing steps for institutions and employees to correct coverage issues.
See template
See template
GIC Employment Status Change Form
PDF template
A form for documenting changes in employment status, leave of absence, and associated health insurance coverage elections.
See template
See template
2023 EMRA RenewalSurvey Form
PDF template
Form for renewing and surveying emergency medical transport agency licenses in Oklahoma, with two renewal options for 2024 and 2025.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
A form for submitting out-of-network vision service claims with instructions for online or mail submission.
See template
See template
Architects And Engineers Professional Liability Insurance Application
PDF template
An insurance application form for architects and engineers to obtain professional liability coverage.
See template
See template
Authorization And Consent To Treatment
PDF template
A comprehensive document outlining patient consent for medical treatment, insurance benefits assignment, and payment responsibilities.
See template
See template
Enhanced Dental Benefits Enrollment Form
PDF template
A self-enrollment form for additional dental coverage for members with specific medical conditions through Blue Cross Blue Shield of Massachusetts.
See template
See template
ENJAYMO Patient Solutions Enrollment Form
PDF template
Comprehensive patient enrollment form for ENJAYMO patient assistance program, collecting personal and insurance information.
See template
See template
VEHICLE INSPECTION FORM
PDF template
A comprehensive form for documenting vehicle condition and existing damage for insurance purposes.
See template
See template
Enrollment Change Waiver Group Insurance Form
PDF template
Insurance enrollment form for adding or changing group dental and eye care coverage for employees and their dependents.
See template
See template
Continuing Consent To Treatment And Authorization To Release Information
PDF template
A consent form allowing medical treatment for a minor student and authorizing release of medical information to insurance services.
See template
See template
Northern California Carpenter Funds Enrollment Form
PDF template
Form for enrolling or updating records with the Northern California Carpenter Funds, including health plan selection and participant information.
See template
See template
SISC Flex Plan Enrollment Form
PDF template
Employee enrollment form for health care, limited purpose, and dependent care flexible spending accounts with benefit election options.
See template
See template
Delta Dental Of Rhode Island Enrollment Form
PDF template
An enrollment form for Delta Dental insurance coverage in Rhode Island, used to add or modify dental insurance coverage for individuals and families.
See template
See template
Vision Service Plan EnrollmentChange Form
PDF template
Form for employees of Fallbrook Elementary School District to enroll or modify vision insurance coverage for themselves and dependents.
See template
See template
Application And Change Form For Delta Dental Individual And Family
PDF template
A comprehensive dental insurance enrollment form for individual and family coverage with personal and dependent information sections.
See template
See template
Superior Dental Care Employee Enrollment Form
PDF template
Form for employees to enroll in dental and vision insurance benefits through Superior Dental Care.
See template
See template
ENROLLMENT FORM
PDF template
A comprehensive form for enrolling in insurance coverage and adding spouse and dependent information for IBEW Local 26 members.
See template
See template
ENROLLMENT FORM GL.2017.010
PDF template
A comprehensive employee insurance enrollment form for selecting life and AD&D coverage options for employees and dependents.
See template
See template
ENROLLMENT FORM NATIONAL ELEVATOR INDUSTRY BENEFIT PLANS
PDF template
An enrollment form for employees of the National Elevator Industry to enroll in benefit plans and update personal and dependent information.
See template
See template
VEHICLE INSPECTION FORM
PDF template
Insurance form for documenting existing vehicle damage during policy inspection or claim process.
See template
See template
Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, contact, medical, and insurance information for healthcare providers.
See template
See template
Health History Examination Form South Carolina Envirothon Program
PDF template
Comprehensive health and emergency contact form for documenting medical information and insurance details for program participants.
See template
See template
Youth Sports Medical History Form
PDF template
A comprehensive medical history form for youth sports participants, requiring detailed health information and medical practitioner verification.
See template
See template
Equipment Booking Form And Hire Agreement
PDF template
A form for requesting and hiring equipment from Uralla Shire Council with terms and conditions for equipment use.
See template
See template
ERM 14 FormConfidential Request For Ownership Information
PDF template
A confidential form for reporting changes in business ownership, legal entity status, or organizational structure for workers compensation insurance purposes.
See template
See template
Applied Behavior Analysis (ABA) Clinical Service Request Form
PDF template
A form for requesting clinical services related to Applied Behavior Analysis treatment, used by Blue Cross Blue Shield of Texas for initial or concurrent treatment requests.
See template
See template
RETIREE INSURANCE ENROLLMENT FORM
PDF template
A form for Texas Employees Retirement System retirees to enroll in insurance and provide Medicare information
See template
See template
2012 OPERS Prescription Plan Guide
PDF template
Guide for OPERS health care plan participants explaining prescription drug coverage options for Medicare-eligible members
See template
See template
Getting Started With Home Delivery From Express Scripts Pharmacy
PDF template
Comprehensive guide for managing prescription home delivery services through Express Scripts online platform and mobile app.
See template
See template
MEDICAL BENEFITS SUBSCRIBER CLAIM FORM
PDF template
A comprehensive medical insurance claim form for submitting healthcare reimbursement or coverage information.
See template
See template
Exchange Privilege Application
PDF template
A form for requesting policy exchanges between term life insurance policies without requiring evidence of insurability.
See template
See template
Master Services Agreement
PDF template
An agreement between Chartis International and MMR Information Systems for providing electronic medical record storage services to insurance customers.
See template
See template
Washoe County Liability Property Loss Report Form
PDF template
A comprehensive form for reporting personal injuries, property damage, and county property losses in Washoe County.
See template
See template
Notification Of Intent To Use Exhibitor Appointed Contractor
PDF template
Form for exhibitors to notify event management about using a non-official service contractor for an event
See template
See template
Liability Waiver Form
PDF template
A liability waiver form for exhibitors at conferences or events at the Hyatt Regency Newport, requiring insurance documentation and releasing Hyatt from potential claims.
See template
See template
Instructions For Application To Sell UnitedHealthcare Products
PDF template
Comprehensive guide for external producers seeking authorization to sell UnitedHealthcare insurance products and become appointed agents.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
A claim form for submitting out-of-network vision services reimbursement to First American Administrators for EyeMed Vision Care plans.
See template
See template
EnrollmentChange Form
PDF template
A form for enrolling or changing employee and family insurance coverage with Fidelity Security Life Insurance Company.
See template
See template
EnrollmentChange Form
PDF template
Insurance enrollment and change form for employees and their family members, underwritten by Fidelity Security Life Insurance Company.
See template
See template
Out Of Network Claim Form
PDF template
A form for EyeMed Vision Care members to submit claims for out-of-network vision care services and receive reimbursement.
See template
See template
OTHER INSURANCE FORM
PDF template
A form for collecting details about additional insurance coverage for a Medicaid client
See template
See template
Employer Health Insurance Verification Individual Follow Up Health Insurance Information
PDF template
A form for employers to verify health insurance benefits offered to employees and their families for BadgerCare Plus applicants.
See template
See template
TIAA BROKERAGE INDIVIDUAL TRANSFER ON DEATH ACCOUNT AGREEMENT
PDF template
A legal document outlining the terms and conditions for a transfer on death brokerage account, specifying how assets will be transferred upon the account holder's death.
See template
See template
PDP Prescription Reimbursement Request Form
PDF template
A form for members to request reimbursement for prescription medications purchased at retail cost when standard prescription drug coverage was not used.
See template
See template
Form 14135 Application For Certificate Of Discharge Of Property From Federal Tax Lien
PDF template
IRS form used to request discharge of property from a federal tax lien, allowing property to be transferred or sold free of the lien.
See template
See template
GENERATOR WARRANTY SERVICE CLAIM FORM
PDF template
A form for submitting warranty service claims for Winco generators, detailing equipment failure and repair information.
See template
See template
Medical Dental Time Loss Claim Form
PDF template
A comprehensive medical claim form for employees and dependents to submit healthcare and time loss claims.
See template
See template
Dual Option Enrollment Form
PDF template
An enrollment form for dental insurance coverage through Transport Workers Union, Local 100, allowing members to select dental plans and add dependents.
See template
See template
General Provider Billing Manual
PDF template
Comprehensive guide for healthcare providers on billing procedures for workers' compensation and crime victims services in Washington state.
See template
See template
Puget Sound Benefits Trust Short Term Disability Claim Form
PDF template
A comprehensive form for employees to file a short-term disability claim, requiring details from the employee, employer, and attending physician.
See template
See template
F262 024 000 Claims Suppression Complaint Form
PDF template
A form for reporting potential claims suppression by employers in workers' compensation cases.
See template
See template
Medical Dental Vision Prescription Weekly Disability Claim Form
PDF template
Comprehensive claim form for medical, dental, vision, prescription, and weekly disability benefits for NW Plumbers & Pipefitters Health Fund members.
See template
See template
Enrollment Form F33
PDF template
Comprehensive enrollment form for employees to register dependents and update personal information for benefit plans
See template
See template
Disability Claim Form
PDF template
A comprehensive form for submitting a disability insurance claim, covering coverage information, work schedule, and earnings details.
See template
See template
Western Metal Industry Pension Fund Pre Retirement Death Application
PDF template
A form for surviving spouses to apply for pension benefits after the death of a participant in the Western Metal Industry Pension Fund.
See template
See template
Huntsville Public Library Standard Rental Agreement Form
PDF template
A comprehensive form for renting rooms and facilities at the Huntsville Public Library, including event details, insurance requirements, and payment information.
See template
See template
Warranty Claim Form
PDF template
A comprehensive form for customers to submit warranty claims for mattresses, requiring detailed product and condition information.
See template
See template
Contract Intelligence
PDF template
An advanced AI system for automated, high-precision extraction of key information from complex contracts using neuroscience-based technology.
See template
See template
Exhibitor Appointed Contractors (EACs)Third Party Contractor Guidelines
PDF template
Comprehensive guidelines for exhibitors using third-party contractors for booth installation, dismantling, and services at a trade show event.
See template
See template
Westtown Township Health And Fitness Registration And Insurance Form
PDF template
Registration form for fitness programs with health history and medical information collection
See template
See template
Family Contact Form
PDF template
Form for collecting comprehensive contact and insurance details for a client's family members and guardians.
See template
See template
FAMILY EMERGENCY CONTACT FORM
PDF template
A comprehensive document listing essential emergency contacts and insurance information for family disaster preparedness.
See template
See template
NECAIBEW Family Medical Care Plan Family Enrollment Form
PDF template
An enrollment form for employees to enroll in the NECA/IBEW Family Medical Care Plan, including personal, spousal, and dependent information.
See template
See template
Family Notification Of Death, Injury, Or Illness In Custody Act Of 2022
PDF template
A bill to establish federal policies for notifying next-of-kin when an individual dies, becomes seriously ill, or is seriously injured while in federal custody.
See template
See template
FAQs About Affordable Care Act Implementation Part 31, Mental Health Parity Implementation, And Wome
PDF template
Frequently Asked Questions regarding implementation of market reform provisions in healthcare, covering preventive services, mental health parity, and women's health rights.
See template
See template
FAQs About Affordable Care Act Implementation Part 31, Mental Health Parity Implementation, And Wome
PDF template
Guidance document providing frequently asked questions about preventive services coverage under the Affordable Care Act, Mental Health Parity Act, and Women's Health and Cancer Rights Act.
See template
See template
FAQs CVS Caremark Pharmacy Transition
PDF template
Frequently asked questions about prescription drug benefits transition from Medco to CVS Caremark for PERS Select/Choice/Care members.
See template
See template
Charge Authorization Form
PDF template
Form for authorizing and documenting charges for campus service center work orders and internal billing processes.
See template
See template
Farm Emergency Contact Form
PDF template
A comprehensive emergency contact and insurance information form for farm operations, listing critical emergency and support service contacts.
See template
See template
Farm Emergency Contact Form
PDF template
Comprehensive form for documenting emergency contacts, insurance policies, and critical service providers for a farm operation.
See template
See template
FirstAir Warranty Claim Form
PDF template
A comprehensive warranty claim form for documenting air compressor failures and service details by authorized channel partners.
See template
See template
Cancellation Form
PDF template
A form for subscribers to cancel their health or dental insurance coverage with Farm Bureau Health Plans.
See template
See template
Retiree Enrollment Form
PDF template
Enrollment form for Fulton County retirees to select health and dental plan coverage options and update personal information.
See template
See template
INCLUSA CLAIM FORM
PDF template
A claim form for submitting healthcare service claims to Inclusa Family Care through WPS Health Insurance.
See template
See template
Statement Of Claim Option C Family Life Insurance
PDF template
Claim form for Federal Employees' Group Life Insurance (FEGLI) Program death benefits administered by MetLife.
See template
See template
Claim For Dismemberment Benefits
PDF template
A federal employee insurance claim form for documenting loss of limb or eyesight benefits under the Federal Employees' Group Life Insurance Program.
See template
See template
OWCP 92 Uniform Billing Form
PDF template
Guidelines for submitting medical service bills for federal employees under compensation programs related to work-related injuries and occupational illnesses.
See template
See template
NATIONAL FLOOD INSURANCE PROGRAM PUBLICATIONS ORDER FORM
PDF template
Order form for free publications from the National Flood Insurance Program covering flood insurance resources and materials.
See template
See template
Health Benefits Claim Form
PDF template
A comprehensive form for submitting health insurance benefits claims, including patient and insurance information.
See template
See template
UHC WTIA (EnrollCancelWaiverChanges)
PDF template
A comprehensive form for employees to enroll, modify, or cancel health insurance benefits and personal information.
See template
See template
YMCA Camp Independence 2024 Health History And Examination Form
PDF template
Medical form for collecting camper health information and emergency contact details for YMCA summer camp participation.
See template
See template
Standard Form For Presentation Of Loss And Damage Claim
PDF template
A standard form used by shippers to file claims for lost or damaged shipments with freight carriers.
See template
See template
CLAIM FORM MISCELLANEOUS EXPENSES
PDF template
A form for submitting and documenting miscellaneous expense claims for reimbursement or processing.
See template
See template
Patient Demographics Form
PDF template
Comprehensive medical intake form collecting patient personal, contact, insurance, and consent information for healthcare services.
See template
See template
Client Financial Responsibility Agreement
PDF template
A comprehensive agreement outlining financial responsibilities and payment terms for clients receiving services from The Wellness Centre.
See template
See template
ClaimIncident Report Form
PDF template
A comprehensive form for documenting insurance claims, liability incidents, and property damage details.
See template
See template
PRODUCER AGREEMENT
PDF template
A legal agreement between KIS Surety Bonds, LLC and an independent insurance producer defining their business relationship and operational responsibilities.
See template
See template
Massachusetts Collaborative Behavioral Health Level Of Care Request Form
PDF template
A comprehensive form for requesting behavioral health services and documenting patient clinical information for insurance and treatment purposes.
See template
See template
Patient Registration Form
PDF template
Comprehensive medical intake form for collecting patient personal information, emergency contact details, insurance information, and health history.
See template
See template
Patient Discharge Form
PDF template
A standardized form for documenting patient discharge details, treatment status, and medical recommendations.
See template
See template
Annual Report Form For Administrators
PDF template
Annual reporting form for insurance administrators holding a certificate of authority under Texas Insurance Code Chapter 4151
See template
See template
Dental Patient Information Form
PDF template
Comprehensive form for collecting patient personal, dental, and insurance information for dental services.
See template
See template
Kentucky FAIR Plan Reinsurance Association Homeowner Manual
PDF template
Comprehensive manual for homeowner insurance policies and guidelines issued by the Kentucky FAIR Plan Reinsurance Association.
See template
See template
Contract Types And Required Documents
PDF template
Guidelines for required documentation for different types of consultant agreements based on contractor status and licensing
See template
See template
Suburban Urologic Associates Financial Policy
PDF template
Detailed financial policy outlining insurance, payment, and billing procedures for a urology medical practice.
See template
See template
FinlandS Response To Questionnaire On Social Protection Of Older Persons
PDF template
Comprehensive document detailing Finland's legal framework for pension and social protection systems for older persons, covering national and employment-based pension schemes.
See template
See template
Inter Department Charge Requisition Form
PDF template
A form for charging purchases from campus departments to specific budget accounts within an organization.
See template
See template
FITNESS INSTRUCTORPERSONAL TRAINER Insurance Program And Enrollment Form
PDF template
Insurance program designed for U.S.-based fitness instructors providing coverage for personal training and exercise activities.
See template
See template
Management Benefits Fund (MBF) Health And Fitness Reimbursement Program Claim Form
PDF template
A form for MBF members to claim reimbursement for health and fitness expenses for themselves and their spouse/domestic partner.
See template
See template
HealthFitness Center Reimbursement Form
PDF template
A form for Capital Health Plan members to request reimbursement for health and fitness center memberships up to $150 per family or member.
See template
See template
Fitness Benefit Coverage Form Instructions
PDF template
Instructions and form for members to request reimbursement for fitness-related expenses through their health plan
See template
See template
Reimbursement Form For Flexible Spending Account (FSA)
PDF template
Form for employees to request reimbursement for healthcare and dependent care expenses through a Flexible Spending Account.
See template
See template
MEDICAL FLEX REIMBURSEMENT FORM
PDF template
A form for employees to request reimbursement for medical and dental expenses through a flexible spending account program.
See template
See template
Privacy Impact Assessment For Federal Long Term Care Insurance Program (FLTCIP) System
PDF template
Assessment of privacy considerations for the Federal Long Term Care Insurance Program's system that manages insurance enrollment and claims for federal employees and uniformed service members.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims detailing product issues, repairs, and customer information.
See template
See template
Form FMC 67 Ocean Transportation Intermediary (OTI) Insurance Form
PDF template
Insurance form certifying financial responsibility for ocean transportation intermediaries under the Shipping Act of 1984.
See template
See template
Hospital Discharge Plan For Tuberculosis Patients
PDF template
Comprehensive discharge planning document for patients being treated for tuberculosis, including medical details and follow-up instructions.
See template
See template
FOOT Medical And Insurance Form
PDF template
Medical and insurance form for participants in the Yale First-Year Outdoor Orientation Trips (FOOT) program, collecting health and emergency contact information.
See template
See template
Student Travel Profile General Liability Waiver
PDF template
A comprehensive waiver and medical procedure document for students participating in a mission trip, covering liability release and medical emergency protocols.
See template
See template
Foreign Travel Insurance Guidelines For STUDENTS
PDF template
Guidelines for foreign travel insurance coverage for California State University students traveling domestically or internationally.
See template
See template
TxDOT Form 1560 Certificate Of Insurance
PDF template
An official form for contractors to provide proof of required insurance coverage for TxDOT contracts.
See template
See template
NEW PATIENT INSURANCE AND OFFICE POLICIES CONSENT FORM
PDF template
A comprehensive form for collecting patient personal, insurance, and medical history information for dental office registration.
See template
See template
Application Q A Waste Discharge Permits
PDF template
Guidance document explaining permit requirements for various types of water discharge activities in California by Regional Water Quality Control Board.
See template
See template
Expenditure Approval Form 201
PDF template
A form for South Carolina fire departments to request approval for utilizing local Firemen's Inspection Fund expenses
See template
See template
FORM 28C
PDF template
A North Carolina Industrial Commission form for reporting workers' compensation settlement details and payments.
See template
See template
Acceptance Of Site Specific Health And Safety Plan (SSHASP) Form
PDF template
Internal form for documenting compliance and acceptance of a contractor's site-specific health and safety plan by an NJSDA Field Compliance Inspector.
See template
See template
Report Of Job Injury Or Illness
PDF template
A form for workers to report work-related injuries or illnesses to their employer and SAIF Corporation.
See template
See template
Medical Claim Form
PDF template
A comprehensive form for submitting medical claims and patient information to Anthem Blue Cross and Blue Shield insurance plan.
See template
See template
Accident Report Form
PDF template
Comprehensive form for documenting details of a vehicle accident involving a mini-bus, including vehicle information, witness details, and incident description.
See template
See template
Informed Risk Insurance Form For Allied Health Students
PDF template
A form documenting student awareness of potential infectious disease risks in clinical settings and insurance requirements for Allied Health students.
See template
See template
Lost Warrant Affidavit Form
PDF template
A form used to request replacement of a lost, stolen, or undelivered warrant or check for Los Angeles Community College District (LACCD).
See template
See template
Nebraska FBLA Medical Release Form
PDF template
A medical release and emergency contact form for Future Business Leaders of America (FBLA) chapter members during events or activities.
See template
See template
Form PF 1 A Annual Report For Prepaid Funeral Benefits And Funds
PDF template
Annual report form for funeral homes to verify prepaid funeral contract details and compliance with regulatory requirements.
See template
See template
Professional Liability Insurance Declaration Form
PDF template
A form for healthcare professionals to confirm their professional liability insurance coverage for the 2024-2025 period.
See template
See template
Patient Registration
PDF template
A comprehensive medical patient registration form for collecting personal, contact, and insurance information for a dental practice.
See template
See template
Prescription Drug Reimbursement Coordination Of Benefits Claim Form
PDF template
A form for submitting prescription drug reimbursement claims with details about medication, pharmacy, and patient information.
See template
See template
Substance Use Disorder IOP Program Prior Authorization RequestDischarge Form
PDF template
A healthcare form for prior authorization and discharge requests for Intensive Outpatient Program (IOP) substance use disorder treatment.
See template
See template
Add Insurance Form
PDF template
A form used to add payer information to the Community Practice Services database for insurance and billing purposes.
See template
See template
SERVICE REQUEST FORM
PDF template
A healthcare service request form for Medi-Cal, Healthy Families, and Medicare prior authorization submissions.
See template
See template
Keenan Insurance Scholarship Application
PDF template
A scholarship application for students pursuing insurance, risk management, financial services, or benefits-related education
See template
See template
Financial Agreement Appointment Reminders
PDF template
A comprehensive financial agreement outlining patient payment responsibilities, insurance billing, and appointment policies for counseling services.
See template
See template
Change Address
PDF template
Guide for employees to update personal information and manage insurance-related documentation
See template
See template
Psychiatric Inpatient Discharge Form
PDF template
A comprehensive form documenting patient discharge details from psychiatric inpatient care, including follow-up care instructions.
See template
See template
ACORD Forms Added Or Updated In AMS360 2016 R2
PDF template
Comprehensive list of ACORD insurance forms added or updated in the AMS360 2016 R2 software release.
See template
See template
FORTIFIED Roof Designation Requirement FORTIFIED HomeHigh Wind ROOFING COMPLIANCE FORM
PDF template
A form for documenting roof installation and compliance with FORTIFIED Home high wind roofing standards.
See template
See template
Foster Provider Liability Insurance Incident Report Form
PDF template
A comprehensive form for reporting incidents involving foster care providers, documenting details of potential insurance claims and liability events.
See template
See template
Faith Pharmacy New Patient Intake Form
PDF template
Comprehensive medical intake form for new patients at Faith Pharmacy, collecting personal, insurance, and medical information.
See template
See template
Florida Petroleum Liability Restoration Insurance Program Claim
PDF template
Florida state form for reporting petroleum storage tank discharges and claiming liability restoration insurance under Section 376.3072.
See template
See template
Patient Registration Form
PDF template
A comprehensive patient intake and dental insurance information form for a dental practice in Lancaster, Ohio.
See template
See template
Medical Reimbursement Form
PDF template
A comprehensive checklist for submitting medical reimbursement claims to Mass General Brigham Health Plan, detailing required documentation and submission process.
See template
See template
VendorExhibitorThird Party Entity Agreement Form
PDF template
A contractual agreement outlining terms and conditions for vendors, exhibitors, and third-party entities conducting business on Auburn University campus.
See template
See template
Dependent Care And Health Care Reimbursement Claim Form
PDF template
Form for submitting claims for dependent care and health care expenses under a flexible spending account benefit plan.
See template
See template
Flexible Spending Account Claim Form
PDF template
A form for employees to request reimbursement for healthcare and dependent care expenses through a Flexible Spending Account.
See template
See template
Healthcare FSA Expense Claims
PDF template
A form for submitting unreimbursed medical expenses for reimbursement through a Flexible Spending Account (FSA)
See template
See template
Reimbursement Of Orthodontic Expenses
PDF template
Detailed guidelines for reimbursing orthodontic expenses, explaining IRS guidelines and requirements for monthly service reimbursements.
See template
See template
Discharge Form
PDF template
A comprehensive form for tracking patient discharge details, follow-up care, and medical conditions in a healthcare setting.
See template
See template
Funeral Benefit Application Form
PDF template
Application form for claiming funeral benefits through the JLT (CSI Member Benefits) Discretionary Trust
See template
See template
MEDICAL HISTORY FORM
PDF template
Comprehensive form for collecting patient personal information, medical history, and dental visit details
See template
See template
Pre Authorization Form
PDF template
Medical form for patients seeking insurance pre-authorization for hospital treatment, documenting patient and medical details for insurance approval.
See template
See template
Rental Checklist
PDF template
A comprehensive checklist for renting the Fairmount Water Works venue, outlining required steps, documentation, and payment procedures.
See template
See template
Exhibitor Appointed Contractor Form
PDF template
A form for exhibitors to declare independent contractors working at the event with required insurance and service details.
See template
See template
Out Of Network Claim Form
PDF template
A comprehensive form for submitting out-of-network vision care claims to EyeMed Vision Care for reimbursement of medical services.
See template
See template
Non Tagged Mobile (Transient) Property Inventory FY2023 DOAS Insurance Agreement Renewals
PDF template
Instructions for Kennesaw State University departments to submit an inventory of mobile property for insurance coverage purposes.
See template
See template
Non Tagged Mobile (Transient) Property Inventory FY2022 DOAS Insurance Policy Renewal
PDF template
A document requiring Kennesaw State University departments to provide an accurate inventory of non-tagged mobile property for insurance coverage purposes.
See template
See template
DR 1 Disability Benefit Application
PDF template
A comprehensive form for Ohio Public Employees Retirement System members to apply for disability benefits, requiring detailed personal and physician information.
See template
See template
GAANN Fellowship Application Form
PDF template
Application form for GAANN Fellowship at FIU, focused on AI and Cybersecurity research doctoral programs.
See template
See template
Accident And Claim Reporting Procedure
PDF template
Procedure for reporting accidents and filing insurance claims during dance activities for the Folk Dance Federation of California, South, Inc.
See template
See template
GAPWise Cancellation Request Form
PDF template
A form for cancelling a Guaranteed Asset Protection (GAP) insurance addendum with supporting documentation requirements.
See template
See template
FORTIFIED Home Continuous Load Path Form
PDF template
A form documenting the proper installation of continuous load path design elements in a home construction project, verifying structural integrity.
See template
See template
Global Counseling Patient Intake Form
PDF template
Comprehensive medical intake form for counseling services, collecting patient personal and insurance information.
See template
See template
Property And Casualty Model Rate And Policy Form Law Guideline
PDF template
A comprehensive model law guideline for regulating property and casualty insurance rates, policy forms, and competitive market practices.
See template
See template
Medical Claim Form
PDF template
Comprehensive guide for completing and submitting medical insurance claims to GEHA, including instructions for in-network and out-of-network claims.
See template
See template
CLAIM FORM
PDF template
Claim form for reporting property loss or damage related to utility operations by Consolidated Edison Company of New York, Inc.
See template
See template
Louisiana Department Of Insurance Complaint Report Form
PDF template
A form for filing complaints against insurance companies or agents with the Louisiana Department of Insurance for various insurance-related disputes.
See template
See template
Certification As To Status Of Licensure Licensed General Contractor
PDF template
Official document certifying a general contractor's license status, insurance coverage, and legal compliance for construction contracts in North Carolina.
See template
See template
General Liability Insurance For MTNA Affiliated State And Local Associations
PDF template
Comprehensive guide to liability insurance coverage for Music Teachers National Association (MTNA) state and local associations, detailing event coverage and insurance procedures.
See template
See template
General Liability Claim Form
PDF template
A comprehensive form for reporting general liability claims related to Little League activities and incidents.
See template
See template
General Liability Loss Reporting Form
PDF template
A comprehensive form for reporting general liability insurance claims, documenting injuries, property damage, and incident details.
See template
See template
GENERAL LIABILITY PERSONAL INJURY CLAIM FORM
PDF template
A comprehensive form for documenting details of a personal injury claim, including claimant, injured person, incident, and witness information.
See template
See template
City Of Chicago Property Damage Claim Form
PDF template
Official form for submitting property damage claims to the City of Chicago, requiring detailed incident and claimant information.
See template
See template
Prior Authorization Form
PDF template
A form for healthcare providers to request prior authorization for prescription medications through Express Scripts.
See template
See template
GENERAL CLAIM SUBMISSION FORM
PDF template
A comprehensive form for submitting insurance claims with sections for member information, coverage details, and claim specifics.
See template
See template
Section 5. Refill Reminder Program Consumer Enrollment Form
PDF template
A form for consumers to enroll in a pharmacy's prescription refill reminder and medication management service.
See template
See template
Pre Authorization For Genomic Testing Form
PDF template
A form for obtaining insurance pre-authorization for genomic testing with required patient and clinical information.
See template
See template
Personal Vehicle Use Form
PDF template
Form documenting employee personal vehicle usage and insurance details for official district business and field trips.
See template
See template
Patient Intake Form
PDF template
Comprehensive patient intake document for healthcare services, collecting personal, contact, and medical information with insurance and consent provisions.
See template
See template
ACCIDENT INFORMATION FORM
PDF template
A comprehensive form for documenting details of a motor vehicle accident, including personal and insurance information.
See template
See template
Employer Notice Of Claim Long Term Disability
PDF template
A comprehensive claim package for employers to submit long-term disability claims for employees, including detailed instructions and employee information sections.
See template
See template
Short Term Disability Claim Form
PDF template
A form for employees to file a claim for short-term disability benefits, documenting medical leave and disability details.
See template
See template
Quartz Medicare Advantage (HMO) Quartz CashCard Reimbursement Form
PDF template
Form for Medicare members to request reimbursement for fitness memberships or medical transportation rides using their Quartz CashCard.
See template
See template
Dental Claim Form
PDF template
A comprehensive form for submitting dental insurance claims, capturing patient, subscriber, and dental service details.
See template
See template
Giant Food Pharmacy Vaccine Informed Consent
PDF template
A comprehensive form for collecting patient information, insurance details, and consent for vaccination at Giant Food Pharmacy.
See template
See template
Gibson Beach Rentals, Inc. Rental Policies
PDF template
Comprehensive rental policies for daily, weekly, and monthly beach rental guests, covering payment terms, cancellation rules, and travel insurance options.
See template
See template
Illegal Immigration Reform And Enforcement Act Notice
PDF template
Official document outlining requirements for verifying lawful presence for insurance applications in Georgia.
See template
See template
Advancing Access Patient Support Form
PDF template
A comprehensive form for patient information, contact authorization, and insurance details for Gilead medication support programs
See template
See template
Health And Medical History Form
PDF template
A comprehensive medical history and health information form for American Heritage Girls members, valid for 12 months.
See template
See template
Girl Scouts Health History And Medical Examination Form For Minors
PDF template
Comprehensive medical and health history form for Girl Scout participants to capture essential health information and emergency contact details.
See template
See template
Health History And Medical Examination Form For Minors
PDF template
Comprehensive medical form for collecting health information and medical history for Girl Scouts participants under 18 years old.
See template
See template
Request For Benefits ClaimantS Report Of Loss
PDF template
A claim form for filing disability benefits for Glaziers, Architectural Metal and Glass Workers Local Union 1399 members.
See template
See template
Short Term Disability Claim Form Statement Of Employee
PDF template
A comprehensive form for employees to file a short-term disability claim with detailed personal, employment, and medical information.
See template
See template
Long Term Disability Claim Form PhysicianS Statement
PDF template
A comprehensive medical form for submitting a long-term disability insurance claim, requiring detailed patient and medical information.
See template
See template
Commercial General Liability
PDF template
An insurance endorsement modifying commercial general liability policy to provide additional coverage and protections for insureds.
See template
See template
Government Claim
PDF template
Official form for filing a claim against state agencies or employees in California, detailing incident information and damages.
See template
See template
OPIC Handbook
PDF template
Comprehensive guide for international investment and political risk insurance provided by the Overseas Private Investment Corporation (OPIC)
See template
See template
PATIENT ENROLLMENT FORM
PDF template
A comprehensive form for collecting patient personal, insurance, and contact information for medical enrollment purposes.
See template
See template
Student Health Insurance Plan Cancellation Form
PDF template
Form for cancelling health insurance coverage for spouse, partner, or dependent students at Washington State University for Spring 2024 semester.
See template
See template
Certificate Of Insurance On Grain In Licensed Missouri Public Grain Warehouses
PDF template
Official document certifying insurance coverage for grain warehouses in Missouri, demonstrating compliance with state regulations.
See template
See template
Pre Authorisation Form Group Care
PDF template
A medical insurance form for requesting cashless hospitalization, to be filled by the patient and treating doctor
See template
See template
Insurance Information At Retirement
PDF template
Comprehensive guide for Illinois state employees regarding insurance eligibility, coverage, and options at retirement.
See template
See template
Group Optional Life Insurance Application
PDF template
Insurance application for employees to select optional term life and accidental death & dismemberment (AD&D) coverage for themselves and spouse.
See template
See template
Group Policy Change Form
PDF template
A form used to modify group life insurance policy details, including member information, beneficiary changes, and account transfers.
See template
See template
Group Short Term Disability Claim Form
PDF template
A comprehensive form for filing a short-term disability insurance claim with Dearborn National, capturing employee medical and income details.
See template
See template
G.S. 58 65 40
PDF template
Legal statute governing hospital service corporation contract filing and rate approval requirements with the Commissioner of Insurance.
See template
See template
Blach V. Diaz Verson Supreme Court Of Georgia Decision
PDF template
Supreme Court of Georgia case examining whether an insurance company qualifies as a 'financial institution' under the state's garnishment statute.
See template
See template
Tag Along Insurance Form
PDF template
Form for purchasing required Tag-Along Insurance coverage for non-registered children and adults attending Girl Scout troop activities.
See template
See template
Intent For International Travel
PDF template
Form for Girl Scout troops to request approval and document details for international travel experiences.
See template
See template
Girl Scouts Health History And Medical Examination Form For Minors
PDF template
Comprehensive health history and medical examination form for Girl Scout participants to document medical information and insurance details.
See template
See template
Accident Claim Form
PDF template
Insurance claim form for documenting student accident details and health information authorization
See template
See template
Dental Claim Form
PDF template
Comprehensive form for documenting dental procedures, treatments, and insurance billing details.
See template
See template
Your Guide To Filing A Long Term Disability (LTD) Claim
PDF template
A comprehensive guide for filing a long term disability claim with Guardian, providing step-by-step instructions for completing the required forms and submission process.
See template
See template
Guardian Life Insurance Enrollment Form
PDF template
Insurance enrollment form for University of Massachusetts Medical School employees to select benefits and coverage options.
See template
See template
Reimbursement Form
PDF template
A form for submitting optical service reimbursement claims to General Vision Services by members.
See template
See template
REIMBURSEMENT FORM
PDF template
Form for submitting optical services reimbursement to General Vision Services by members.
See template
See template
Reimbursement Request Form
PDF template
A form for members to request reimbursement for eligible healthcare services paid out-of-pocket.
See template
See template
PATIENT INTAKE FORM
PDF template
Comprehensive form for collecting patient personal, contact, insurance, and medical information for healthcare providers.
See template
See template
Request For Hospital DischargeTransfer Approval Form (H 804)
PDF template
A medical form for documenting tuberculosis patient discharge, medication regimen, and transfer details for healthcare providers.
See template
See template
Town Hall Rental Form
PDF template
Application form for renting the Duluth Township Town Hall, with requirements for event details, insurance, and usage guidelines.
See template
See template
Notification Of Injury
PDF template
Detailed guidelines for submitting medical accident insurance claims, including documentation requirements and claim processing procedures.
See template
See template
Supplemental Life Insurance
PDF template
Document outlining eligibility, enrollment, and approval process for supplemental life insurance for county employees.
See template
See template
Wellness Reimbursement Form Instructions
PDF template
Instructions and guidelines for submitting wellness program and fitness reimbursement claims through Harvard Pilgrim Health Care.
See template
See template
Registration Form
PDF template
Comprehensive intake form for collecting patient personal, contact, insurance, and medical history information for mental health services.
See template
See template
Registration Form
PDF template
Comprehensive registration form for healthcare services, collecting patient demographic, contact, insurance, and medical history information.
See template
See template
Record Of Employment
PDF template
A form used by employers to document an employee's job separation for unemployment insurance purposes in New York State.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for bus repairs, parts, and service credits.
See template
See template
Hiram College Enrollment Form
PDF template
A comprehensive benefits enrollment form for Hiram College employees covering medical, dental, vision, and supplemental insurance options.
See template
See template
CruzCare Enrollment Cancellation Form
PDF template
Pre-paid access for students waiving UC SHIP, providing on-campus health care visits for acute illness or injury at the Student Health Center.
See template
See template
Health Referral And Coverage Form
PDF template
A comprehensive health referral form capturing patient details, insurance information, and social determinants of health
See template
See template
HEALTHCARE ADVOCATE TOOLS LINKS PHONE NUMBERS
PDF template
Comprehensive guide for AlaskaCare employees and retirees with contact information and resources for health insurance plans and provider networks.
See template
See template
Huntley Community Centre Outdoor Rink Rental Application
PDF template
Rental application for Huntley Community Centre and outdoor rink facilities, including terms of use and liability requirements.
See template
See template
1500 Health Insurance Claim Form
PDF template
Standard medical claim form used for submitting healthcare insurance reimbursement requests.
See template
See template
CMS 1500 Claim Filing Instructions
PDF template
Detailed guidelines for completing the CMS-1500 healthcare claim form with specific instructions for each field.
See template
See template
Tips For Claim Submission
PDF template
Comprehensive guide for submitting healthcare and flexible spending account claims, detailing documentation requirements and eligible expenses.
See template
See template
Expense Reimbursement Voucher For Healthcare Flexible Spending Account (Healthcare FSA)Health Reimbu
PDF template
A form for employees to request reimbursement for medical expenses through their flexible spending account or health reimbursement arrangement.
See template
See template
Health Benefits Plan Enrollment For Retirees And Survivors
PDF template
Enrollment form for CalPERS retirees and survivors to manage health benefits coverage and dependent information.
See template
See template
Health Extras Reimbursement Form
PDF template
Form for submitting healthcare service reimbursement claims through Independent Health's Health Extras program.
See template
See template
Health History Form
PDF template
Comprehensive health form for students to provide medical history, insurance, and emergency contact information to the university's student health center.
See template
See template
Health Information Form
PDF template
Detailed medical history and personal health form for participants, collecting comprehensive health information and emergency contact details.
See template
See template
Retiree Health Cancellation Form
PDF template
A form for retirees to cancel their health coverage and dependent coverage through Blue Cross Blue Shield.
See template
See template
Health Insurance Refund Request Form For F 1 Students
PDF template
Form for international F-1 students to request a refund of their health insurance premium under specific conditions at Santa Monica Community College.
See template
See template
Medical Claim Form
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient, subscriber, and medical service details.
See template
See template
10 Day Agreement Review Cancellation
PDF template
A form for subscribers to request cancellation of a health insurance policy within 10 days of coverage effective date.
See template
See template
New Provider Contract Inquiry Form
PDF template
A comprehensive form for healthcare providers seeking to join a health insurance network, detailing provider information and contract review process.
See template
See template
Health Screening Benefit Claim Form
PDF template
Claim form for requesting reimbursement of health screening benefits under critical illness or supplemental health plans.
See template
See template
DCH 1315 Health Risk Assessment
PDF template
A confidential form for collecting personal health information to help individuals improve their health and healthcare coverage through the Healthy Michigan Plan.
See template
See template
Heart Failure Discharge Plan FAQ
PDF template
A comprehensive FAQ document providing guidance for completing a heart failure patient discharge plan with detailed instructions on documenting patient information, weights, heights, and follow-up schedules.
See template
See template
Disability Claim Form
PDF template
A comprehensive claim form for submitting disability insurance claims with Unum Group subsidiaries.
See template
See template
Important Notice For Household Goods Carriers Previously Designated As Type B
PDF template
Notice for household goods carriers regarding registration status, requirements, and re-establishing active registration with the Texas Department of Transportation.
See template
See template
2018 HMIS Discharge HHS RHY Outreach
PDF template
Discharge form for tracking health insurance, exploitation status, and client information for runaway and homeless youth services
See template
See template
Patient Intake Form
PDF template
Comprehensive medical questionnaire collecting patient personal, insurance, and health history information for medical providers.
See template
See template
HIRER COLLISION Or DAMAGE REPORT FORM
PDF template
Comprehensive form for documenting details of a vehicle rental accident, including vehicle, driver, witness, and incident information.
See template
See template
Accident Report Form
PDF template
A comprehensive form for documenting details of a motor vehicle accident for legal and insurance purposes.
See template
See template
HMIS Project Discharge Form Emergency Shelter Street Outreach (Including PATH)
PDF template
Form for documenting client exit and destination details for emergency shelter and street outreach programs.
See template
See template
HMIS Project Discharge Form
PDF template
A comprehensive form for documenting client discharge from transitional or permanent housing programs, capturing basic client information and exit destination details.
See template
See template
Hmsa Travel Assistance Request Form
PDF template
A form for requesting travel-related medical assistance or coverage through HMSA health plan
See template
See template
Harvard Outing Club Medical Form
PDF template
A comprehensive medical form for Outing Club members to provide emergency medical information and disclose health conditions that might impact trip participation.
See template
See template
Home Care Discharge Communication Form
PDF template
A form used to communicate the discharge of a home care member from services to Neighborhood Health Plan of Rhode Island.
See template
See template
HOME INVENTORY
PDF template
A comprehensive guide for documenting household valuables to assist in theft recovery, insurance claims, and disaster preparedness.
See template
See template
HOME INVENTORY FORM
PDF template
A comprehensive form for documenting household possessions and their replacement costs across different rooms for insurance purposes.
See template
See template
Norandex Claim Procedures Overview For Homeowners
PDF template
Comprehensive guide for homeowners to submit product warranty claims, detailing required documentation and sample submission procedures.
See template
See template
Hospice RevocationDischarge Form
PDF template
A form for documenting hospice patient discharge or service revocation under Medicaid guidelines
See template
See template
Hospital Discharge Form
PDF template
A form to document patient details and discharge readiness, including medical conditions and follow-up care requirements.
See template
See template
Hospitalization Pre Authorization Form
PDF template
A comprehensive form for patients and healthcare providers to request pre-authorization for hospital admission and medical treatment from Jubilee Health Insurance.
See template
See template
Industrial Waste Program Discharge Application For HospitalsMedical Laboratories
PDF template
A comprehensive form for hospitals and medical laboratories to report industrial wastewater discharge details to King County Industrial Waste Program.
See template
See template
Hotel Guest Shipping Form
PDF template
A form for hotel guests to request shipping of lost or found items with mailing and insurance options.
See template
See template
AUTHORIZATION FOR PRE AUTHORIZED DEBITS (PADS) AND CREDIT CARD DEBITS
PDF template
A form authorizing Howick Mutual Insurance Company to automatically debit insurance premiums from a bank account or credit card.
See template
See template
How To Choose The Correct Proof Of Insurance Form
PDF template
A decision tree for University of Illinois staff, faculty, students, and medical professionals to determine the appropriate proof of insurance form to submit.
See template
See template
How To Submit A Claim For Critical Illness, Accident And Hospital Indemnity Insurance
PDF template
Comprehensive guide for filing insurance claims for critical illness, accident, and hospital indemnity coverage with The Hartford.
See template
See template
Short Term Disability Claim Form
PDF template
Instructions for filing a short-term disability insurance claim through Mutual of Omaha, detailing submission methods and required sections.
See template
See template
Medical Release Form
PDF template
Step-by-step guide for completing an online medical release form for Forest Home organization through CircuiTree registration account.
See template
See template
Entity Professional Liability Insurance Application
PDF template
An insurance application form for healthcare entities seeking professional liability coverage for their practice and healthcare professionals.
See template
See template
Health Reimbursement Arrangement (HRA) Claim Form
PDF template
Claim form for health reimbursement arrangements for members of Operating Engineers Local #49, used to request reimbursement for eligible healthcare expenses.
See template
See template
Mid Central Operating Engineers Health And Welfare Fund Health Reimbursement (HRA) Account Reimburse
PDF template
A form for submitting health care expense reimbursement claims through a Health Reimbursement Arrangement (HRA) account.
See template
See template
Health Reimbursement Account (HRA) Claim Form
PDF template
A form for employees to submit healthcare expense reimbursement claims through their Health Reimbursement Account (HRA)
See template
See template
Service Request Form
PDF template
A comprehensive form for making various changes to an insurance policy, including beneficiary, name, address, and ownership modifications.
See template
See template
REQUEST FOR REIMBURSEMENT FORM
PDF template
A form for submitting healthcare expense reimbursement requests through the Southern California Pipe Trades Health & Welfare Fund HRA program.
See template
See template
Active Local Government And Local Education Employee Group Employee Coverage WaiverReinstatement For
PDF template
Form for New Jersey state employees to waive or reinstate health benefits coverage under the State Health Benefits Program (SHBP) or School Employees' Health Benefits Program (SEHBP).
See template
See template
Supplemental Insurance Cancellation Form
PDF template
A form for employees to cancel pre-tax and post-tax supplemental insurance deductions with specified effective date.
See template
See template
International Travel Authorization Request
PDF template
A form for requesting and documenting international travel for university employees, students, and volunteers, including safety and risk assessment details.
See template
See template
Claim Form
PDF template
A form for seeking reimbursement of eligible out-of-pocket expenses with participant certification and submission instructions.
See template
See template
Health Savings Account (HSA) Contribution Form
PDF template
A form for employees to enroll in and specify Health Savings Account (HSA) contributions, including eligibility requirements and tax considerations.
See template
See template
Health Savings Account (HSA) Contribution Form
PDF template
A form for individuals to make contributions to their Health Savings Account through various deposit methods.
See template
See template
HSA Enrollment Form
PDF template
A form for employees to enroll in a Health Savings Account (HSA) with employer contribution and payroll deduction options.
See template
See template
Health Savings Account FAQs
PDF template
Comprehensive guide explaining Health Savings Accounts (HSAs), their benefits, eligibility, and tax advantages for participants.
See template
See template
Health Savings Account Payroll Deduction 2021
PDF template
Form for employees to authorize health savings account contributions through payroll deduction for qualified high deductible medical plans.
See template
See template
Health Savings Account (HSA) Payroll Deduction Form
PDF template
A form for employees to establish, change, or stop payroll deductions for their health savings account (HSA)
See template
See template
Health Savings Account Payroll Deduction Form
PDF template
Form for employees to set up payroll deductions for a Health Savings Account with High Deductible Health Plan coverage details.
See template
See template
BlueFund HSA Payroll Deduction Form
PDF template
A form for employees to set up payroll deductions for a Health Savings Account (HSA) with contribution guidelines and instructions.
See template
See template
HSA Transfer Request Form
PDF template
A form for transferring Health Savings Account assets between custodians or trustees, potentially involving a former spouse in a divorce scenario.
See template
See template
Concurrent Enrollment Agreement
PDF template
Application for high school students to enroll concurrently in college courses at Northeastern State University
See template
See template
HSR Special Risk Claim Form Fill Able
PDF template
Comprehensive guide for filing a special risk insurance claim, detailing required documentation and submission process.
See template
See template
State University Of New York Medical Reimbursement Form Claims Incurred Outside Of The United States
PDF template
A medical reimbursement form for SUNY employees and members to claim medical expenses incurred outside the United States.
See template
See template
Prescription Reimbursement Form
PDF template
A form for submitting prescription drug expenses for insurance reimbursement, requiring patient and prescription details.
See template
See template
HUDESGSTEHP ES PREV DISCHARGE
PDF template
A form used to collect universal data elements and income/benefits information when a client exits a homeless shelter or prevention program.
See template
See template
Voluntary Benefits Whole Life Cash Surrender, Dividend Withdrawal, Cancellation And Loan Request For
PDF template
A form for managing whole life insurance policy transactions including cash surrender, dividend withdrawal, cancellation, and policy loans.
See template
See template
HGG Warranty Claim Form
PDF template
A warranty claim form for Huttig-Guard fastener products to document potential product defects and request warranty service.
See template
See template
Record Of Employment
PDF template
A form for documenting employment status for unemployment insurance purposes in New York State.
See template
See template
Record Of Employment
PDF template
A form for documenting employment details for unemployment insurance claims in New York State.
See template
See template
Newborn Notification Of Delivery Form
PDF template
Healthcare form for providers to report newborn details for Amerigroup Iowa, Inc. Medicaid members within 24 hours of delivery.
See template
See template
Iowa Accident Report Form
PDF template
Official form for reporting motor vehicle accidents in Iowa involving death, injury, or property damage over $1,000.
See template
See template
Irrevocable Burial Trust Form
PDF template
A comprehensive form for documenting personal, financial, and funeral service preferences with detailed client and next of kin information.
See template
See template
Cancel My Insurance Cover
PDF template
Form for members to cancel some or all of their insurance coverage with Brighter Super for Local Government & Associated Industries.
See template
See template
Patient Discharge Form
PDF template
A comprehensive form for documenting patient discharge details, medical treatment, and follow-up information.
See template
See template
Patient Intake Form Template
PDF template
A comprehensive form for collecting patient personal, medical, insurance, and payment information during initial healthcare visit.
See template
See template
ICSVEBA 2021 Back To School E Kit Guide
PDF template
Comprehensive benefits enrollment guide for San Pasqual Valley Unified School District employees for the 2021-2022 school year
See template
See template
MVA Report Form 111121
PDF template
A comprehensive form for reporting details of a motor vehicle accident for insurance and workplace documentation purposes.
See template
See template
INDIVIDUAL AND FAMILY GROUP TERM LIFE INSURANCE
PDF template
Comprehensive employer manual detailing group term life insurance policy guidelines, coverage, enrollment, and claims processing.
See template
See template
Personal Automobile Policy Change Form
PDF template
A form for making changes to a personal automobile insurance policy, including options to reject certain coverages.
See template
See template
Minutes Of The Meeting Of The New Jersey Individual Health Coverage Program Board
PDF template
Official minutes documenting the meeting of the New Jersey Individual Health Coverage Program Board, including staff reports and board actions.
See template
See template
Direct Deposit Form
PDF template
Form for setting up or updating direct deposit payment instructions for Independent Life Insurance Company
See template
See template
Incident Report Form
PDF template
A comprehensive form for reporting incidents across various settings, capturing details about the event, location, and involved parties.
See template
See template
New York State PTA Incident Report Form
PDF template
A detailed form for documenting incidents, accidents, or injuries during PTA-related activities or events.
See template
See template
Incident Report Form
PDF template
A comprehensive form for documenting incidents resulting in bodily injury during approved club activities or potential insurance issues.
See template
See template
RESIDENT DAMAGESINCIDENT CLAIM FORM
PDF template
A form for reporting property damage or personal injury incidents for residents to document details and submit to management.
See template
See template
Incident Report Form
PDF template
A form for documenting and reporting incidents, injuries, or accidents within an organization or club setting.
See template
See template
Incident Reporting Procedure
PDF template
Comprehensive procedure defining incident types and reporting requirements for various critical events in family and child services.
See template
See template
Incoming Loan Agreement
PDF template
A form for borrowing artwork or objects for temporary exhibition, detailing loan conditions, insurance, shipping, and signatures.
See template
See template
Surety Program Application
PDF template
Application for surety bond program with details on fees, levels, and payment terms for potential applicants.
See template
See template
How To Use Your New Caremark Prescription Drug Program
PDF template
Guide explaining new prescription drug coverage details for county employees through Caremark beginning January 1, 2011.
See template
See template
IRO Annual Report
PDF template
Annual reporting form for Independent Review Organizations detailing external health insurance review processes in Oklahoma.
See template
See template
Indirect Membership Agreement
PDF template
A membership and loan agreement document outlining membership eligibility, insurance requirements, and authorization for joining Lewis Clark Credit Union.
See template
See template
Initial Disability Claim Form
PDF template
Insurance claim form for reporting initial disability claims, covering policyholder and patient information related to sickness or injury.
See template
See template
Individual Life Insurance Application Outline
PDF template
Comprehensive guidelines for submitting individual life insurance application forms to regulatory authorities through the SERFF system.
See template
See template
Form 2C Uniform Certificate Of Authority Application (UCAA) Corporate Amendments Application
PDF template
A form used by insurance companies to request changes to their existing certificate of authority across multiple states.
See template
See template
Uniform Certificate Of Authority Application (UCAA) Corporate Amendments Application Checklist
PDF template
A checklist and guide for insurers submitting corporate amendments to their certificate of authority application.
See template
See template
Uniform Certificate Of Authority Application (UCAA) Expansion Application Checklist
PDF template
A comprehensive checklist for insurance companies seeking to expand their operational jurisdictions and obtain new insurance authority.
See template
See template
Form 2C Uniform Certificate Of Authority Application (UCAA) Corporate Amendments Application
PDF template
A comprehensive form for insurance companies to request amendments to their existing certificate of authority across multiple U.S. states and territories.
See template
See template
Uniform Certificate Of Authority Application (UCAA) Expansion Application
PDF template
A form for insurance companies to apply for expansion of business lines across multiple states in the United States.
See template
See template
West Virginia Informational Letter No. 1 A
PDF template
Guidelines for insurance companies regarding policy cancellation notices and policyholder rights in West Virginia.
See template
See template
Informed Risk Insurance Form For Allied Health Students
PDF template
A document detailing potential infectious disease risks for allied health students and insurance requirements during clinical studies.
See template
See template
Mortgage Full Discharge Request
PDF template
A form for completely discharging a loan by paying out with own funds, refinancing, or selling property without other loans attached.
See template
See template
ING Discharge Authority
PDF template
Guidelines for initiating a mortgage discharge with ING Bank in Australia.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims to an insurance provider, detailing patient, pharmacy, and insurance information.
See template
See template
Initial Disability Claim Form
PDF template
Insurance claim form for reporting initial disability claim with details about injury, hospitalization, and patient information.
See template
See template
Initial Disability Claim Form
PDF template
Insurance claim form for reporting initial disability due to sickness or injury, used by Aflac to process insurance claims.
See template
See template
Notice Of Injury And Claim
PDF template
Official state form for filing a notice of injury or damage claim against the State of Wisconsin as required by state statute.
See template
See template
Injury Incident Report Workers Compensation
PDF template
A form documenting workplace injury incidents with no medical treatment required, used for tracking workplace safety and potential compensation claims.
See template
See template
Injury And Third Party Liability Form
PDF template
A form for documenting injuries potentially involving third-party liability for the Southern California Pipe Trades Health & Welfare Fund.
See template
See template
Empire Life Participating Whole Life Additional Deposit Option (ADO)
PDF template
Guide explaining the Additional Deposit Option for Empire Life participating whole life insurance policies, detailing benefits and eligibility for purchasing additional Paid Up Additions.
See template
See template
CERTIFICATE REQUEST FORM
PDF template
Form for requesting insurance certificates with coverage details for Colorado State University.
See template
See template
Reimbursement Account Claim Form
PDF template
Claim form for submitting healthcare and dependent care expenses for reimbursement through a flexible spending account or reimbursement account.
See template
See template
Instruction Kit For Form No. IEPF 5
PDF template
A comprehensive instruction kit for users to fill out Form IEPF-5 for claiming unpaid amounts and shares from the Investor Education and Protection Fund.
See template
See template
CMS 1500 Claim Form Instructions
PDF template
Detailed instructions for completing the CMS 1500 form for medical service billing to SFHP by healthcare providers.
See template
See template
INSTRUCTIONS FOR PRE AUTHORIZATION FORM
PDF template
Detailed instructions for completing a pre-authorization form for medical procedures and services at Kaiser Permanente.
See template
See template
Insurance And Safety Policy
PDF template
Policy document outlining safety standards and insurance coverage for Seventh-day Adventist Medical Cadet Corps activities in Florida.
See template
See template
MOTOR VEHICLE INSURANCE AGENT INSURANCE BINDER CANCELLATION FORM
PDF template
Official form for cancelling a temporary motor vehicle insurance binder in Kentucky, required by state regulation.
See template
See template
SPD SP048 Insurance And Bonding Guidelines
PDF template
Comprehensive guide detailing insurance types, limits, certificates, and bonding recommendations for vendors and contractors working with Georgia state entities.
See template
See template
Certificate Of Insurance Form
PDF template
Insurance requirements and guidelines for parade participants, mandating a minimum $2 million public liability insurance policy.
See template
See template
Certificate Of Insurance Form
PDF template
Insurance requirements and documentation for parade participants at Westerner Days Fair and Exposition
See template
See template
INSURANCE FINANCIAL POLICY
PDF template
A comprehensive financial policy document outlining insurance billing, payment expectations, and patient responsibilities for chiropractic services.
See template
See template
Insurance Form 1
PDF template
Details insurance coverage requirements for contractors, specifying minimum insurance limits across multiple categories.
See template
See template
Insurance Form 1
PDF template
Detailed insurance requirements for a contract, specifying minimum insurance limits and coverage types for a seller.
See template
See template
Insurance Requirements Form
PDF template
A document outlining insurance requirements and indemnification terms for vendors participating in a Rotary Club event.
See template
See template
Insurance Form 2
PDF template
Detailed insurance coverage requirements for a seller, specifying minimum insurance limits and types of coverage needed for contractual performance.
See template
See template
Dental Insurance Information
PDF template
Insurance form for collecting patient dental insurance details and treatment consent
See template
See template
KAPOS Insurance Information Form
PDF template
A form to collect insurance and personal details for team participation in a regional competition.
See template
See template
Insurance Form Filing Procedures
PDF template
Official document outlining procedures for submitting insurance form filings through the System for Electronic Rate and Form Filing (SERFF) for the District of Columbia.
See template
See template
Insurance Form For Residence Hall Students
PDF template
Form for collecting student health insurance information for residential students at Monroe Community College.
See template
See template
Insurance Information And Authorization Form
PDF template
Medical insurance and patient authorization document for Drs. Mark and Suzanne Boas' eyecare practice, collecting patient insurance details and financial responsibilities.
See template
See template
NEW PATIENT INFORMATION SHEET
PDF template
Comprehensive patient intake form for collecting personal, contact, and insurance information for new patients at the university student health center.
See template
See template
Student Athlete Insurance Information Form
PDF template
A comprehensive insurance information form for student-athletes at Kutztown University to provide medical and contact details.
See template
See template
Insurance Reference Manual
PDF template
Comprehensive insurance manual for Moose International lodges, chapters, and associated organizations covering various insurance programs and risk management guidelines.
See template
See template
Insurance Form
PDF template
Form for requesting, canceling, or changing insurance coverage for members of iQ Super For Life and iQ Super Business.
See template
See template
CA.04 21.REF.05 Insurance Terms And Conditions
PDF template
Detailed insurance guidelines and requirements for applicants seeking an encroachment agreement with the City of Mississauga.
See template
See template
PARKS RECREATION DEPARTMENT PERMIT INSURANCE REQUIREMENTS
PDF template
Detailed guidelines for insurance requirements for organizations seeking permits for events in Palm Beach County Parks & Recreation Department
See template
See template
Insurance WaiverChange Of Address
PDF template
A document for patients to waive insurance coverage and update contact information for medical services.
See template
See template
Change Of Address Form
PDF template
Official form for updating company contact and address information with the Nevada Division of Insurance.
See template
See template
Insuring Technology Risks In A Professional Environment
PDF template
A white paper addressing technology-related risks and insurance considerations for professional engineering practices.
See template
See template
Primary Eyecare Associates Patient Form
PDF template
Comprehensive medical and vision history intake form for eye examination and patient records.
See template
See template
Patient Intake Form
PDF template
A comprehensive patient intake document for collecting detailed personal, medical, and contact information at a memory clinic.
See template
See template
Adult Patient Intake Form
PDF template
Comprehensive medical intake form for collecting patient personal, contact, emergency, and insurance information for medical treatment.
See template
See template
New Patient Intake Form
PDF template
Comprehensive form for collecting patient demographic, contact, insurance, and scheduling information for new healthcare patients.
See template
See template
NEW PATIENT INTAKE FORM
PDF template
Comprehensive medical and insurance information form for new patients, focusing on vision and health insurance details.
See template
See template
Patient Intake Form
PDF template
Comprehensive patient intake form collecting personal information, medical history, insurance details, and pre-examination assessment for medical treatment.
See template
See template
Claim Form ICS Non Medical Expenses Aon Student Insurance
PDF template
A comprehensive claim form for reporting various types of non-medical insurance damages and losses for student insurance policies.
See template
See template
Neighborhood Health Plan Of Rhode Island (NHPRI) DME Authorization Form
PDF template
Healthcare authorization form for durable medical equipment (DME) services from Neighborhood Health Plan of Rhode Island
See template
See template
Interlocal Contact Form
PDF template
A form for submitting contact details for interlocal entities to the Oklahoma Insurance Department.
See template
See template
International Claim Form
PDF template
A comprehensive form for submitting international healthcare insurance claims with patient and coverage details.
See template
See template
International Student Insurance Refund Request
PDF template
A form for international students studying remotely due to COVID-19 to request a health insurance refund for the Spring 2023 semester.
See template
See template
Intern Medical Treatment Authorization Form
PDF template
Medical authorization form for interns to provide emergency treatment details and contact information in case of medical incidents.
See template
See template
INTERNSHIPFIELD EXPERIENCE RESPONSIBILITIES AGREEMENT
PDF template
Legal document outlining responsibilities, insurance requirements, and liability terms for student internships and field experiences.
See template
See template
Internship Learning Agreement Form
PDF template
A comprehensive agreement outlining student responsibilities, expectations, and legal considerations during an internship placement.
See template
See template
University Of Oregon Controlled Substance Inventory Form
PDF template
A document used to track and record inventory of controlled substances within an institutional setting.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for refrigeration equipment repairs and service requests.
See template
See template
Salesian College IPad LossDamage Report Form
PDF template
A form for reporting lost, stolen, or damaged iPads at Salesian College with details about the incident and insurance claim process.
See template
See template
Medicare Part B Income Related Monthly Adjustment Amount (IRMAA) Reimbursement Form
PDF template
Form for NYC employees to request reimbursement for Medicare Part B premiums exceeding standard monthly amounts.
See template
See template
ISS Trip Liability Waiver Form
PDF template
A legal waiver form for students participating in an ISS trip, releasing the University at Buffalo from liability for potential injuries or damages.
See template
See template
Scholars Insurance Compliance Form
PDF template
A form for verifying health insurance requirements for international scholars, conforming to US Department of State guidelines.
See template
See template
Patient Intake Form
PDF template
Comprehensive medical intake document collecting patient personal, contact, insurance, and consent information for medical services.
See template
See template
Job Application Form
PDF template
Comprehensive job application form for potential employees seeking work at Jones & Associates Insurance, collecting personal, employment, and educational information.
See template
See template
JudicialCourt Bond Application
PDF template
Application form for obtaining a judicial or court bond for legal proceedings, used by attorneys or law firms.
See template
See template
FSCS Newsletter
PDF template
Newsletter from FSCS detailing changes to pension application forms for seven specific firms, including new mandatory questions and document requirements.
See template
See template
Artwork Loan Agreement
PDF template
A legal agreement for loaning artwork to The Joy & Whimsy Depot for exhibition purposes, outlining responsibilities of the lender and the exhibitor.
See template
See template
Designation Of Beneficiary For Life Insurance
PDF template
Form for Kansas Board of Regents members to designate life insurance beneficiaries for KPERS group life insurance benefits.
See template
See template
DESIGNATION OF BENEFICIARY FOR LIFE INSURANCE KANSAS BOARD OF REGENTS MEMBERS
PDF template
Official form for Kansas Board of Regents members to designate life insurance beneficiaries for KPERS insurance benefits.
See template
See template
Kentucky Assigned Claims Plan Billing Summary Form
PDF template
A detailed form for submitting reimbursement requests and subrogation recoveries for insurance claims in Kentucky's Assigned Claims Plan.
See template
See template
Kentucky Assigned Claims Plan Billing Summary Form
PDF template
Detailed guide for insurers on submitting reimbursement requests and subrogation details for the Kentucky Assigned Claims Plan.
See template
See template
Kaiser Permanente Payment Selection Form
PDF template
A form for selecting automatic payment methods via bank account or credit card for Kaiser Permanente services.
See template
See template
Member Reimbursement Form For Medical Claims
PDF template
A comprehensive form for submitting medical claim reimbursement requests, including patient and provider details.
See template
See template
Kaiser Permanente Senior Advantage (HMO) Group Medicare Election Form
PDF template
Form for enrolling in Kaiser Permanente's Senior Advantage Medicare health plan for group participants.
See template
See template
Keenan Insurance Scholarship Guidelines 2024
PDF template
Guidelines for a scholarship program administered by the Foundation for California Community Colleges, providing funding for students in insurance and related fields.
See template
See template
Keenan Insurance Scholarship Guidelines 2024
PDF template
Guidelines for a scholarship program providing financial support to California Community College students studying insurance and related fields.
See template
See template
Key Facts You Need To Know About Helping Families That Include Immigrants Apply For Health Coverage
PDF template
A guide explaining health coverage application processes and eligibility for families that include immigrants, addressing key concerns and immigration status implications.
See template
See template
SEWAGE DISCHARGE FORM
PDF template
Official report of a combined sewer overflow (CSO) discharge event in Kingston, New York, detailing location, volume, and environmental impact.
See template
See template
Aflac Cancer Wellness Claim Form
PDF template
Document providing guidance on filing wellness claims with Aflac insurance and information about Primary Care Provider (PCP) selection.
See template
See template
Member Reimbursement Form For Over The Counter COVID 19 Tests
PDF template
A form for Kaiser Permanente members to request reimbursement for over-the-counter COVID-19 test purchases.
See template
See template
Property Damage Report Form
PDF template
A form for documenting property damage incidents on university premises, used to record details of loss, damage, or theft.
See template
See template
Competition Entry Form
PDF template
Entry form for a national insurance customer service representative award recognizing excellence in professional performance.
See template
See template
Loan Discharge Application False Certification Of Ability To Benefit
PDF template
A federal loan discharge application for students or parents claiming false certification of ability to benefit from an educational program.
See template
See template
Change Of Ownership Form Life Insurance
PDF template
A form for transferring ownership of a life insurance policy between parties, including options for individual and trust ownership transfers.
See template
See template
Incident Report Form For Bodily Injury
PDF template
Insurance form for documenting details of a bodily injury incident, likely related to cycling or athletic events.
See template
See template
Chronic Illness Benefit Application Form
PDF template
Application form for patients seeking chronic illness benefits through LA Health Medical Scheme, requiring patient and medical professional details.
See template
See template
Bessie Marshall Benefit Fund Instructions
PDF template
Detailed instructions for members to apply for weekly benefits in case of sickness or injury, with specific eligibility requirements and limitations.
See template
See template
Ladies Auxiliary To The Maryland State FiremenS Association Bessie Marshall Benefit Fund Instructi
PDF template
Benefit fund guidelines for sick or injured members of the Maryland State Firemen's Association providing weekly financial assistance under specific conditions.
See template
See template
PROOF OF DISABILITY CLAIM FORM
PDF template
A form for employees to document and claim disability benefits through the Labor Alliance Managed Trust Fund.
See template
See template
Circular Letter 241 Of The Commissariat Aux Assurances On The Insurance Agencies Annual Reporting
PDF template
Official document providing instructions for insurance agencies' annual reporting requirements and submission process for the year 2024.
See template
See template
Claim Form Unclaimed Funds Over Three Years Old
PDF template
A form for claiming unclaimed funds held by the City of La Caada Flintridge that are over three years old.
See template
See template
INSURANCE PRE AUTHORIZATION FORM
PDF template
A form for collecting client and insurance details for pre-authorization of therapeutic services.
See template
See template
Dealership Cancellation Form
PDF template
A form for cancelling a dealer's mechanical breakdown insurance policy with options for various cancellation reasons and refund processing.
See template
See template
Addendum To Lease
PDF template
Supplemental lease agreement outlining additional tenant responsibilities, rent payment terms, and property conduct rules.
See template
See template
Leer Inc. Walk In Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for walk-in units, capturing customer, job site, service provider, and reimbursement information.
See template
See template
Cancellation Form
PDF template
A form for employees to cancel or continue legal resources and identity theft plan coverage during employment termination or open enrollment.
See template
See template
ARAG Legal Insurance LLNS Benefit Program Summary
PDF template
Summary of legal insurance benefits for employees and retirees under the LLNS Health and Welfare Benefit Plan
See template
See template
ARAG Legal Insurance LANS Benefit Program Summary
PDF template
Summary of legal insurance benefits for LANS employees and retirees, effective January 1, 2017.
See template
See template
Friction Warranty Claim Form
PDF template
A form for submitting warranty claims for friction products with detailed instructions and warranty terms.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for employees to file a disability claim, documenting injury/illness details, personal information, and income sources.
See template
See template
Warranty Claim Form
PDF template
A detailed form for submitting warranty claims for machinery, requiring comprehensive documentation and specific details about equipment failure.
See template
See template
Maryland Insurance Administration Complaint Form Life And Health Insurance
PDF template
Official form for submitting complaints about insurance companies to the Maryland Insurance Administration, covering various insurance types and policy details.
See template
See template
Review Requirements Checklist Group Accident Only And Indemnity Insurance
PDF template
A comprehensive checklist for insurance carriers to submit group accident and indemnity insurance forms for approval in Virginia.
See template
See template
Long Term Care Applications Review Requirements Checklist
PDF template
A comprehensive checklist for insurance carriers preparing long-term care application form filings for approval by the Virginia Bureau of Insurance.
See template
See template
Liability And Indemnity Agreement
PDF template
Legal agreement outlining contractor responsibilities, indemnification, and insurance requirements for performing work in the Town of West Hartford.
See template
See template
Personal Liability Claim Form
PDF template
A comprehensive form for filing a personal liability insurance claim, specifically related to travel incidents.
See template
See template
City Of South Gate Liability Claim Form
PDF template
Official form and instructions for filing a liability claim against the City of South Gate for personal injury or property damage.
See template
See template
City Of South Gate Liability Claim Form
PDF template
Official form for filing a liability claim with the City of South Gate for personal injury or property damage.
See template
See template
Liability Insurance Form
PDF template
A form for obtaining a certificate of insurance and listing additional insured parties for facility usage events.
See template
See template
Professional Liability Insurance For Nurse Aide Students
PDF template
Insurance option for nurse aide students providing professional liability coverage with policy limits between $1,000,000 and $3,000,000.
See template
See template
UNIVERSITY DAY LIABILITY RELEASE FORM
PDF template
A legal document for releasing liability and providing medical consent for campus visitors to Franciscan University of Steubenville.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for employees to report disability, injury, or illness for benefits claim purposes.
See template
See template
EmployerS Statement For Disability Insurance
PDF template
Comprehensive employer documentation form for reporting employee disability insurance details and work status
See template
See template
Contractor License Application
PDF template
A comprehensive application form for obtaining a contractor license in Pennington County, South Dakota, with detailed requirements and checklist.
See template
See template
License Cancellation Request Form 206
PDF template
Official form for cancelling various types of insurance-related licenses in the State of New Mexico.
See template
See template
Long Term Disability Insurance, Short Term Disability Insurance, And Term Life Insurance FAQs
PDF template
Comprehensive FAQ document about disability and life insurance options for New Mexico Judicial Branch judges, attorneys, and magistrates through Principal Financial Group.
See template
See template
LIFE INSURANCE FORM
PDF template
A form for employees to designate primary and contingent life insurance beneficiaries with personal and contact information.
See template
See template
Group Term Life Insurance Enrollment Form
PDF template
An enrollment form for group term life insurance for employees, specifically for Episcopal Church clergy and employees
See template
See template
Retiree Life Cancellation Form
PDF template
Form for cancelling retiree life insurance coverage with UCM Benefits Group, with a warning that once cancelled, participation cannot be reinstated.
See template
See template
AAFMAA Beneficiary Designation Form
PDF template
A form for designating life insurance beneficiaries and selecting policy coverage details for AAFMAA members.
See template
See template
Beneficiary Designation Form
PDF template
A form for designating primary and contingent beneficiaries for an employee life insurance benefit plan.
See template
See template
Life Insurance Enrollment Form
PDF template
Insurance enrollment form for employees to select life and dependent life insurance coverage through Reliance Standard Life Insurance Company
See template
See template
Life Insurance Service Request Form
PDF template
A form for making changes to a life insurance certificate, including personal information updates and policy modifications.
See template
See template
Warranty Claim Form
PDF template
A warranty claim document for documenting product failure, repairs, and reimbursement details for industrial equipment.
See template
See template
State Of Florida Group Long Term Disability Claim Form
PDF template
A comprehensive claim form for employees seeking long-term disability benefits through the State of Florida's insurance program administered by Cigna.
See template
See template
Life Solutions COVID 19 Impacts Frequently Asked Questions
PDF template
Document providing guidance on Lincoln Financial Group's operational changes and policies during the COVID-19 pandemic for financial professionals.
See template
See template
ENROLLMENT FORM FOR GROUP INSURANCE
PDF template
Insurance enrollment form for employees of Ashland School District to select various life and disability coverage options
See template
See template
Adult LIPOS Private BedPHPAdmissionUtilization Form
PDF template
A form for documenting admission and utilization details for mental health hospital or partial hospitalization program (PHP) services.
See template
See template
ADULT LIPOS PRIVATE BED PHP DISCHARGE FORM
PDF template
A discharge form for inpatient psychiatric or Partial Hospitalization Program services documenting patient transfer and clinical disposition.
See template
See template
Youth LIPOS Funding Discharge Form
PDF template
Form for documenting discharge and funding verification for youth psychiatric inpatient or partial hospitalization services without insurance coverage.
See template
See template
LLNS Prescription Drug Benefit For Anthem Members
PDF template
A summary of prescription drug benefits for Anthem members provided by CVS/Caremark, covering retail and mail-order pharmacy options.
See template
See template
Vessel Liveries Inspection Form
PDF template
Inspection form for boat rental businesses to ensure safety standards and liability compliance at Lake Norman.
See template
See template
LOAN AGREEMENT REPAYMENT FORM
PDF template
A form for policyholders to document and agree to loan repayment terms for their life insurance policy.
See template
See template
Loan Application Form
PDF template
A form detailing loan terms and conditions for policyholders seeking to borrow against their life insurance policy's surrender value.
See template
See template
Application For First Loan In Respect Of Policies Prior To 1 6 69
PDF template
Application form for obtaining a loan against a life insurance policy from the Life Insurance Corporation of India, with specific terms and conditions.
See template
See template
Loan Application Form
PDF template
A loan application form for borrowing money against a life insurance policy from the Eswatini Royal Insurance Corporation (ESRIC).
See template
See template
Loan Service Request Form SubordinationPayoffDischarge
PDF template
A form for requesting loan services including payoff statements, loan discharge, and subordination from the Providence Department of Housing & Human Services.
See template
See template
Local Membership Expense Claim Form
PDF template
A comprehensive expense claim form for Ontario Public Service Employees Union members to document and request reimbursement for various expenses.
See template
See template
NJDOBI Location Of Records Agreement Form
PDF template
A legal agreement between a licensee and the New Jersey Department of Banking and Insurance regarding the storage and accessibility of business records.
See template
See template
Lodge Transfer Request Form
PDF template
A form for members to request transfer of their lodge membership to a different location or lodge chapter.
See template
See template
Lodge Transfer Request Form
PDF template
Form for requesting transfer of lodge membership to another location or lodge within Hermann Sons Life organization.
See template
See template
Disability Claim Form FL
PDF template
A comprehensive form for filing a disability insurance claim with detailed sections for employer and employee information.
See template
See template
Student Blanket Insurance Policy Disability Claim Form
PDF template
A comprehensive form for students to file a disability insurance claim, documenting medical conditions, educational status, and treatment details.
See template
See template
Long Term Disability Insurance For Judges Attorneys FAQs
PDF template
Informational document about long-term disability insurance options for New Mexico Judicial Branch judges and attorneys through Northwestern Mutual.
See template
See template
Lost Instrument Bond Application
PDF template
A legal form used to apply for a bond when an original financial instrument has been lost, requiring comprehensive applicant information.
See template
See template
Group Health Claim Form
PDF template
A comprehensive form for submitting healthcare claims for employees, spouses, and dependents under the LSU First Health Plan.
See template
See template
Invoice For Independent Health Care Providers
PDF template
A form for independent healthcare providers to record time and cost of care services provided to insured individuals under a long-term care insurance policy.
See template
See template
Long Term Care Insurance Medical History Form
PDF template
A medical history form for long-term care insurance professionals to collect patient health information for underwriting purposes.
See template
See template
Insurance Cancellation Request
PDF template
A form for employees to request cancellation of group insurance coverage, specifically long-term disability insurance.
See template
See template
Group LTD Insurance Cancellation Form
PDF template
Form for employees to cancel voluntary long-term disability insurance coverage with Tennessee Board of Regents
See template
See template
2024 LTD Change Form
PDF template
Form for employees to select or modify their Long-Term Disability (LTD) coverage options at the University of Rochester
See template
See template
Long Term Disability Claim Form
PDF template
A claim form for employees to submit long-term disability insurance claims with personal and medical information.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for filing a disability insurance claim, requiring input from the member, plan sponsor, and attending physician.
See template
See template
Group Long Term Disability Claim Form
PDF template
A comprehensive claim form for employees seeking long-term disability benefits, requiring details from both the employee and attending physician.
See template
See template
Long Term Disability Claim Form Employer Statement
PDF template
Comprehensive employer statement form for filing a long-term disability insurance claim, capturing employee and claim details.
See template
See template
Long Term Disability Claim Form Statement Of Employer
PDF template
A form used by employers to submit details for an employee's long-term disability insurance claim with Lincoln Financial Group.
See template
See template
NRECA Long Term Disability Plan Summary Plan Description
PDF template
A comprehensive summary plan description detailing the long-term disability benefits provided by the National Rural Electric Cooperative Association for eligible participants.
See template
See template
LU 1071 (11 20) Policy Change Form
PDF template
A form for making changes to an existing life insurance policy, including coverage, payment mode, and payor details.
See template
See template
LAMAR UNIVERSITY UNIVERSITY INSURANCE POLICY
PDF template
Policy governing insurance procurement and risk management for Lamar University, defining institutional approaches to purchasing property, liability, and other non-benefit insurance.
See template
See template
Fax Referral Form
PDF template
A comprehensive medical referral form for patient information, insurance details, and provider selection in pulmonary and sleep medicine.
See template
See template
Liability Waiver Form
PDF template
A municipal form for waiving insurance requirements for building and construction-related permit applications in Boston.
See template
See template
Digital Application For Contraception Management Member Reimbursement Form
PDF template
A form for members to request reimbursement for digital contraception management application subscriptions under their Blue Cross and Blue Shield of Minnesota plan.
See template
See template
Emergency Contact Form
PDF template
A form for parents to provide comprehensive emergency contact, health, and medical information about their child
See template
See template
Medical Claim Form
PDF template
A form for submitting out-of-network medical claims for reimbursement by UnitedHealthcare for Pennsylvania members.
See template
See template
WARRANTY RETURN CLAIM FORM
PDF template
A warranty claim form for vehicle parts with detailed sections for dealer, customer, vehicle, and part replacement information.
See template
See template
Workers Compensation Audit Report Form
PDF template
A detailed form for documenting payroll, employee information, and policy details for workers compensation insurance auditing purposes.
See template
See template
Group Life Insurance Application
PDF template
Application for employees to select group life insurance coverage options for themselves and dependents.
See template
See template
Professional Liability Insurance Form
PDF template
Form for medical doctors to provide professional liability insurance details for employment with Research Foundation for Mental Hygiene, Inc.
See template
See template
Malpractice Payment Report Form For Insurance Companies
PDF template
Official form for reporting medical malpractice judgments and settlements in Alabama by insurance companies and healthcare entities.
See template
See template
Managed Care Referral Form
PDF template
A medical referral form for Blue Cross and Blue Shield of Minnesota managed care patients requiring specialist or additional medical services.
See template
See template
Mandatory Travel Form
PDF template
A required form for documenting details of Sport Club travel, including participant information and trip itinerary for insurance purposes.
See template
See template
Medical History Form
PDF template
A comprehensive medical form for camp participants to document health information, emergency contacts, and treatment authorization.
See template
See template
PolicyholderS Change And Service Request
PDF template
A form for making changes to a ManhattanLife insurance policy, including coverage modifications, beneficiary updates, and personal information changes.
See template
See template
Manual Claim Form
PDF template
Form for submitting out-of-pocket healthcare expense claims for reimbursement through Flexible Spending Accounts (FSAs) or Health Reimbursement Arrangements (HRAs).
See template
See template
Extended Health Care Claim
PDF template
Insurance claim form for submitting extended healthcare expenses to Manufacturers Life Insurance Company group benefits plan.
See template
See template
Massachusetts Property Insurance Underwriting Association Producers Operations Manual
PDF template
A comprehensive manual for licensed insurance producers in Massachusetts detailing procedures and guidelines for placing business with the Association.
See template
See template
Marketplace Appeal Request EAII Form (062019)
PDF template
A form for appealing decisions related to health insurance marketplace eligibility and financial assistance.
See template
See template
Marketplace Medical Claim Form
PDF template
A comprehensive form for submitting medical insurance claims, including subscriber and patient information, accident details, and coverage information.
See template
See template
Life Insurance Service Request Form
PDF template
A form for making service requests related to a life insurance certificate, including changes to premium loan, dividend options, and cash loan requests.
See template
See template
Material Damage Proposal
PDF template
Insurance proposal form for documenting property details, insurance requirements, and risk assessment for material damage coverage.
See template
See template
Pregnancy Tips And Information For MUSC University Employees
PDF template
Comprehensive guide for MUSC university employees providing information about pregnancy-related benefits, insurance, and leave policies.
See template
See template
Short Term Disability Insurance For Maternity Leave
PDF template
A detailed explanation of short-term disability insurance coverage for maternity leave, including claim filing process and state-specific benefits.
See template
See template
Alcohol Service Request Form
PDF template
Form for requesting permission to serve alcohol at city facilities, requiring approval and documentation for event organizers.
See template
See template
Bank Account Withdrawal Pre Authorization Form
PDF template
A form allowing Medicare Advantage members to authorize electronic funds transfer for monthly plan premiums from their bank account.
See template
See template
Multnomah Bar Association Enrollment Application Change Of Information Form
PDF template
A comprehensive form for enrolling or making changes to membership or insurance coverage for Multnomah Bar Association members
See template
See template
Multnomah Bar Association EnrollmentChange Of StatusWaiver Form
PDF template
A comprehensive form for attorneys to enroll in or modify health insurance coverage through the Multnomah Bar Association.
See template
See template
MetroPlusHealth Wellness And Fitness App Reimbursement Program
PDF template
A program offering up to $300 per year in reimbursements for specific wellness and fitness mobile applications for MetroPlusHealth members.
See template
See template
Sharp Health Plan Reimbursement Request Form
PDF template
A form for submitting medical expense reimbursement claims to Sharp Health Plan with detailed instructions and personal information fields.
See template
See template
Insurance Declaration Form 1 To Participate In 2023 South Dakota 4 H Rodeo
PDF template
Insurance form for 4-H members to declare insurance coverage for participation in South Dakota 4-H Rodeo events
See template
See template
WARRANTY CLAIM FORM
PDF template
A detailed form for submitting warranty claims for vehicle parts, requiring comprehensive vehicle and failure information.
See template
See template
Vehicle Use Permit Power Of Attorney
PDF template
A legal document granting permission to another person to operate a specific vehicle at MCB Camp Lejeune
See template
See template
Exhibitor Appointed Contractors (EACs)Third Party Contractor Guidelines
PDF template
Guidelines for using third-party contractors at the MC2020 event, including requirements for insurance and contractor approval.
See template
See template
Chronic Illness Benefit Application Form 2024
PDF template
An application form for patients seeking chronic illness benefits through the MultiChoice Medical Aid Scheme for the year 2024.
See template
See template
MCO Discharge Form
PDF template
A comprehensive discharge form for behavioral health and recovery services tracking client status, diagnoses, and referral information.
See template
See template
CVS Caremark Mail Service Order Form
PDF template
A form for submitting prescription medication orders through CVS Caremark's mail service pharmacy program.
See template
See template
Medical Expense Claim Form
PDF template
A form for employees to claim medical expense reimbursements through their flexible spending account with detailed claim submission instructions.
See template
See template
Miami Dade County Employee Benefits
PDF template
Comprehensive overview of employee benefits package for Miami-Dade County employees, including insurance, retirement, and support services.
See template
See template
CLAIM FORM PART A
PDF template
A comprehensive form for filing health insurance claims, designed to collect detailed patient and insurance information.
See template
See template
Standardized Health Claim Form Model Regulation
PDF template
A model regulation for standardizing health care claim forms to reduce complexity and encourage electronic data interchange in healthcare billing and reimbursement.
See template
See template
MEDICAL BENEFITS SUBSCRIBER CLAIM FORM
PDF template
A comprehensive medical insurance claim form for submitting healthcare expense reimbursement and insurance details.
See template
See template
Medco By Mail Order Form
PDF template
A form for submitting prescription medication orders through Medco Health Solutions via mail, including payment and patient information.
See template
See template
Prescription Drug Reimbursement Form
PDF template
A form for submitting prescription medication reimbursement claims through an insurance or benefits program.
See template
See template
ENROLLMENT FORM
PDF template
A comprehensive form for employees to enroll in medical, dental, vision, and life insurance benefits with dependent information and coverage election details.
See template
See template
Medex Subscriber Claim Form
PDF template
A claim submission form for medical services processed by Blue Cross Blue Shield of Massachusetts for Medex subscribers.
See template
See template
Student Medical Form
PDF template
Comprehensive medical form collecting student health details, emergency contact information, and medical history for school purposes.
See template
See template
Medical History Form
PDF template
Instructions and form for students to provide medical history, immunization records, and insurance information for campus health services.
See template
See template
Studentsafe Inbound Medical Risk Assessment Form
PDF template
Insurance form for international students to disclose pre-existing medical conditions for coverage under Studentsafe insurance policy.
See template
See template
Subscriber Medical Claim Form
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient and insurance details.
See template
See template
H.P.T.R.6 MEDICAL CHARGES REIMBURSEMENT FORM
PDF template
A comprehensive form for employees to claim reimbursement of medical expenses with detailed documentation and verification requirements.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive form for submitting medical insurance claims, capturing patient and treatment details for reimbursement.
See template
See template
Medical Claim Form
PDF template
Insurance claim form for submitting medical expenses and travel-related healthcare claims with multiple payment options.
See template
See template
Medical Claim Form
PDF template
Form for submitting out-of-network health care claims to UnitedHealthcare for reimbursement of eligible medical services.
See template
See template
Medical Claim Form
PDF template
A form for submitting medical insurance claims with patient and insurance details for reimbursement processing.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive insurance claim form for submitting medical treatment claims, capturing patient and treatment details.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive medical insurance claim form for submitting healthcare treatment reimbursement or payment requests.
See template
See template
Claim Form To Pay InsuredSubscriber
PDF template
A comprehensive form for submitting medical insurance claims with details about patient, treatment, and coverage information.
See template
See template
Direct Member Reimbursement Form
PDF template
A form for AvMed members to request reimbursement for covered medical services by submitting documentation and details of treatment.
See template
See template
Medical Plan Enrollment Form
PDF template
Comprehensive form for enrolling in medical coverage, changing plans, or adding/dropping dependents for ACERA members.
See template
See template
Medical Consent Form
PDF template
Comprehensive medical form for collecting a child's health history, emergency contact information, and medication permissions.
See template
See template
Medical Form
PDF template
A comprehensive medical form for collecting student health information, emergency contacts, and parental consent for medical treatment.
See template
See template
Adult Confidential Medical Record
PDF template
A comprehensive medical form for collecting personal health information and emergency contact details for program participation.
See template
See template
Cottonwood Crossing Summer Institute Health Insurance And Medical History Form
PDF template
A form collecting student health information, insurance details, and medical emergency consent for a summer program participation.
See template
See template
MEDICAL HISTORY FORM
PDF template
A comprehensive form for collecting patient personal and insurance information for medical purposes.
See template
See template
MEDICAL HISTORY FORM
PDF template
Comprehensive form for collecting patient personal and insurance information for medical purposes.
See template
See template
MEDICAL HISTORY FORM
PDF template
Comprehensive medical history and personal health information form for students at Vanguard University's Health Center.
See template
See template
MSSU Willcoxon Health Center Medical History
PDF template
Comprehensive medical history and contact form for Missouri Southern State University students to provide health and emergency information.
See template
See template
University Health Center Medical Insurance Form
PDF template
A form for collecting student and insurance policy details for medical services at a university health center.
See template
See template
PATIENT INTAKE FORM PPOMEDICARESELF PAY
PDF template
Comprehensive patient registration form collecting personal, insurance, and financial information for medical services.
See template
See template
Medical Release FormPermission To Treat
PDF template
A comprehensive medical form for collecting personal, emergency contact, insurance, and medical information with treatment authorization.
See template
See template
Medical Liability Release Form
PDF template
A medical liability release form for HOSA delegates, parents, and guardians to attend conferences and experiences during the 2019-2020 academic year.
See template
See template
IM, Inc. ETEAM MEDICAL RELEASE FORM
PDF template
A comprehensive medical information and emergency contact form for gathering participant health details and insurance information.
See template
See template
Medical Liability Release Form
PDF template
A liability release form for HOSA delegates, parents/guardians, guests, and advisors to participate in conferences and experiences.
See template
See template
Medical Release Form
PDF template
A form to authorize the release of patient medical information for insurance claim processing.
See template
See template
Soapstone United Methodist Church Information, Permission And Medical Release Form For Adults
PDF template
A comprehensive medical release and information form for adults participating in church activities, including emergency contact and medical details.
See template
See template
USAV YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
A medical release form for youth and junior volleyball players to capture medical information, emergency contacts, and insurance details.
See template
See template
Youth Junior Volleyball Player Medical Release Form
PDF template
A comprehensive medical release and consent form for youth and junior volleyball players to participate in volleyball activities and competitions.
See template
See template
IUOE Local 4 Reimbursement Form
PDF template
Medical reimbursement form for IUOE Local 4 members seeking compensation for DOT physical exams, massage therapy, and related services.
See template
See template
New York Health Benefits Waiver Of Coverage
PDF template
Form for employees to decline group health insurance coverage and document alternative coverage status
See template
See template
Direct Member Reimbursement Request Form
PDF template
A form for Medicare plan members to request reimbursement for dental, eyewear, and hearing aid services.
See template
See template
Medical Reimbursement Request Form
PDF template
A form used to request reimbursement for medical, dental, vision, hearing, and foreign travel care and supplies from a health insurance plan.
See template
See template
Plan Selection Form Retiree Supplemental Medical
PDF template
A form for retired Oklahoma State University employees to select supplemental medical insurance plans with Medicare eligibility requirements.
See template
See template
PATIENT INTAKE FORM
PDF template
Comprehensive form for collecting patient personal, medical, and insurance information for medical services or therapy referral.
See template
See template
Pre Authorization Form
PDF template
A form for requesting pre-authorization for cashless hospitalization under a medical insurance policy.
See template
See template
Medication Incidents Associated With Hospital Discharge A Multi Incident Analysis By ISMP Canada
PDF template
A research report examining medication incidents and safety concerns during patient transitions from hospital to community care.
See template
See template
Medication Prior Approval Form
PDF template
Healthcare form for requesting prior approval of medical procedures, medications, and services with patient and provider information.
See template
See template
Fidelis Care Medication Request Form
PDF template
A comprehensive form for requesting medications through Fidelis Care health plans, requiring detailed patient and prescription information.
See template
See template
Cancellation Request Form
PDF template
A form used to request cancellation of Medigap insurance plan coverage, including provisions for refund of premiums.
See template
See template
Claim Form Instructions
PDF template
Detailed instructions for submitting prescription medication reimbursement claims with specific guidance on documentation requirements.
See template
See template
Medicine Reconciliation Form
PDF template
A medical form for documenting patient medication history, current medicines, and discharge instructions during an outpatient visit.
See template
See template
Chronic Medicine Benefit Application
PDF template
A medical form for applying to a chronic medicine benefit program, to be completed by patients seeking ongoing medication coverage.
See template
See template
Bedside Medication Delivery Service Form
PDF template
A hospital-based medication delivery service that allows patients to fill prescriptions before hospital discharge at no extra cost.
See template
See template
BULLETIN MEL 24 04 Crime Statutory Bond Coverage
PDF template
Provides guidelines for statutory bond coverage for specific municipal positions requiring underwriting in joint insurance funds.
See template
See template
Member Claim Form
PDF template
A form for Quartz health plan members to submit claims for medical services paid out-of-pocket when providers will not submit claims directly.
See template
See template
Member Claim Form
PDF template
Insurance claim form for submitting medical service reimbursement requests to BlueCross North Carolina.
See template
See template
Member Claim Reimbursement Form
PDF template
A form for Scripps Health Plan members to request direct reimbursement for covered medical benefits and provide claim details.
See template
See template
Member Claim Submission Form
PDF template
A comprehensive form for submitting medical, vision, and other healthcare-related insurance claims with detailed service type options.
See template
See template
Claim Form 1 Reimbursement For Out Of Network Benefit
PDF template
Form for submitting vision service reimbursement claims for out-of-network eye doctor visits and services.
See template
See template
Member Reimbursement Form
PDF template
A form for members to request reimbursement for healthcare services and medical expenses from Network Health insurance.
See template
See template
Member Reimbursement Form
PDF template
A form for members to request reimbursement for various medical services and expenses from Network Health insurance plan.
See template
See template
Member Reimbursement Form
PDF template
A form for Kaiser Permanente members to request reimbursement for medical expenses paid directly to a healthcare provider.
See template
See template
MEMBERSHIP FORM
PDF template
A form for individuals to apply for membership with various membership tier options.
See template
See template
Method Schools Insurance Proposal
PDF template
Insurance coverage proposal for Method Schools by California Charter Schools Joint Powers Authority for the 2015-2016 school year.
See template
See template
Cancer, Specified Disease And Intensive Care Coverage
PDF template
Instructions for filing claims related to cancer, specified disease, and intensive care coverage under a MetLife insurance policy.
See template
See template
Disability Claim For Accident SicknessShort Term DisabilitySalary Continuance
PDF template
A comprehensive form for employers to document employee disability claims and related employment details.
See template
See template
Insurance Enrollment Form
PDF template
Comprehensive form for employees to enroll in various insurance coverages including life, disability, dental, and vision.
See template
See template
MetLife Legal Plans EnrollmentCancellation Form
PDF template
Form for enrolling in or canceling MetLife Legal Plans insurance coverage for San Diego and Imperial County Schools employees.
See template
See template
MetLife Legal Plans EnrollmentCancellation Form
PDF template
Insurance enrollment form for MetLife Legal Plan for San Diego and Imperial County Schools employees to select and authorize payroll deductions for legal plan coverage.
See template
See template
POLICYHOLDERS CHANGE AND SERVICE REQUEST
PDF template
A form for making changes to a MetLife insurance policy, including coverage modifications, beneficiary updates, and personal information changes.
See template
See template
Disability Claim For Accident SicknessShort Term DisabilitySalary Continuance
PDF template
A comprehensive form for employees to file a disability claim, capturing details about the employee, work status, and disability information.
See template
See template
MetLife WELL V1
PDF template
Insurance claim form for wellness benefit submission by policyholders of MetLife Insurance Company
See template
See template
Discharge Authority Form
PDF template
A form used to authorize the discharge of a mortgage loan and provide settlement details for property transactions.
See template
See template
MF Fire Warranty Claim Form
PDF template
A warranty claim form for processing replacement parts and potential reimbursement for MF Fire products.
See template
See template
A MasterS Guide To Shipboard Accident Response
PDF template
A comprehensive guide for ship masters on handling incidents and protecting shipowner interests in Protection and Indemnity (P&I) risks.
See template
See template
CLHIA Standardized MGA Compliance Review Survey
PDF template
A standardized survey used by CLHIA member companies to assess compliance functions of Managing General Agencies (MGAs)
See template
See template
Form To Request Documentation From An Employer Sponsored Health Plan Or A Group Or Individual Market
PDF template
A tool to help patients request information about mental health and substance use disorder treatment limitations from health insurers, based on mental health parity laws.
See template
See template
PCA 1 24 01338 Clinical FM 05142024
PDF template
A medical referral form used by primary care physicians to authorize specialist consultations and treatments within a health plan network.
See template
See template
Claim Form
PDF template
A comprehensive form for submitting claims involving bodily injury, medical treatments, or other damages to a district or agency.
See template
See template
Terminal Leave And Discharge Confirmation Form
PDF template
Official document from Texas Department of Public Safety verifying an individual's military terminal leave and discharge status.
See template
See template
LANDLORD RISK MITIGATION ENROLLMENT FORM
PDF template
A form for landlords to enroll in a risk mitigation program that provides financial protection against tenant damages and lost rent.
See template
See template
ACCIDENTINCIDENT REPORT FORM
PDF template
A comprehensive form for reporting accidents or incidents involving Maryknoll Lay Missioners during overseas missions, documenting details of the occurrence, injuries, and follow-up actions.
See template
See template
Digital Patient Intake Form
PDF template
Form for medical providers to submit patient information, treatment details, and request insurance verification for wound care products.
See template
See template
Digital Patient Intake Form
PDF template
A medical form for provider and patient information collection, insurance verification, and wound treatment documentation.
See template
See template
Patient Intake Form
PDF template
A medical reimbursement form for verifying insurance coverage and documentation for skin substitute treatments.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for equipment, likely used by service centers and equipment owners.
See template
See template
Patient Information Form
PDF template
Comprehensive intake form for collecting patient personal, contact, and insurance information for dental practice.
See template
See template
Medicare Billing Form CMS 1450 And The 837 Institutional
PDF template
A comprehensive guide for healthcare providers on submitting Medicare claims using Form CMS-1450 and 837I electronic format.
See template
See template
No Fault Insurance Form
PDF template
A medical insurance claim form for documenting patient information and authorizing insurance benefits for accident-related medical services.
See template
See template
Workers Compensation Insurance Form
PDF template
A comprehensive form for documenting patient and employment details related to a workplace injury insurance claim.
See template
See template
PreventiveCareAppealForm 20200507 V1.0
PDF template
Form for submitting preventive care exam documentation to Medical Mutual Wellness for wellness program compliance.
See template
See template
Patient And Insurance Claim Form
PDF template
A standardized form for submitting medical insurance claims with patient and subscriber information details.
See template
See template
Certificate Of Compliance
PDF template
A form required for businesses in Minnesota to verify workers' compensation insurance coverage when applying for licenses or permits.
See template
See template
Mobile Food Unit Discharge Approval Form
PDF template
Form for mobile food units to obtain approval for proper wastewater and greywater discharge through a designated commissary.
See template
See template
Life Insurance Policy Change Form
PDF template
A form for making changes to a life insurance policy within a deferred compensation plan, particularly for employees who have separated from service.
See template
See template
Model Authorization Form For Certified Application Counselors (CACs) In A Federally Facilitated Mark
PDF template
Authorization form allowing Certified Application Counselors to collect, access, and use personal information for healthcare marketplace enrollment assistance.
See template
See template
Model Authorization Form For Certified Application Counselors (CACs) In A Federally Facilitated Mark
PDF template
A consent form allowing Certified Application Counselors to handle and process personally identifiable information for healthcare marketplace enrollment assistance.
See template
See template
Standardized Health Claim Form Model Regulation
PDF template
A model regulation aimed at standardizing health care claim forms, reducing form complexity, and promoting electronic data interchange for healthcare billing and reimbursement.
See template
See template
Mail Service Order Form
PDF template
A form for Service Benefit Plan members to order prescription medications through mail service pharmacy
See template
See template
Money Insurance Proposal Form
PDF template
Insurance proposal form for money protection and insurance coverage by Fidelity Shield Insurance Company in Kenya.
See template
See template
Insurance Of Money Proposal
PDF template
Insurance coverage proposal for loss of money in various scenarios including transit, premises, and personal custody.
See template
See template
Monroe Community College International Student Accident And Sickness Insurance Waiver Form
PDF template
A waiver form for international students to demonstrate alternative health insurance coverage in lieu of the college's mandatory insurance plan.
See template
See template
InstallerRetailer Warranty Claim FORM
PDF template
A warranty claim form for Tenneco product replacements, detailing consumer and vehicle information for warranty claims.
See template
See template
Enrollment Form
PDF template
A comprehensive life insurance and AD&D enrollment form for employees of the University of the Incarnate Word.
See template
See template
ACCIDENT INCIDENTS REPORTING AND ACTIONS PROCEDURE
PDF template
A procedure for reporting and processing accidents and incidents within the Model Aeronautical Association of Australia (MAAA) to minimize recurrence and manage potential insurance claims.
See template
See template
MortgagorS And ContractorS Affidavit
PDF template
Document for releasing insurance claim funds for property damage repair by American Airlines Federal Credit Union
See template
See template
MOTOR ACCIDENT REPORT FORM
PDF template
A comprehensive form for documenting details of a motor vehicle accident for insurance claim purposes.
See template
See template
MOTOR ACCIDENT REPORT FORM
PDF template
Comprehensive form for documenting details of a motor vehicle accident for insurance claim purposes.
See template
See template
University Of Kentucky Vehicle Accident Report Form
PDF template
A comprehensive form for reporting vehicle accidents involving University of Kentucky vehicles, capturing details about the accident, vehicles, drivers, and potential injuries.
See template
See template
PATIENT INFORMATION AND MEDICAL RELEASE FORM (FORM I)
PDF template
A comprehensive form for patient medical information, insurance details, and authorization for medical information release and claims processing.
See template
See template
Filing A Claim For Insurance Benefits
PDF template
Guide for lenders on submitting insurance benefit claims through the FHA Connection system for various claim types and loss mitigation options.
See template
See template
CEAR Construction And Erection All Risk Policy
PDF template
A comprehensive insurance policy covering project works, third-party liability, and potential delays in project start-up for construction and erection projects.
See template
See template
ACORD 131
PDF template
Standard insurance form for documenting policy details, liability limits, and carrier information.
See template
See template
MRV Communications, Inc. Stockholder Litigation Proof Of Claim And Release
PDF template
Legal claim form for stockholders in the MRV Communications litigation settlement allowing shareholders to receive compensation for their shares.
See template
See template
PLAN YEAR 2024 ENROLLMENTCHANGE FORM MEDICAL SPENDING CONVERSION (MSC) HEALTH BENEFITS BUY OUT WAIVE
PDF template
Form for NYC employees to enroll in or change health benefits buy-out waiver program for plan year 2024.
See template
See template
Medicare Secondary Payer (MSP) Manual
PDF template
A comprehensive manual detailing billing requirements and guidelines for healthcare providers under Medicare Secondary Payer regulations.
See template
See template
Missouri State University Sugar Bears Dance Team 2023 24 Medical And Liability Release
PDF template
A medical and liability release form for participants of the Missouri State University Sugar Bears Dance Team for the 2023-24 season.
See template
See template
Employee Disability Claim Form
PDF template
Comprehensive guidelines for completing an employee disability claim form with detailed instructions for each section.
See template
See template
MultiPlan Service Request Form
PDF template
A form for providers to investigate and submit claims processed through the MultiPlan network for service inquiries.
See template
See template
Group Voluntary Term Life Benefits Certificate
PDF template
Group voluntary term life insurance benefits document for employees of the University of North Dakota, providing details about insurance coverage and terms.
See template
See template
Accessing Claims Online Using The Employee Portal
PDF template
A guide for employees on how to access and manage insurance claims through Mutual of Omaha's online employee portal.
See template
See template
Enrollment Form
PDF template
Insurance enrollment form for selecting life and AD&D coverage options for employees and dependents.
See template
See template
Mutual Of Omaha And Affiliates Transfer Request Form
PDF template
A form for transferring insurance producer contracts and downlines between marketing agencies within Mutual of Omaha's network.
See template
See template
Medical Claim Reimbursement Request
PDF template
A form for members to request reimbursement for medical expenses paid out of pocket, requiring itemized receipts and proof of payment.
See template
See template
Prescription Enrollment Form
PDF template
Comprehensive medical enrollment form for patients receiving Pyrukynd (mitapivat) tablets, collecting patient, insurance, and prescription details.
See template
See template
Enrollment Form
PDF template
A comprehensive enrollment form for patients seeking to enroll in VYVGART treatment pathway and services.
See template
See template
Claim Form
PDF template
Official document for filing a legal claim in a county court with details of claimant, defendant, and claim specifics.
See template
See template
NACo Prescription Discount Card FAQ
PDF template
Informational document explaining the details and usage of a county-provided prescription discount card program for residents.
See template
See template
NAF 2018 Alabama Department Of Insurance Name Approval Form
PDF template
Official form for requesting name approval for insurance producer business entities in Alabama.
See template
See template
NAIC Uniform Risk Retention Group Registration Form
PDF template
Official registration form for Risk Retention Groups operating under the Federal Liability Risk Retention Act of 1986.
See template
See template
NAIC Uniform Risk Retention Group Registration Form
PDF template
Official registration form for Risk Retention Groups operating under the Liability Risk Retention Act, used to register insurance operations across states.
See template
See template
Naming Beneficiaries
PDF template
A comprehensive guide explaining key considerations and potential pitfalls when naming beneficiaries on life insurance policies and estate planning documents.
See template
See template
MOTOR VEHICLE INSPECTION FORM
PDF template
A detailed form for documenting vehicle condition, specifications, accessories, and modifications for insurance or registration purposes.
See template
See template
DIRECT CANCELLATION FORM
PDF template
A form for requesting cancellation of service contracts, including vehicle-related contracts and services
See template
See template
National Producer Agreement
PDF template
A comprehensive agreement between Ryan Services Group and an insurance producer outlining terms of collaboration for specialty insurance products.
See template
See template
Post Employment Health Plan (PEHP) Claim Form
PDF template
Form for requesting medical expense reimbursement for post-employment health benefits, including insurance premiums and medical expenses.
See template
See template
Claim Form
PDF template
A form for employees to submit healthcare and dependent care expenses for reimbursement through flexible spending accounts.
See template
See template
NavigatorAO Service Request Form
PDF template
Official form for licensed Navigators and Application Organizations to request changes to their licensing information with the Indiana Department of Insurance.
See template
See template
When You Go On LeaveMake Sure Your 1199SEIU Benefits Are Active
PDF template
Instructions for maintaining benefits during various types of leave, including paid family leave, disability, FMLA, and workers' compensation.
See template
See template
InsuranceAHCCCS Verification Form
PDF template
Form for verifying insurance and collecting information for newborn bloodspot screening in Arizona.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for brake system components, detailing product information and reason for removal.
See template
See template
Cancer Coverage With Optional Riders Claim Form
PDF template
Insurance claim form for filing cancer coverage benefits with American Heritage Life Insurance Company.
See template
See template
North Country HealthCare ParentalPatient Consent Form
PDF template
Consent form for healthcare services provided by North Country HealthCare's School-Based Health Services Mobile Unit for students and parents/guardians.
See template
See template
NC Psychology Board Change Of Address Form
PDF template
A form for North Carolina psychology licensees to update their professional contact information and address with the state licensing board.
See template
See template
TSB Leased Vehicle AccidentInsurance Claim Procedure
PDF template
Procedure for handling accident reports and repair claims for leased vehicles at TSB, involving reporting, estimates, insurance review, and repair coordination.
See template
See template
Form 17483 Warranty Claim Form
PDF template
A form for customers to submit warranty claims for Neoteric Hovercraft products, documenting product details and failure information.
See template
See template
Sample Liability Insurance Form
PDF template
A standard form for documenting liability insurance coverage and related details.
See template
See template
IRS Form 1095 C
PDF template
A tax form documenting health coverage offered by the University of Alabama System as required by the Affordable Care Act (ACA)
See template
See template
Patient Information And Dental Insurance Questionnaire
PDF template
Comprehensive form for collecting patient personal, contact, and dental insurance information for a dental practice.
See template
See template
BROWN UNIVERSITY AUTO ACCIDENT REPORT FORM
PDF template
A comprehensive form for documenting vehicle accidents involving Brown University employees or vehicles.
See template
See template
980 Retiree Welcome Packet Retirement Medical Benefit Account Claim Form
PDF template
A claim form for retirees to submit medical insurance premium reimbursement requests with specific documentation guidelines.
See template
See template
Patient Treatment And Cancellation Policy
PDF template
Policy document outlining patient responsibilities, insurance claims processing, and appointment cancellation terms for physical therapy services.
See template
See template
New Contractor Form
PDF template
A registration form for new contractors seeking to obtain permits in the City of Okeechobee, requiring submission of various business and insurance documents.
See template
See template
Application For Discharge As Executor
PDF template
Legal document for an executor seeking to be discharged from fiduciary responsibilities of an estate in Union County, New Jersey.
See template
See template
Benefits Presentation Closed Caption
PDF template
Comprehensive presentation providing instructions for new and transferring FBI employees on completing benefits forms and understanding health insurance options.
See template
See template
GAP Cancellation Form
PDF template
Form for cancelling a Guaranteed Asset Protection (GAP) insurance policy with options for refund destination and cancellation reasons.
See template
See template
Emergency Contact Form
PDF template
A form for collecting student emergency contact details, medical information, and insurance status for school records.
See template
See template
PATIENT GASTROENTEROLOGY HISTORY FORM
PDF template
Comprehensive medical intake form for gastroenterology patients, collecting personal, demographic, and insurance information.
See template
See template
New Hire Benefits Enrollment Checklist
PDF template
Comprehensive checklist for new employees of the Office of the Comptroller of the Currency to complete benefits enrollment and required forms within specified timeframes.
See template
See template
Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, medical, and insurance information for healthcare providers.
See template
See template
Newly Wed Checklist (Active Retired)
PDF template
Instructions for adding a spouse to welfare benefits for Uniformed Firefighters Association members.
See template
See template
Annual Minor Participant Health And Medical Form
PDF template
Comprehensive medical information form for minors under 18 years old, collecting health details, emergency contacts, and medical consent.
See template
See template
New Patient Intake Form
PDF template
Comprehensive form for collecting new patient medical information, health history, and insurance details.
See template
See template
NEW PATIENT REGISTRATION FORM
PDF template
Comprehensive medical form for collecting new patient personal, contact, insurance, and emergency contact information.
See template
See template
Patient Intake Form
PDF template
Comprehensive medical intake form collecting patient personal information, insurance details, medical history, and treatment authorization.
See template
See template
New Patient Insurance Form
PDF template
A comprehensive intake form for new patients seeking outpatient therapy, collecting personal, insurance, and referral information.
See template
See template
New Patient Intake Form
PDF template
Comprehensive medical intake form for collecting new patient personal, contact, medical, and insurance information.
See template
See template
NEW PATIENT INTAKE FORM
PDF template
Comprehensive medical intake form for new pediatric patients, collecting personal, medical, and insurance information.
See template
See template
New Patient Intake Form
PDF template
Comprehensive form for new pharmacy patients to provide personal, medical, and insurance information for prescription services.
See template
See template
NEW PATIENT INTAKE FORM
PDF template
Comprehensive medical intake form for collecting patient personal, insurance, and health information for a medical clinic or practice.
See template
See template
NEW PATIENT INTAKE FORM
PDF template
Comprehensive form for collecting new patient personal, medical, insurance, and contact information for healthcare providers.
See template
See template
NEW PATIENT INTAKE FORM
PDF template
Comprehensive intake form for new patients at Chicago Gastro, collecting personal and medical contact information along with financial policy acknowledgment.
See template
See template
NEW PATIENT REFERRAL FORM
PDF template
Comprehensive medical referral form for new patients seeking cardiothoracic surgical consultation, collecting patient, insurance, and medical information.
See template
See template
Patient Intake Form
PDF template
A comprehensive patient intake form for collecting personal, medical, and insurance information with communication preferences and service consent.
See template
See template
NEW PATIENT INTAKE FORM (With TriCare Insurance)
PDF template
Comprehensive medical intake form for new patients, collecting detailed personal and medical history information.
See template
See template
New Patient Intake Form
PDF template
Comprehensive medical intake form for new patients at Rowan Tree Medical, collecting personal, medical, and contact information.
See template
See template
Demographic Form
PDF template
Comprehensive patient intake form collecting personal, contact, insurance, and medical information for Centeno-Schultz Clinic.
See template
See template
New Additional Insured Endorsement Forms Will Impact Contractors, Project Owners, Lessees
PDF template
Overview of new ISO insurance endorsement forms affecting Additional Insured status and risk management in the construction industry.
See template
See template
Patient Information Form
PDF template
A comprehensive medical intake form collecting patient personal, insurance, and workplace injury details for healthcare providers.
See template
See template
Appeal Of A Discharge Form
PDF template
A form for appealing a transfer or discharge from a registered nursing facility in Arizona.
See template
See template
NFDA INSURANCE FORM PACKET
PDF template
A collection of forms and guidance for funeral homes to manage insurance policy assignments for preneed and at-need funeral arrangements.
See template
See template
Nashville Fairgrounds Speedway Registration Form
PDF template
Registration and contract form for race car drivers participating in Nashville Fairgrounds Speedway racing events for the 2022 season.
See template
See template
NHES 0180 R Aug 2022 NEW HAMPSHIRE EMPLOYMENT SECURITY CONTINUED CLAIM FORM
PDF template
Form for unemployment claimants to report weekly work status, availability, and potential income sources during unemployment period.
See template
See template
NJPEC 1634 19 Therapy Services Request Form
PDF template
A healthcare form for requesting and documenting therapy services, including patient and provider information, diagnosis, and treatment details.
See template
See template
HEALTH, ACCIDENT, DISABILITY CLAIM FORM
PDF template
Comprehensive claim form for health, accident, and disability insurance claims from National Teachers Associates Life Insurance Company.
See template
See template
Neuromodulation Pre Authorization Support Resources
PDF template
Comprehensive guide for healthcare professionals seeking pre-authorization support for neuromodulation therapy, including contact information and process details.
See template
See template
New Mexico Uniform Prior Authorization Form
PDF template
A comprehensive form for healthcare providers to request prior authorization for medical services, procedures, or treatments.
See template
See template
No Fault Insurance Form
PDF template
A form for filing a no-fault insurance claim with personal and injury details for insurance processing.
See template
See template
Texas Standard Prior Authorization Request Form For Prescription Drug Benefits
PDF template
A standardized form for requesting prior authorization of prescription drug benefits in Texas, used by various healthcare and insurance providers.
See template
See template
Common Nomination Form For Gratuity, General Provident Fund And Central Government Employees Group I
PDF template
A comprehensive form for Central Government employees to nominate beneficiaries for gratuity, provident fund, and group insurance benefits.
See template
See template
Nondomestic User Survey Form
PDF template
A comprehensive survey form for collecting industrial facility waste discharge and environmental compliance information
See template
See template
Non Medication Preauthorization Request
PDF template
A form for healthcare providers to request preauthorization for non-medication medical services and procedures from the Motion Picture Industry Health Plan (MPI).
See template
See template
Private Medical Consultations Price List
PDF template
Comprehensive pricing guide for private medical services, consultations, certificates, and travel-related medical procedures
See template
See template
EHS Non Standard Discharge Form
PDF template
Form for documenting and requesting approval for non-standard discharge into the UMass Amherst sewer system with specific chemical and environmental parameters.
See template
See template
Trust Policy Form
PDF template
A comprehensive guide for setting up a trust policy, outlining key considerations, beneficiary selection, and trustee appointment.
See template
See template
Northwell Health, Health Welfare Flex Benefit Program Summary Plan Description
PDF template
Comprehensive overview of short-term and long-term disability options for Northwell Health employees administered by Sedgwick and The Hartford.
See template
See template
Incident Claim Form
PDF template
A form for reporting non-vehicular related claims involving injury or property damage within the City of West Linn
See template
See template
Surprise Billing Protection Form
PDF template
A document explaining patient protections against unexpected out-of-network medical billing and requesting consent for potential additional charges.
See template
See template
NOTICE OF CLAIM FORM
PDF template
Official form for submitting a claim to the Maryland State Treasurer's office detailing loss or damage incident.
See template
See template
Excess Secondary Insurance Plan For Sports Club Athletes
PDF template
Insurance policy document outlining coverage details for San Diego State University sports club athletes, explaining secondary insurance provisions and claim procedures.
See template
See template
Authorization Request Form
PDF template
Medical service authorization request form for providers to submit routine and urgent pre-service requests for patient care.
See template
See template
Patient Intake Form
PDF template
Comprehensive patient intake form for prosthetics services, collecting medical history, contact details, and amputation information.
See template
See template
Patient Intake Form
PDF template
Comprehensive intake form for patients seeking prosthetic services, capturing medical history, contact information, and amputation details.
See template
See template
NUSS TRUCK EQUIPMENT PART REPLACEMENT WARRANTY FORM
PDF template
A warranty claim form for documenting part replacements and failures for trucks and equipment
See template
See template
Spinraza Pre Authorization Form
PDF template
A medical pre-authorization form for requesting Spinraza medication treatment, used for documenting patient details and motor ability assessments.
See template
See template
CMS 1500 Claim Form Instructions
PDF template
Comprehensive instructions for completing the CMS-1500 medical claim form with detailed field requirements and change history.
See template
See template
Certificate Of Insurance
PDF template
Detailed instructions for submitting a proof of liability insurance certificate with specific coverage requirements for New World Symphony.
See template
See template
Member Medical Reimbursement Claim Form
PDF template
A claim form for Wellcare By Fidelis Care members to request reimbursement for out-of-pocket medical expenses.
See template
See template
Continuation Of Disability Claim Form
PDF template
A form for reporting ongoing disability status, medical treatments, and work return details for an insurance claim.
See template
See template
Disability Claim Form
PDF template
Comprehensive form for employees to report disability, medical information, and related benefit claims.
See template
See template
UnitedHealthcare Community Plan Of New York Specialist Referral Form
PDF template
A referral form for UnitedHealthcare Community Plan of New York members to obtain specialist services with specific guidelines and requirements.
See template
See template
Record Of Employment
PDF template
Official form for documenting employment status for unemployment insurance purposes in New York State.
See template
See template
American Arbitration Association SumUM Arbitration Request
PDF template
A legal form for requesting arbitration in uninsured or underinsured motorist insurance disputes through the American Arbitration Association.
See template
See template
ACORD Cancellation Form
PDF template
A standardized document used to officially terminate an insurance policy and provide formal documentation of cancellation.
See template
See template
Oberlin College Employer Contribution Amounts Health Savings AccountHealth Reimbursement Account
PDF template
Details employer contributions to health savings accounts for Oberlin College employees in 2024, including contribution amounts and IRS limits.
See template
See template
Recurring Premium Reimbursement Form
PDF template
Form for requesting reimbursement of recurring insurance premiums through OneExchange
See template
See template
Off Campus Event Risk Assessment Form
PDF template
A comprehensive form for evaluating risks and safety protocols for off-campus university events and activities.
See template
See template
IWU University Sponsored Off Campus Travel Form
PDF template
A liability release and consent form for students participating in off-campus university-sponsored travel activities.
See template
See template
Claim Form
PDF template
Official document used to claim unclaimed funds from the New York State Office of Unclaimed Funds.
See template
See template
IBEW Local No. 683 Health Welfare Fund Weekly Disability Benefits Claim Form
PDF template
Claim form for obtaining weekly disability benefits from the IBEW Local No. 683 Health & Welfare Fund, providing compensation for disabled workers.
See template
See template
Job Aid Discharge
PDF template
A job aid detailing step-by-step instructions for completing a discharge form within the OhioMHAS MRSS Provider portal.
See template
See template
Applied Behavior Analysis (ABA) Clinical Service Request
PDF template
A healthcare form for requesting Applied Behavior Analysis clinical services, used for initial or concurrent treatment requests.
See template
See template
On Duty Death Or Catastrophic Injury To City Of Pittsburgh Employees
PDF template
Policy outlining procedures and support for handling employee deaths or catastrophic injuries in the line of duty, including notification and benefits processes.
See template
See template
Services Agreement Fee Disclosure
PDF template
A services agreement detailing the terms of retirement plan administration and recordkeeping for a 403(b) Tax-Deferred Annuity Plan.
See template
See template
WHOLEGOODS WARRANTY Claim Form
PDF template
A comprehensive warranty claim form for processing equipment repairs and warranty claims with detailed labor and parts information.
See template
See template
WHOLEGOODS WARRANTY Claim Form
PDF template
A warranty claim form for submitting equipment repair and parts replacement requests to Modern Manufacturing.
See template
See template
Online Will And Legal Form Preparation
PDF template
An online service offering employees the ability to create legal documents like wills, living wills, and powers of attorney through a secure platform.
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for requesting reimbursement for vision services from providers outside the Davis Vision network, covering examinations and eyewear expenses.
See template
See template
Out Of Network Reimbursement Instructions
PDF template
Detailed instructions for submitting out-of-network healthcare reimbursement claims with VBA, including required documentation and submission methods.
See template
See template
Vision Plan Out Of Network Claim Form
PDF template
Form for employees to submit out-of-network vision care expenses for reimbursement from their employer's vision plan.
See template
See template
WFU Outdoor Pursuits Medical Form
PDF template
A comprehensive medical form for WFU Outdoor Pursuits participants collecting personal, emergency contact, and insurance information.
See template
See template
Patient Intake Form
PDF template
Comprehensive medical intake form for collecting patient personal, contact, and insurance information for medical treatment.
See template
See template
Patient Intake Form
PDF template
Comprehensive medical intake form for collecting patient personal, contact, and insurance information with consent and assignment sections.
See template
See template
Diaper Request Form
PDF template
A form for TennCare and CoverKids members to request diaper coverage for children under 2 years old, with specific guidelines for diaper allocation.
See template
See template
OPT OUT AFFIDAVIT
PDF template
A form for healthcare practitioners to formally opt out of Medicare billing and payment systems for a two-year period.
See template
See template
Voluntary Waiver Of Health Insurance For Enrollment In Opt Out Program
PDF template
A voluntary form allowing City of Somerville retirees to waive health insurance coverage in exchange for a monetary opt-out payment.
See template
See template
New Prescription Mail In Order Form
PDF template
A form for submitting prescription medication orders via mail with patient and payment details
See template
See template
ILWU PMA Welfare Plan Prescription Drug Program
PDF template
Supplemental summary plan description for prescription drug benefits for ILWU-PMA Welfare Plan participants, detailing eligibility and prescription acquisition methods.
See template
See template
Oregon Vehicle Title And Registration Application
PDF template
Official Oregon state form for vehicle title registration and ownership transfer with legal certifications and insurance declarations.
See template
See template
Frequently Asked Questions Professional Indemnity
PDF template
Comprehensive overview of professional indemnity insurance covering legal costs, damages, and incidences of professional liability.
See template
See template
Consent To Treat Form
PDF template
A patient consent form authorizing medical treatment, information release, and assignment of benefits at a medical practice.
See template
See template
Medical Form
PDF template
Confidential medical form for collecting student health information prior to educational travel programs, enabling emergency preparedness and medical screening.
See template
See template
Patient Intake Form
PDF template
Comprehensive form for collecting patient personal, medical, and insurance information for healthcare providers.
See template
See template
Record Of Other Insurance Form
PDF template
A comprehensive form for collecting student and family insurance and employment details for the Foothill-DeAnza Community College District.
See template
See template
Excess Accident Medical Expense Insurance Claim Requirements Guidance
PDF template
Guidelines for submitting medical insurance claims for sports-related injuries with detailed documentation requirements for students.
See template
See template
Event Planning In An Outdoor Space Resource Guide
PDF template
Comprehensive guide for planning events in outdoor campus spaces, covering policies, catering, food service, insurance, and equipment requirements.
See template
See template
Out Of Network Prior Authorization Form
PDF template
A form for requesting prior authorization for out-of-network medical services from Neighborhood Health Plan
See template
See template
Out Of Network Referral Form
PDF template
A form for requesting authorization to see an out-of-network healthcare provider with detailed patient and service information.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
Claim form for reimbursement of vision services obtained from providers outside the Blue View Vision network.
See template
See template
Outpatient Referral Form
PDF template
A comprehensive referral form for patients seeking outpatient services at Children's Hospital Los Angeles, collecting physician, patient, clinical, and insurance information.
See template
See template
Declaration Of Trust
PDF template
A legal document for assigning a life insurance policy to trustees, establishing the terms of trust for the policy.
See template
See template
Overseas Treatment Benefit Application Form 2024
PDF template
Application form for members seeking medical treatment coverage outside their home country under the Executive and Comprehensive Plans.
See template
See template
Voluntary Audit Form
PDF template
Guide explaining the process of completing a voluntary premium audit form for insurance policy premium adjustments.
See template
See template
Employee Enrollment Form
PDF template
A comprehensive form for employees to enroll in or waive health insurance coverage with detailed personal and employment information.
See template
See template
Aftercare Plan Summary And Discharge Form
PDF template
A comprehensive form for documenting patient discharge details, medical referrals, and post-discharge care instructions for mental health facilities.
See template
See template
Accident Report Form
PDF template
A comprehensive form for documenting transportation-related accidents, including provider, member, and incident details.
See template
See template
Pre Authorization Form Revision
PDF template
Notice of revision to the pre-authorization/prior approval request form with new form number and submission guidelines.
See template
See template
Removal Of Benefit Riders AndOr Dependents
PDF template
A form for policy owners to remove specific insurance riders or dependent coverage from their Trustmark insurance policy.
See template
See template
Split Trust Discretionary
PDF template
A trust document designed to manage life insurance plan proceeds with inheritance tax planning considerations and discretionary beneficiary provisions.
See template
See template
Sewer Disposal Or Storm Water System Event Notice Of Claim Form
PDF template
A form for reporting property damage or physical injury related to sewer or storm water system events in Saginaw County.
See template
See template
Incident Report Form
PDF template
A comprehensive form for documenting injuries or incidents occurring during sports club activities, events, or premises.
See template
See template
IHCP Prior Authorization Request Form Instructions
PDF template
Detailed instructions for completing a prior authorization request form for Indiana Health Coverage Programs, covering submission requirements and field details.
See template
See template
Prior Authorization Form
PDF template
Comprehensive instructions for completing a Medicaid prior authorization request form with detailed field guidance.
See template
See template
INSURANCE CLAIM FORM
PDF template
Insurance claim form for reporting tank-related releases or environmental incidents at business locations.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims, detailing patient and pharmacy information for insurance processing.
See template
See template
AHCA B P 222 Prescription Drug Program Direct Member Reimbursement Form
PDF template
Form for members to request reimbursement for out-of-pocket prescription drug expenses through their healthcare plan.
See template
See template
School Parental Consent Form (Grades PK 12)
PDF template
A comprehensive form for collecting student medical, contact, and insurance information for school admission purposes.
See template
See template
PARENTGUARDIANSTUDENT INFORMATION FORM
PDF template
A comprehensive form for collecting student, parent, and guardian contact and medical insurance details for athletic purposes.
See template
See template
Insurance Information
PDF template
Guidelines for sport-related injury insurance claims and reporting procedures for students at Chattanooga State.
See template
See template
PARENTS INSURANCE FORM
PDF template
A form for collecting parent/guardian insurance information for student athletes participating in intercollegiate sports.
See template
See template
Standardized Prior Authorization Request Form
PDF template
A standardized form for submitting prior authorization requests to multiple health plans in Massachusetts, designed to streamline the administrative process for healthcare providers.
See template
See template
Application For Use Of Village Property For Municipal Parking Lots
PDF template
Application form for obtaining permission to use municipal parking lots in the Incorporated Village of Westhampton Beach
See template
See template
REQUEST FOR REIMBURSEMENT DUE TO PARTIAL DISCHARGE OF A FEDERAL CONSOLIDATION LOAN
PDF template
A form for requesting reimbursement for partial discharge of a federal consolidation loan due to specific qualifying circumstances.
See template
See template
Participant Release And Waiver Of Liability Form
PDF template
Legal document releasing Optimist Club from liability for a minor participant's activities and potential injuries.
See template
See template
PARTICIPANT TRAVEL FORM
PDF template
A comprehensive form for students, chaperones, and directors to complete for group travel, including personal and emergency contact information and travel insurance options.
See template
See template
Exchange Student Application Packet Part II Visa, Finances, And Insurance Certification
PDF template
Application packet for international exchange students detailing required documentation for visa, finances, and insurance for the Fall 2023 semester at Baruch College.
See template
See template
Motor Warranty Claim Form
PDF template
A form for submitting warranty claims for defective motors with specific return instructions and failure reason selection.
See template
See template
HMIS Project Discharge Form
PDF template
A form for documenting client discharge details and destination for homeless support services program
See template
See template
PATIENT MEDICAL HISTORY FORM
PDF template
A comprehensive form for collecting patient personal and medical information, including previous physicians, pharmacies, and insurance details.
See template
See template
Privacy Rule Of Patient Consent Agreement
PDF template
A consent form for medical treatment and information disclosure at Pacific Northwest Recovery and Counseling, outlining patient rights and treatment terms.
See template
See template
Demographic Insurance Form
PDF template
Comprehensive form for collecting patient personal, emergency contact, medical provider, and insurance information.
See template
See template
Patient Demographic Insurance Billing Form
PDF template
A comprehensive form for patient demographic information, insurance details, and billing for diagnostic services.
See template
See template
Patient Intake Form
PDF template
Comprehensive patient registration and medical history form for Swank Chiropractic Sports Medicine & Wellness Center
See template
See template
PATIENT INTAKE FORM
PDF template
Comprehensive form for collecting patient personal, insurance, and medical history information for healthcare providers.
See template
See template
PATIENT INTAKE FORM
PDF template
Comprehensive form for collecting patient personal, medical, insurance, and contact information for healthcare purposes.
See template
See template
Initial Intake Form
PDF template
Comprehensive form for collecting patient personal, contact, insurance, and medical visit information.
See template
See template
PATIENT INTAKE FORM
PDF template
Comprehensive patient intake form for chiropractic services, collecting personal, medical, and insurance information.
See template
See template
Patient Information Form
PDF template
Comprehensive medical intake form collecting patient personal details, medical history, and insurance information.
See template
See template
NEW PATIENT INTAKE FORM
PDF template
Comprehensive form for collecting new patient personal, medical, insurance, and emergency contact information.
See template
See template
Patient Referral Form
PDF template
A comprehensive form for patients seeking specialist medical referrals through We Care Manatee health services.
See template
See template
PATIENT REGISTRATION FORM
PDF template
Comprehensive form for collecting patient personal, contact, insurance, and payment responsibility information for medical or dental services.
See template
See template
Patient Registration Form
PDF template
Comprehensive patient information and insurance registration document for healthcare services.
See template
See template
Patient Registration Form
PDF template
A form for collecting patient insurance details and establishing financial responsibilities for medical services.
See template
See template
Patient Registration Form
PDF template
Comprehensive form for collecting patient personal information, contact details, insurance, and demographic data for healthcare providers.
See template
See template
Patient Registration Form
PDF template
Comprehensive form for collecting patient personal, contact, employment, emergency contact, and insurance information for healthcare providers.
See template
See template
PHAS Empowered Patient Online Toolkit Insurance Form
PDF template
A comprehensive document for collecting and organizing personal insurance details across multiple insurance types and providers.
See template
See template
Paxman Hub Enrollment Form
PDF template
Comprehensive enrollment form for patient information, insurance, and treatment details for Paxman medical services.
See template
See template
Foreign Travel Insurance Form
PDF template
Form for registering and obtaining mandatory travel insurance for university-sponsored international group travel
See template
See template
NYSUT Member Benefits Payroll Deduction Authorization
PDF template
A form allowing NYSUT members to authorize payroll deductions for various member benefits programs.
See template
See template
NEW ENROLLMENTCHANGE FORM
PDF template
A form for employees to enroll in or modify flexible spending account (FSA) and dependent care spending account benefits.
See template
See template
PINE BEACH YACHT CLUB RENTAL APPLICATION AGREEMENT
PDF template
Application and agreement for renting the Pine Beach Yacht Club facility for private events.
See template
See template
Discharge Form
PDF template
Official form for requesting discharge from a Primary Care Health Home program in Missouri's Medicaid system
See template
See template
MO HealthNet Primary Care Health Home Discharge Protocol
PDF template
Protocol for discharging patients from a Primary Care Health Home, outlining procedures for submission and communication of discharge forms.
See template
See template
SCUSD Sun Life Insurance Beneficiary Change Update Form
PDF template
Insurance enrollment and beneficiary designation form for Sacramento City Unified School District employees
See template
See template
Miscellaneous Cancellation Form
PDF template
A form for employees to cancel insurance or annuity policies through their employer's benefits office.
See template
See template
Miscellaneous Cancellation Form
PDF template
A form for UNC Health Care System employees to cancel insurance or annuity policies with specific details about policy types and premium amounts.
See template
See template
Owner Builder Declaration Form
PDF template
A legal form informing property owners of their responsibilities and risks when obtaining an owner-builder building permit in California.
See template
See template
PDS Cancel Form
PDF template
A form for cancelling non-GAP warranty products with options for refund and various cancellation reasons
See template
See template
Incoming Referral Form
PDF template
A comprehensive form for collecting patient demographics, insurance details, and referral information for medical practices.
See template
See template
Physician Referral Service Form
PDF template
A comprehensive medical referral document for patient transfer between healthcare providers, capturing patient and insurance details.
See template
See template
Post Employment Health Plan (PEHP) Claim Form
PDF template
Form for requesting health plan reimbursements for medical expenses or insurance premiums after employment separation.
See template
See template
NRECA Long Term Disability Plan Summary Plan Description
PDF template
A summary plan description detailing the long-term disability benefits provided by the National Rural Electric Cooperative Association (NRECA) for eligible participants.
See template
See template
FORM OF PENSION BENEFIT ELECTION
PDF template
A form for selecting pension benefit options, including single life and joint survivor annuity choices for retirees.
See template
See template
CLAIM FORM
PDF template
Insurance claim form for students with international visa status, covering injury and medical claims.
See template
See template
PERS Group Life Insurance
PDF template
Comprehensive document detailing noncontributory and contributory group life insurance coverage for PERS members.
See template
See template
Personal Automobile Policy Forms And Endorsements
PDF template
Comprehensive reference guide for personal automobile insurance policy forms and endorsements across different states.
See template
See template
Personal Effects Claim Form
PDF template
Insurance claim form for reporting loss, damage, or theft of personal items during travel, used to request compensation from Chubb insurance.
See template
See template
PATIENT INJURYMEDICAL HISTORY FORM
PDF template
A comprehensive form documenting patient details and medical information following a vehicle accident.
See template
See template
Loss Or Damage Report Form Personal
PDF template
A comprehensive form for reporting property loss or damage claims to NFU Mutual, providing detailed instructions for claim submission.
See template
See template
Registered Food Business Booking Form
PDF template
A form for registered food businesses to apply for a stall at the Malmesbury Carnival, including business details, insurance, food safety, and operational compliance.
See template
See template
Pfizer EnCompass Enrollment Form For INFLECTRA And RUXIENCE
PDF template
Enrollment form for Pfizer medications with patient and insurance information collection for Inflectra and Ruxience prescriptions.
See template
See template
Pfizer EnCompass Enrollment Form For INFLECTRA (Infliximab Dyyb) For Injection And RUXIENCE (Rituxim
PDF template
Enrollment form for patients seeking information and assistance for specific Pfizer medications, including insurance verification and potential co-pay assistance.
See template
See template
Form PFL 1 Applying For Paid Family Leave Military
PDF template
A form for requesting paid family leave to assist family members of military personnel on active duty or impending active duty abroad.
See template
See template
Proposal Form Motorcycle
PDF template
Insurance proposal form for motorcycle coverage by Liberty Insurance in Singapore, requiring detailed personal and driving information.
See template
See template
General Liability Insurance Form Update (PGL1)
PDF template
Update to General Liability Insurance form allowing insurance agents and brokers to validate insurance documentation.
See template
See template
Pharmacy Pre Authorization Form General Requests
PDF template
A form for healthcare providers to request pre-authorization for medication coverage from an insurance provider.
See template
See template
Prior Authorization Request Form
PDF template
A form for requesting prior authorization for specialty medical services through Positive Healthcare in California.
See template
See template
Physical Therapy Overview
PDF template
Comprehensive overview of physical therapy services, treatment approaches, and insurance information for patients at a student health center.
See template
See template
Sound Health Wellness Trust Physical Therapy Pre Authorization Request Form
PDF template
A medical form used to request pre-authorization for physical therapy services from Sound Health & Wellness Trust.
See template
See template
Notice Of Claim For Short Term Disability Benefits
PDF template
A form for employees to file a claim for short-term disability benefits with insurance details and medical information.
See template
See template
Dental AndOr Vision Option Election Form
PDF template
Form for electing dental and vision insurance coverage for retired laborers in Northern California.
See template
See template
CHRONIC ILLNESS BENEFIT APPLICATION FORM
PDF template
Application form for patients seeking chronic illness benefits through Platinum Health medical scheme, requiring detailed personal and medical information.
See template
See template
PLAT COMPREHENSIVE CHRONIC ILLNESS BENEFIT APPLICATION FORM
PDF template
Application form for patients seeking chronic illness benefits from Platinum Health medical scheme, requiring detailed personal and medical information.
See template
See template
Attending PhysicianS Statement Of Disability
PDF template
Medical form used by physicians to document and certify a patient's disability status and work limitations for insurance purposes.
See template
See template
USAV YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
Medical release and emergency contact form for youth and junior volleyball players participating in sanctioned competitions and practices.
See template
See template
YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
A comprehensive medical release and consent form for youth and junior volleyball players, detailing medical information, emergency contacts, and participation permissions.
See template
See template
Professional Liability Insurance Form
PDF template
Insurance enrollment form for Texas retired teachers returning to work in public schools, providing professional liability coverage.
See template
See template
PROFESSIONAL LIABILITY INSURANCE FORM
PDF template
Insurance application for retired teachers returning to work in public schools, providing professional liability coverage through the Texas Retired Teachers Association.
See template
See template
Patient Intake Form
PDF template
Comprehensive medical intake form for collecting patient demographic, contact, insurance, and referral information for physical therapy services.
See template
See template
POLICY CHANGE FORM TEXAS AUTOMOBILE INSURANCE PLAN ASSOCIATION
PDF template
A form used to modify automobile insurance policy details, including vehicle and operator information for the Texas Automobile Insurance Plan Association.
See template
See template
University Housing Policy And Procedures Manual Personal Liability Claims
PDF template
Guidelines for reporting and managing personal liability claims involving injury or property damage in university housing settings
See template
See template
Accident Reports Policy
PDF template
Policy requiring employees to report workplace injuries within 24 hours and complete an accident report form to maintain insurance eligibility.
See template
See template
Policy Change Form
PDF template
A comprehensive form for policyholders to request changes to their insurance coverage, including termination, dependent modifications, and benefit adjustments.
See template
See template
Policy Change Form
PDF template
A comprehensive form for modifying insurance coverage, including terminating coverage, adding/removing dependents, and adjusting benefits.
See template
See template
Policy Change Form
PDF template
A form used to modify insurance policy details including address, driver, vehicle, and coverage information.
See template
See template
Policy Change Request
PDF template
A form for requesting changes to an existing insurance policy, to be submitted via fax or email to Richards Insurance.
See template
See template
POLICYHOLDER REQUEST CHANGE FORM
PDF template
A form for policyholders to request changes to their insurance coverage, including name changes, beneficiary updates, and coverage modifications.
See template
See template
Policy Change Form
PDF template
A comprehensive form for making changes to an existing insurance policy, including address, driver, vehicle, and coverage details.
See template
See template
DriverS Declaration Form
PDF template
A form for adults who transport youth during diocesan events, requiring driver and vehicle details, license and insurance verification.
See template
See template
Policy Loan Agreement
PDF template
A loan agreement document for policyholders of RF&G Life Insurance Company, outlining terms and conditions for borrowing against a life insurance policy.
See template
See template
Service Request
PDF template
Form for making changes to an insurance policy, including name, address, premium mode, and non-forfeiture options.
See template
See template
WARRANTY CLAIM FORM
PDF template
Document used to report and document warranty claims for building construction or materials.
See template
See template
Patient Discharge Form
PDF template
A form used to document patient discharge details, care instructions, and follow-up services.
See template
See template
Warranty Claim Form
PDF template
A form used to submit warranty claims for DENSO PowerEdge Diesel Particulate Filters (DPF) and Diesel Oxidation Catalysts (DOC)
See template
See template
Power Of Attorney Form
PDF template
Legal document granting power of attorney for executing DEA Forms 222 and electronic orders for controlled substances
See template
See template
Discharge Process
PDF template
Policy outlining documentation standards and requirements for client discharge from behavioral health services, including progress note and administrative procedures.
See template
See template
Pfizer Dermatology Patient Access Form
PDF template
A multi-page form for patient information, prescription selection, and insurance details for Pfizer dermatology medications.
See template
See template
Prescription And Patient Support Enrollment Form
PDF template
Comprehensive patient enrollment form for Pfizer dermatology medications, capturing patient and insurance information for prescription support.
See template
See template
TRUST PREFERRED PROVIDER ORGANIZATION (PPO) PROGRAM REFERRAL FORM
PDF template
A form for referring patients to non-PPO healthcare providers when services are medically necessary and not available within the TRUST network.
See template
See template
WARRANTY CLAIM FORM
PDF template
A comprehensive form for submitting warranty claims for various product models and brands, detailing product defects and installation information.
See template
See template
FCL Pre Authorization Form
PDF template
A medical insurance pre-authorization form for requesting approval of medical procedures and services
See template
See template
Pre Authorization Form
PDF template
A form for requesting pre-authorization for medical procedures or treatments from GBG Assist insurance provider.
See template
See template
Admission Request Note
PDF template
A comprehensive form for requesting medical admission and insurance coverage, capturing patient and medical details for hospital admission.
See template
See template
Pre Authorization Form (PAF)
PDF template
A form used by insured members to request pre-approval for non-emergency hospitalization and medical procedures through Allianz EFU health insurance.
See template
See template
Pre Authorization Form
PDF template
A form for requesting pre-authorization for medical procedures and treatments through TieCare insurance.
See template
See template
REQUEST FOR CASHLESS HOSPITALISATION FOR MEDICAL INSURANCE POLICY
PDF template
A form for requesting cashless hospitalization under a medical insurance policy, to be completed by the patient and treating doctor.
See template
See template
Pre Authorization Form
PDF template
A form allowing credit card charges for medical services when insurance reimbursement is received.
See template
See template
Predetermination Request Form
PDF template
A medical form used to request pre-approval for medical treatments, procedures, or services from a health insurance provider.
See template
See template
BN 688 1117, Routine Pregnancy Claim Form
PDF template
A claim form for processing routine pregnancy and childbirth claims through American Fidelity Assurance Company.
See template
See template
Preliminary Inquiry Life Insurance
PDF template
A form for collecting personal and health information for a potential life insurance policy application.
See template
See template
Policyholder Payroll Audit Report
PDF template
A comprehensive form for reporting payroll details, employee information, and subcontractor details for insurance policy purposes.
See template
See template
PRESCRIPTION AND SERVICE REQUEST FORM FOR CINQAIR (Reslizumab) Injection 100mg10mL
PDF template
Medical form for prescribing Cinqair medication, collecting patient and insurance information, and requesting support services.
See template
See template
Prescription Claim Reimbursement Form
PDF template
A form for submitting prescription medication claims for reimbursement by a pharmacy services provider.
See template
See template
Prescription Drug Claim Form
PDF template
A form for submitting prescription drug claims and receiving pharmacy benefits reimbursement.
See template
See template
Prescription Drug Claim Form
PDF template
Form for members to request reimbursement for prescription medication expenses with various claim scenarios.
See template
See template
Prescription Drug Claim Form
PDF template
A form for submitting prescription drug claims to Blue Cross Blue Shield for reimbursement or processing.
See template
See template
Prescription Pre Authorization Request Form
PDF template
A medical form used to request pre-authorization for prescription medications from Sound Health & Wellness Trust.
See template
See template
Prescription Drug Reimbursement Form
PDF template
Form for submitting prescription drug reimbursement claims to an insurance provider, including details about medication and patient information.
See template
See template
PRESCRIPTION AND ENROLLMENT FORM
PDF template
A comprehensive form for patients to provide personal, insurance, and healthcare provider information for medical enrollment purposes.
See template
See template
Prescription Drug Reimbursement Form
PDF template
Form for submitting prescription drug reimbursement claims, including patient and pharmacy information, with certification of medication receipt and eligibility.
See template
See template
Prescription Drug Reimbursement Form
PDF template
A form for submitting prescription drug reimbursement claims with patient, pharmacy, and member information.
See template
See template
PCP CHANGE February 2014
PDF template
A form for members of Health Plan of San Mateo (HPSM) health insurance programs to select or change their primary care physician and update their address.
See template
See template
Referral Form Submission Instructions
PDF template
Comprehensive instructions for submitting medical referrals including patient demographics, service details, and pre-authorization requirements.
See template
See template
Member Refund Request Form
PDF template
A form for members to request refunds for medical expenses through Prime Cure medical scheme.
See template
See template
PROPERTY SELF INSURANCE PROGRAM TRANSIT (BUS 28 COVERAGE C) PRIOR APPROVAL FORM
PDF template
A form for prior approval of property shipments over $100,000 or involving household moves under the University of California's self-insurance program.
See template
See template
Data Protection Consent Form For Consulting And Support
PDF template
A document outlining how Swiss Life processes personal data for consulting and support purposes, with details on privacy protection and data handling.
See template
See template
Online Privacy Policy Agreement
PDF template
Privacy policy detailing data collection, usage, and user rights for Harpenau Insurance's online services and website.
See template
See template
Prize Claim Form
PDF template
Form for claiming a prize award, with sections for winner identification, citizenship status, and tax documentation requirements.
See template
See template
Proposed Amendments N.J.A.C. 114 40.2 And 43.3
PDF template
Proposed regulatory changes for life insurance, annuity, and variable contract form filing requirements in New Jersey.
See template
See template
Producer Controlled Insurer Information Report Form
PDF template
Annual reporting form for property and casualty insurers detailing producer relationships and financial information
See template
See template
Producer Appointment Request Form
PDF template
A form used by insurance professionals to request appointment as a producer, requiring personal and professional background information.
See template
See template
Bosch Spark Plugs Professional Technician Warranty Claim Form
PDF template
A form for professional technicians to submit warranty claims for Bosch spark plugs with details about vehicle and part failure.
See template
See template
Important Notices To The Applicant
PDF template
Legal notice outlining an applicant's duty of disclosure when applying for a general insurance contract, including potential consequences of non-disclosure.
See template
See template
Shasta County HHSA Program Diagnosis And Discharge Form
PDF template
A form used by healthcare professionals to document patient diagnosis, medical conditions, and discharge details for mental health programs.
See template
See template
2025 Plan Year Draft QIS Progress Report Form
PDF template
A form for healthcare issuers to report on their quality improvement strategy progress for the 2025 plan year.
See template
See template
Proof Of Claim And Release
PDF template
Legal claim form for participating in the securities litigation settlement for DVI, Inc.
See template
See template
Disability Claim Form
PDF template
A comprehensive form for employees to file a disability claim, documenting medical condition, work status, and physician certification.
See template
See template
Proof Of Insurance Form
PDF template
Form for verifying medical and emergency insurance coverage for students, faculty, and staff traveling internationally.
See template
See template
Proof Of Insurance Form
PDF template
Official document used to verify vehicle insurance coverage at the time of an offense in Ohio.
See template
See template
Illinois Department Of Insurance Consumer Complaint Form
PDF template
Official form for filing insurance-related complaints with the Illinois Department of Insurance for auto, home, property, or commercial insurance issues.
See template
See template
Risk Management Property Damage Claim Form
PDF template
A form for reporting and documenting property damage incidents within an organization's risk management process.
See template
See template
PROPERTY DAMAGE REPORT FORM
PDF template
A comprehensive form for documenting property damage incidents, including details about the loss, damaged property, and involved parties.
See template
See template
Property Damage Report Form (Other Than Auto)
PDF template
A detailed form for reporting property damage incidents, capturing details about the damage, location, type of loss, and estimated costs.
See template
See template
PROPERTY INVENTORY FORM
PDF template
A form for documenting property details, purchase information, and valuation for insurance claim purposes
See template
See template
PROPERTY INVENTORY FORM
PDF template
A comprehensive form for documenting credit cards, vehicles, and theft-prone items for personal record-keeping and potential insurance purposes.
See template
See template
Property Inventory Record
PDF template
A comprehensive form for documenting personal belongings, their details, and values to assist in potential theft or loss scenarios.
See template
See template
PROPOSAL FORM QUICK QUOTE FORM
PDF template
Insurance proposal form for taxi businesses covering 1-4 vehicles, detailing duty of disclosure and personal information handling.
See template
See template
PolicyholderS Change And Service Request
PDF template
A form for making changes to a life insurance policy, including coverage modifications, beneficiary updates, and contact information changes.
See template
See template
Patient Referral Form
PDF template
A referral form for dental patients seeking prosthodontic or general dentistry services at a dental practice or clinic.
See template
See template
Provider Doctor Claim Inquiry
PDF template
A form for healthcare providers to request review of a previously adjudicated medical claim with Blue Cross Blue Shield of North Carolina.
See template
See template
Provider ContractAmendment Inquiry Form
PDF template
Form for healthcare providers to join AmeriHealth Caritas Florida's network across multiple health plan options
See template
See template
Provider Inquiry Form
PDF template
A confidential form for healthcare providers to submit claims, coordination of benefits, and related inquiries to Independent Health insurance.
See template
See template
Group Disability Insurance Disability Claim Instructions
PDF template
Comprehensive instructions for filing a disability insurance claim with Prudential, detailing required documentation and submission process.
See template
See template
PATIENT INTAKE FORM
PDF template
A comprehensive medical intake form for workers' compensation patients, capturing personal, insurance, and medical history details.
See template
See template
Paul Tickner Safaris Booking Form
PDF template
A comprehensive booking form for travelers registering for a safari expedition, collecting personal and travel details.
See template
See template
Understanding Our Mutual Obligations For Dental Insurance
PDF template
A document explaining dental insurance benefits, patient obligations, and the relationship between dental practice and insurance providers.
See template
See template
Medical Service Authorization Request Form
PDF template
A form used to request medical service authorization for PrimeWest Health members, requiring detailed provider and patient information.
See template
See template
Short Term Disability Claim Form
PDF template
A form for employees to file a short-term disability insurance claim with details about their disability and work status.
See template
See template
Velodrome Authorized Motor Vehicle Registration
PDF template
A registration form for motor-pacers seeking authorization to enter the velodrome with specific vehicle and insurance requirements.
See template
See template
Questions And Answers Regarding Parental Consent And Notification Requirements For Access To Public
PDF template
Guidance document explaining parental consent requirements for accessing public benefits and insurance programs for students with disabilities.
See template
See template
Quality Management Memo New Updated Discharge Form
PDF template
Memo introducing changes to the discharge documentation process for mental health service providers, enhancing information capture about client discharge reasons and destinations.
See template
See template
DBPR EL 4504 Employee Leasing Company Quarterly Report Form
PDF template
Quarterly reporting form for employee leasing companies in Florida, detailing financial and insurance compliance requirements.
See template
See template
Artist Waiver Form For Alumni Art Exhibit
PDF template
Waiver form for artists submitting artwork to an alumni art exhibit, outlining submission requirements and liability terms.
See template
See template
Disability Form
PDF template
A comprehensive form for documenting an employee's disability status, medical details, and work-related information for insurance or employer records.
See template
See template
Underground Discharge System (Class V) Inventory Sheet
PDF template
Official EPA form for documenting underground discharge systems, including details about system type, location, and fluid discharge characteristics.
See template
See template
PATIENT INTAKE FORM
PDF template
A comprehensive patient intake form collecting personal, contact, insurance, and medical authorization details for healthcare services.
See template
See template
ARCHITECTS AND ENGINEERS PROFESSIONAL LIABILITY INSURANCE APPLICATION
PDF template
An insurance application form for architects and engineers to obtain professional liability coverage through a claims made and reported policy.
See template
See template
RBC Proposal Form
PDF template
A proposal form for submitting changes to risk-based capital methodology and documentation for insurance regulators.
See template
See template
RBC Proposal Form
PDF template
Proposal form for submitting changes to Risk-Based Capital (RBC) regulations and instructions across different insurance sectors.
See template
See template
A RESOLUTION OF THE TOWNSHIP OF NORTH BRUNSWICK ACCEPTING AND ADOPTING THE CENTRAL JERSEY MUNICIPAL
PDF template
A township resolution adopting the Central Jersey Municipal Joint Insurance Fund's 2024 Safety Incentive Program to ensure workplace safety and compliance.
See template
See template
Refund Request Form Model Year 2008 ZAP Xebra
PDF template
A formal document allowing owners of 2008 ZAP Xebra vehicles to request a refund by submitting vehicle details and supporting documentation.
See template
See template
RC SERVICE AGREEMENT FORM
PDF template
Form for submitting emergency vehicle repair claims under a service agreement warranty.
See template
See template
Downwinder Claim Form
PDF template
Official U.S. Department of Justice claim form for compensation under the Radiation Exposure Compensation Act for individuals exposed to radiation.
See template
See template
Onsite Participant Claim Form
PDF template
A claim form for individuals seeking compensation under the Radiation Exposure Compensation Act for radiation-related illnesses.
See template
See template
Record Of Employment
PDF template
A form for documenting employment status for unemployment insurance claims in New York State
See template
See template
RECOVERY HOME DISCHARGE FORM
PDF template
A comprehensive form capturing client discharge details, substance use history, and recovery status for treatment facilities.
See template
See template
FLORIDA HOMEOWNERS CONSTRUCTION RECOVERY FUND CLAIM FORM
PDF template
A form for homeowners to claim compensation for construction-related financial misconduct or project abandonment by a licensed contractor.
See template
See template
Recreation Insurance Form
PDF template
Insurance form for participants in the Hammonton Recreation Program, covering medical liability and insurance information.
See template
See template
SCAN Referral Authorization Request Form
PDF template
A medical service referral and authorization form for SCAN Health Plan to request prior approval for medical services or procedures
See template
See template
Aetna Better Health Of Florida Referral Form
PDF template
A referral form for healthcare providers to refer patients to specialists or diagnostic services within the Aetna Better Health of Florida network.
See template
See template
Referral Form
PDF template
A form used by healthcare providers to refer a patient to another medical professional or service for specialized care or consultation.
See template
See template
COMMUNITYCARE REFERRALAUTHORIZATION FORM
PDF template
A medical referral and authorization form for Medicaid patients seeking healthcare services through the CommunityCARE program
See template
See template
Client Referral Form
PDF template
A comprehensive form for collecting client personal, contact, insurance, and referral information for healthcare or social services.
See template
See template
Referral Form
PDF template
A comprehensive patient referral form for healthcare services with sections for patient information, insurance details, referral source, and service needs.
See template
See template
Sutter Specialty Services Referral Form
PDF template
A referral form for patients seeking specialty medical services through Sutter Health network with detailed patient, physician, and insurance information.
See template
See template
EDRC 253 REFERRAL FORM
PDF template
Comprehensive medical referral form used to collect patient demographics, insurance information, and clinical details for healthcare services.
See template
See template
Refund Request Form State Employees
PDF template
A form for state employees to request refunds of insurance premium overpayments with W-2 tax adjustment provisions.
See template
See template
REFUSE Insurance Form INTERNATIONAL
PDF template
Form for international students to waive mandatory student insurance by providing alternative coverage documentation.
See template
See template
REFUSE Insurance Form (Montana Medicaid)
PDF template
A form for students to waive student health insurance coverage and acknowledge non-coverage by Montana Medicaid at the Curry Health Center.
See template
See template
REFUSE Insurance Form (U.S. Citizens)
PDF template
A form for students to declare existing private health insurance coverage and waive university-provided insurance requirements.
See template
See template
Regence BlueShield Incident Report
PDF template
A form for reporting medical incidents or injuries that may affect insurance claims processing for Regence BlueShield in Washington State.
See template
See template
MEMBER REIMBURSEMENT FORM
PDF template
A comprehensive form for members to submit healthcare service reimbursement claims, including details about patient, services, and insurance coverage.
See template
See template
Member Reimbursement Form
PDF template
A comprehensive form for members to submit healthcare service reimbursement claims, including details about patient, services, and coverage.
See template
See template
LSA LSC Youth Soccer Medical Release Form And Waiver Hold Harmless Agreement
PDF template
Medical release and consent form for youth soccer players, including emergency contact and medical information
See template
See template
Insurance Referral And Financial Responsibility Form
PDF template
A document outlining patient insurance participation, referral requirements, and financial responsibilities for medical services at Eye Associates of Utica.
See template
See template
Guidelines For Reimbursement Of NAIC Travel Expenses
PDF template
Detailed policy outlining travel expense reimbursement procedures for NAIC-related travel and eligible participants.
See template
See template
Travel Reimbursement Form
PDF template
Form for municipal court employees to submit travel-related expenses for reimbursement with specific guidelines and submission instructions.
See template
See template
Travel Reimbursement Form
PDF template
Form for municipal court employees to claim travel-related expenses and reimbursements from the Texas Municipal Courts Education Center.
See template
See template
Direct Payment Reimbursement Form
PDF template
A form for claiming and seeking reimbursement for expenses related to church activities with payment method options.
See template
See template
Reimbursement Of Orthodontic Expenses
PDF template
Guidelines for reimbursing orthodontic expenses based on IRS rules and service agreements, detailing monthly reimbursement processes.
See template
See template
Volunteer Signup
PDF template
A legal document outlining liability release and waiver for volunteers participating in Next Step STORM activities.
See template
See template
Rental Agreement
PDF template
A rental agreement for municipal facilities in Norwood Young America, covering event space rental, fees, and policies
See template
See template
Pavilion Rental Agreement
PDF template
Comprehensive rental agreement for pavilion facilities in Norwood Young America, covering fees, deposits, event details, and alcohol regulations.
See template
See template
Rental Agreement Form
PDF template
A rental form for equipment rental from Cirrus Research plc, covering terms of equipment usage and insurance responsibilities.
See template
See template
Wellesley Public Schools Rental Agreement
PDF template
Comprehensive terms and conditions for renting school facilities in Wellesley, including payment, permit, and insurance requirements.
See template
See template
Town House School Guidelines Rental Agreement Form
PDF template
Rental guidelines and agreement for the Town House School facility managed by Kennebunkport Historical Society, detailing usage rules and responsibilities.
See template
See template
Request For Mexican Automobile Insurance
PDF template
Form for obtaining Mexican automobile insurance for UC Santa Barbara vehicles traveling to Mexico, as required by Mexican law.
See template
See template
PolicyCertificate Information Updates
PDF template
A form for updating policy details, mailing address, and beneficiary information with Washington National Insurance Company.
See template
See template
Request For Copy Of Military Discharge Form
PDF template
A county-level form for requesting a copy of a military discharge document with personal identification requirements.
See template
See template
Request For Certificate Of General Liability Insurance
PDF template
A form for Boy Scouts of America units to request a general liability insurance certificate for authorized activities.
See template
See template
REQUEST FOR POLICY CHANGE FORM
PDF template
A form for requesting changes to an existing insurance policy with Pacific Life Assurance Co., Ltd.
See template
See template
Request For Reimbursement From FSA Or HRA Form
PDF template
A form used to request reimbursement for eligible healthcare and dependent care expenses through a Flexible Spending Account (FSA) or Health Reimbursement Arrangement (HRA)
See template
See template
REQUEST FOR REIMBURSEMENT DUE TO PARTIAL DISCHARGE OF A FEDERAL CONSOLIDATION LOAN
PDF template
A form for loan holders/servicers to request reimbursement for partial loan discharge under specific conditions such as closed school, death, disability, or false certification.
See template
See template
Aflac Benefit Services Request For Reimbursement Form
PDF template
A form for requesting reimbursement from a Flexible Spending Account (FSA) for medical care expenses.
See template
See template
Request For Reinstatement Of Policy Contract
PDF template
A form for requesting reinstatement of an insurance policy, requiring detailed personal and medical information.
See template
See template
Request For UC Certificate Of Insurance
PDF template
A form used by University of California departments to obtain a certificate of insurance for agreements, contracts, or permits.
See template
See template
MEDICAID HOSPICE DISCHARGE FORM
PDF template
Official form documenting the discharge of a patient from a Medicaid hospice program, including reasons for termination of services.
See template
See template
RequisitionPre Authorization Form
PDF template
A form for requesting additional medical testing at Regional Medical Laboratory, including patient and insurance information verification.
See template
See template
Vantage Learning International Channels Program
PDF template
A strategic program by Vantage Learning to expand international channels and partner with organizations for educational technology services.
See template
See template
Full Discharge Refinance Authority Form
PDF template
A document used for requesting mortgage discharge or refinancing, providing details about loan repayment and property transfer processes.
See template
See template
ResidentResponsible Party Agreement
PDF template
Comprehensive agreement for billing, payment, and medication authorization for a senior living resident
See template
See template
Resolution 2015 01 Confidentiality Of Benefits And Insurance Information
PDF template
A resolution establishing guidelines for accessing and protecting confidential benefits and insurance information in compliance with federal privacy laws.
See template
See template
Hospital Discharge Intake Form
PDF template
A form for evaluating patient eligibility for short-term respite care after hospital discharge, including medical stability and independence requirements.
See template
See template
Retail Prescription Drug Claim Form
PDF template
Claim form for federal employees and retirees to submit prescription drug expenses for reimbursement.
See template
See template
Dental AndOr Vision Option Election Form
PDF template
Form for electing optional dental and vision insurance coverage for retired laborers.
See template
See template
Enrollment Form
PDF template
Insurance enrollment form for University of California employees and retirees seeking accidental death and dismemberment coverage through Prudential Insurance
See template
See template
RETIREE HEALTH COVERAGE CONTACT FORM
PDF template
A form for collecting updated contact and personal information for retirees to maintain health coverage communication.
See template
See template
Retiree Death Benefit Program Highlights
PDF template
A death benefit program offering $1,000 to $10,000 in coverage for retirees and spouses with guaranteed issue and fixed rates.
See template
See template
RETIREE DENTAL VISION ENROLLMENT FORM
PDF template
Form for retirees to enroll in dental and vision insurance coverage through Emory Benefit Plans.
See template
See template
Pre 65 65 Retiree Life Insurance Decrease Coverage Or Cancellation Form
PDF template
Form for University of New Mexico (UNM) retirees to decrease or cancel life insurance coverage based on age category.
See template
See template
Reimbursement Form
PDF template
A form for requesting reimbursement for medical care, supplies, and healthcare expenses from an insurance provider.
See template
See template
Faculty And Staff Retirement Checklist
PDF template
A comprehensive guide for faculty and staff retirement preparation at Seminole State College, outlining key steps for retiring employees.
See template
See template
Faculty And Staff Retirement Checklist
PDF template
Comprehensive retirement checklist for Seminole State College faculty and staff, providing step-by-step instructions for retirement planning and documentation.
See template
See template
State Of West Virginia Public Employee Insurance Agency Retiree Health And Life Insurance Enrollment
PDF template
A form for West Virginia public employees to enroll in health and basic life insurance coverage upon retirement.
See template
See template
State Of West Virginia Public Employee Insurance Agency Retiree Health And Basic Life Insurance Enro
PDF template
A form for West Virginia public employees to enroll in retirement health and basic life insurance coverage
See template
See template
Retirement Plan And Disability Waiver Form
PDF template
Form for waiving waiting period for retirement and disability coverage when transferring employment to Northeastern
See template
See template
Retirements And Retiree Benefits
PDF template
Comprehensive guide for Pittsburg State University employees detailing retirement eligibility, benefits, and process for retiring staff and faculty.
See template
See template
Direct Reimbursement Claim Form
PDF template
A form for submitting vision care service reimbursement claims for out-of-network providers through Davis Vision.
See template
See template
Owner Controlled Insurance Program (OCIP) Manual
PDF template
A comprehensive manual detailing insurance program requirements and responsibilities for the New Ukiah Courthouse construction project.
See template
See template
GRAIN WAREHOUSE CERTIFICATE OF INSURANCE FORM NO. RGW 302
PDF template
Instructions for completing a certificate of insurance for public grain warehouses in Texas, required for licensing and compliance.
See template
See template
PARTS WARRANTY CLAIM FORM
PDF template
Official form for submitting warranty claims for defective Rheem or Ruud water heater component parts without returning the parts.
See template
See template
WATER HEATER WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims for Rheem, Ruud, and Rheem-Ruud water heaters, parts, and labor.
See template
See template
Water Heater Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for water heaters, parts, and labor from Rheem Sales Company, Inc.
See template
See template
NDPERS Retiree Health Insurance Credit (RHIC) Program Claim Form
PDF template
A claim form for North Dakota Public Employees Retirement System retirees to claim health insurance premium reimbursements.
See template
See template
Warranty Claim Form
PDF template
A form used to submit warranty claims for product returns or service requests by customers, distributors, or dealers.
See template
See template
VantageCare RHS Plan Claim Form
PDF template
Form for submitting medical expense reimbursement claims to the VantageCare RHS Plan administered by Meritain Health.
See template
See template
RINGETTE BC MEDICAL FORM
PDF template
A confidential medical form for Ringette BC athletes to collect personal health and emergency contact information.
See template
See template
Retiree Health Care Cancellation Form
PDF template
A form for state retirees to cancel their or their spouse's health care coverage with the Rhode Island Office of Employee Benefits.
See template
See template
Texas AM University San Antonio Risk Assessment Matrix
PDF template
A comprehensive risk assessment tool for evaluating potential hazards and risks associated with university events and activities.
See template
See template
Texas AM International University Risk Management And Insurance Matrix
PDF template
A comprehensive matrix for identifying, assessing, and managing potential risks associated with university activities.
See template
See template
Risk Management Policy
PDF template
A policy to protect the interests of Associated Students, Inc. by providing a safe environment and managing organizational risks.
See template
See template
Accident Claim Form
PDF template
A claim form for submitting accident-related insurance claims with specific filing instructions and requirements.
See template
See template
4 H Risk Management Checklist For Meetings And Events
PDF template
A comprehensive checklist for identifying and managing potential risks in 4-H meetings and events to ensure participant safety.
See template
See template
NAIC Uniform Risk Retention Group Registration Form
PDF template
Official registration form for Risk Retention Groups operating under the Federal Liability Risk Retention Act of 1986
See template
See template
Protection Declaration Form
PDF template
Insurance declaration form for policy underwriting with specific provisions for cancer survivors applying for mortgage protection insurance.
See template
See template
Insurance Bill Requisition Form
PDF template
A medical laboratory test request form for collecting patient information, test orders, and billing details.
See template
See template
Insurance Bill Requisition Form
PDF template
A comprehensive form for collecting patient and practitioner information for medical laboratory testing and insurance billing purposes.
See template
See template
RM 41 Risk Management Property Insurance Claim Form
PDF template
A form for submitting property damage or loss claims to the Office of Risk Management for insurance reimbursement.
See template
See template
Medical Expense Reimbursement Form
PDF template
Step-by-step guide for submitting a medical expense reimbursement claim using a PDF form on the Benserco website.
See template
See template
RoboCamp RIT Medical And Health Insurance Form
PDF template
Comprehensive medical history and health information form for students attending RoboCamp at RIT
See template
See template
PERMITFACILITY USE AGREEMENT WEED COMMUNITY CENTER
PDF template
A legal agreement for using the Weed Community Center, outlining indemnification and insurance requirements for facility renters.
See template
See template
ROW And FOP Contractor Requirements
PDF template
Detailed requirements for contractors seeking to work on right-of-way and fiber optic projects in the City of Lincoln.
See template
See template
Basis Of Claim Form
PDF template
Official document for persons claiming refugee protection in Canada, detailing requirements for submitting a refugee claim.
See template
See template
Patient Intake Form
PDF template
Confidential form for collecting comprehensive patient personal, medical, work, and insurance information for physical therapy services.
See template
See template
Hospice Referral Form
PDF template
A comprehensive form for initiating hospice care referral, collecting patient medical, personal, and insurance information.
See template
See template
NEW PATIENT REGISTRATION FORM
PDF template
Comprehensive medical intake form for new patients, including personal information, insurance details, and arbitration agreement.
See template
See template
Motor Vehicle Procedure Manual Registration Commercial Motor Vehicle Insurance
PDF template
Official procedure manual for collecting and managing commercial motor vehicle insurance requirements in Florida.
See template
See template
Group LTD Insurance Cancellation Form
PDF template
Form for employees to cancel voluntary long-term disability insurance coverage at the University of Tennessee
See template
See template
Application For Benefits Fraud Warning
PDF template
Legal document providing state-specific warnings about insurance claim fraud and potential criminal penalties for false claims.
See template
See template
Insurance Form Number One
PDF template
Administrative rules governing insurance forms used by the State Fire Marshal for fire loss reporting and information requests.
See template
See template
RV Rental Insurance Application
PDF template
Insurance application for RV rental businesses covering liability and physical damage for recreational vehicles
See template
See template
Allergy Reimbursement Claim Form
PDF template
A form for submitting claims for allergy treatments and medications for reimbursement by an insurance provider.
See template
See template
Prescription Drug Reimbursement Coordination Of Benets Claim Form
PDF template
A form for submitting prescription drug reimbursement claims and coordinating medical benefits for pharmacy services.
See template
See template
Accidental Injury Claim Form
PDF template
Insurance claim form for reporting and processing an accidental injury claim with Aflac
See template
See template
Initial Disability Checklist
PDF template
A comprehensive form for filing a disability insurance claim, collecting details about the nature of disability, patient, and policyholder information.
See template
See template
Long Term Care Continuing Claim Form
PDF template
A claim form for submitting long-term care insurance claims through Aflac, requiring detailed policyholder and patient information.
See template
See template
Continuing Disability Claim Form
PDF template
A claim form for filing a continuing disability insurance claim with Aflac, requiring policyholder and patient information.
See template
See template
STUDENT VEHICLE REGISTRATION FORM
PDF template
Form for students to register their vehicles and parking permits at Bethel University in Tennessee.
See template
See template
Sagewell Healthcare Benefits Trust FAQ
PDF template
Detailed FAQ document explaining the structure, administration, and key details of the Sagewell Healthcare Benefits Trust group insurance arrangement.
See template
See template
Same Day Delivery Form
PDF template
Form allowing patients to receive medical devices on the day of evaluation, with information about potential insurance authorization and financial responsibilities.
See template
See template
Auto Accident Report Form
PDF template
A comprehensive form for documenting details and steps to take following an automobile accident.
See template
See template
SAMPLE ASSUMPTION OF RISK RELEASE
PDF template
A legal document that releases event sponsors from liability and acknowledges participant's voluntary assumption of risks during an event.
See template
See template
SAMPLE BANKRUPTCY DISCHARGE FORM
PDF template
A document outlining sample guidelines for bankruptcy discharge procedures.
See template
See template
Ohio Cancellation Form
PDF template
Form documenting termination of insurance agents for various reasons including lack of production and retirement.
See template
See template
Sample Certificate Of Insurance
PDF template
Insurance certification document outlining minimum coverage requirements for a grant agreement with details on liability and insurance provisions.
See template
See template
Sample Discharge Form
PDF template
A comprehensive discharge form for shelter guests documenting medical conditions, transportation needs, and post-evacuation services
See template
See template
Health Care Benefits Renewal
PDF template
A renewal form for health care benefits from the Texas Health and Human Services Commission for individuals to update their personal and financial information.
See template
See template
Sample Incident Reporting Audit Form
PDF template
A comprehensive form for documenting and tracking incidents, their internal reporting contacts, policy references, insurance details, and external regulatory reporting requirements.
See template
See template
Letter Of Intent For Business Asset Acquisition
PDF template
A legal document outlining the potential terms for acquiring a business's assets, book of business, and insurance company appointments.
See template
See template
Rental Agreement, Release And Assumption Of Risks
PDF template
A comprehensive rental agreement that includes risk assumption, liability release, and insurance acknowledgment for renting an interactive inflatable unit.
See template
See template
Sanitary Sewer Discharge
PDF template
Procedure for managing and reporting planned or accidental discharges to sanitary sewer systems, outlining notification requirements and responsible parties.
See template
See template
SB0357 Viatical Disclosure Form Act
PDF template
Legislative act requiring disclosure forms and defining terms related to viatical settlement purchases in Montana.
See template
See template
Massachusetts Workers Compensation Assigned Risk Pool Special Bulletin No. 09 03
PDF template
Bulletin detailing new procedures for requesting and obtaining workers' compensation insurance certificates in the Massachusetts Assigned Risk Pool.
See template
See template
SB 551 Member Enrollment
PDF template
Enrollment form for members to provide personal and medical insurance information for the Oregon Educators Benefit Board (OEBB)
See template
See template
Survivor Benefit Application Form
PDF template
An application form for survivors to claim pension benefits for a deceased account holder
See template
See template
Parental Consent Form To Receive Health Care Services
PDF template
A comprehensive form for parents to provide consent and medical information for student health care services at school-based clinics.
See template
See template
REPORT OF ACCIDENT
PDF template
A comprehensive form documenting details of an accident, including personal information, injury specifics, and medical treatment
See template
See template
PlaintiffS Claim And ORDER To Go To Small Claims Court
PDF template
Official California judicial form for filing a small claims court case, detailing plaintiff's claim and court proceedings.
See template
See template
Semi Annual Scavenger Waste Discharge Report
PDF template
Official form for documenting waste collection and discharge activities within New York City for a six-month reporting period.
See template
See template
Claim Form For Expat Insurance Packages
PDF template
A comprehensive claim form for expatriates to report damages across multiple insurance package types, requiring detailed policy and incident information.
See template
See template
Schedule III V Inventory Form Instructions
PDF template
Detailed instructions for completing an inventory form for Schedule III-V controlled substances for shipment to INMAR/EXP.
See template
See template
School District Student AccidentIncident Report Form
PDF template
A comprehensive form for documenting student accidents or incidents within a school district, capturing details of the event, location, and actions taken.
See template
See template
Pupil Personal Accident Report Form
PDF template
A comprehensive form for reporting and claiming medical expenses for student accidents at school
See template
See template
School Waiver Form Extracurricular Activities
PDF template
A school waiver form for students participating in sports and extracurricular activities, outlining liability and insurance requirements.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for submitting warranty repair claims, requiring details about the product, repair, and associated costs.
See template
See template
Boston Scientific Spinal Cord Stimulation Pre Authorization Form
PDF template
A medical form for pre-authorization of spinal cord stimulation procedures, used to document patient, physician, and procedure details for insurance approval.
See template
See template
Unable To AdmitDischarge Form (SLTC 158)
PDF template
A form used to document when a service provider cannot admit a member or is discharging a member from personal assistance services.
See template
See template
Commercial Automobile Application
PDF template
An insurance application form for commercial automobile coverage detailing business operations and vehicle information.
See template
See template
Dock Rental Form
PDF template
Guidelines and process for renting dock slips within the Sorrento community, including required documentation and administrative procedures.
See template
See template
Certificate Of Insurance Hold Harmless Tracking Form
PDF template
Form for event organizers to provide liability insurance documentation and hold harmless agreement for City of Bellevue special events.
See template
See template
Group Insurance Disability Claim Form
PDF template
A comprehensive form for submitting a disability insurance claim by an employee, physician, and employer or plan administrator.
See template
See template
Medical Claim Form
PDF template
A comprehensive medical claim form for reimbursement of medical expenses through Seib Insurance & Reinsurance Company in Qatar.
See template
See template
Self Service Storage Producer Limited Lines Initial License Application (Business Entity)
PDF template
Application for obtaining a limited lines insurance license for self-service storage producers in Maryland.
See template
See template
PBCI SENIOR MEDICAL TRAVEL FORM
PDF template
Comprehensive medical screening form for senior travel participants detailing health status, medical history, and emergency contact information.
See template
See template
Service Agreement And Financial Policy
PDF template
A comprehensive service and financial policy document outlining service rates, insurance expectations, and patient financial responsibilities for mental health services.
See template
See template
Service Request Form
PDF template
A form for making changes to an insurance policy, including beneficiary, name, address, ownership, and coverage modifications.
See template
See template
Service Request Form
PDF template
A form for members to request changes to their insurance contract, including address updates, name changes, and lost contract replacement.
See template
See template
Supervision Of Normal Pregnancy And Delivery Form
PDF template
A healthcare form for documenting pregnancy details, medical information, and patient consent for medical services related to pregnancy and delivery.
See template
See template
Lifetime Limited Warranty HV Battery
PDF template
A lifetime limited warranty document for a high-voltage battery, covering replacement and repair under specific conditions.
See template
See template
Severe Incident Response And Notification TIMELINE
PDF template
A comprehensive guideline for responding to and managing severe incidents with prioritized notification and action steps.
See template
See template
Residential Sewer Backup Report Form
PDF template
Official form for reporting residential sewer backup incidents and requesting potential reimbursement for cleanup costs.
See template
See template
Santa Fe Conservation Trust Medical Form
PDF template
A comprehensive medical form for participants of Santa Fe Conservation Trust trips, collecting health history and emergency contact details.
See template
See template
Medical Reimbursement Account Claim Form
PDF template
Comprehensive instructions for submitting medical expense reimbursement claims through a Medical Reimbursement Account (MRA)
See template
See template
MIT Student Health Insurance Plan Enrollment Form
PDF template
Comprehensive health insurance enrollment form for MIT students covering individual and family coverage options
See template
See template
Granite School District Short Term Disability Claim Form
PDF template
A form for Granite School District employees to file a claim for short-term disability benefits, documenting medical condition and work absence details.
See template
See template
Granite School District Short Term Disability Claim Form
PDF template
A form for employees of Granite School District to file a claim for short-term disability benefits, detailing medical condition and leave requirements.
See template
See template
Disability Claim For Accident Sickness (AS)Short Term Disability (STD)Salary Continuance
PDF template
A comprehensive form for filing a disability claim, including employer and employee information for accident, sickness, or short-term disability
See template
See template
Short Term Disability Income Claim Form
PDF template
A document used to file a claim for short-term disability benefits, requiring details from the employee, employer, and attending physician.
See template
See template
Short Term Disability Benefits Claim Form
PDF template
A claim form for supplemental short-term disability benefits for hospital staff, providing coverage for up to 26 weeks at 70% of basic weekly salary.
See template
See template
SHORT TERM DISABILITY BENEFITS CLAIM FORM
PDF template
Claim form for supplemental short-term disability benefits for hospital staff, providing up to 70% of weekly salary for up to 26 weeks.
See template
See template
School Based Supplemental Health Services Consent Form
PDF template
A comprehensive health information and consent form for students at Saint Martin de Porres High School, collecting medical history and insurance details.
See template
See template
School Based Supplemental Health Services Consent Form
PDF template
A comprehensive health information and consent form for students at Saint Martin de Porres High School, collecting medical history and insurance details.
See template
See template
Member Claim Form
PDF template
A form for Sutter Health Plus members to request reimbursement for eligible healthcare services and OTC COVID-19 tests they have already paid for.
See template
See template
District Employee Benefits Enrollment Form
PDF template
A comprehensive form for employees to enroll in medical, dental, vision, and life insurance benefits with detailed personal and dependent information.
See template
See template
SELF INSURED SERVICES COMPANY REIMBURSEMENT FORM
PDF template
A form for employees to submit medical expense claims for reimbursement through a self-insured employer benefit program.
See template
See template
Supplementary Statement By Employer
PDF template
A form for employers to report outstanding death or disability claims related to workplace accidents.
See template
See template
Perreard Professional Billing Insurance Form
PDF template
A medical billing form for collecting patient and insurance information for professional healthcare services.
See template
See template
Utah Surplus Line Submission Form
PDF template
Official form for filing insurance policies written by non-admitted insurers in Utah, including premium tax and regulatory compliance documentation.
See template
See template
MISSISSIPPI DEPARTMENT OF INSURANCE ELIGIBLE NONADMITTED INSURANCE FORM
PDF template
A form for Mississippi licensed surplus lines insurance producers to document placement of insurance coverage with nonadmitted insurers and certify diligent effort.
See template
See template
SLTD Premium Waiver Form
PDF template
Form to terminate a Supplemental Long Term Disability premium waiver when an employee returns to work.
See template
See template
Smith Warranty Claim Form
PDF template
A warranty claim form for Smith product returns and claims, valid only for US customers and non-prescription eyewear.
See template
See template
Management Benefits Fund Superimposed Major Medical Plan (SMMP) Claim Form
PDF template
A comprehensive medical claim form for submitting healthcare expenses and patient information to the Management Benefits Fund insurance plan.
See template
See template
Request For Reinstatement Of Policy Contract
PDF template
A form used by insurance policyholders to request reinstatement of a previously lapsed insurance policy by providing updated health information.
See template
See template
Vision Group Insurance Form
PDF template
A comprehensive form for submitting vision insurance claims, to be completed by employees and vision care providers.
See template
See template
Provider Nomination Form
PDF template
A form for members to recommend new dental or eye care providers to be added to Solstice Benefits' network.
See template
See template
Medical Authorization Request Form
PDF template
A comprehensive form for healthcare service authorization by insurance members, used for various medical service requests and approvals.
See template
See template
VISION CLAIM FORM
PDF template
Insurance claim form for submitting vision-related medical service claims and patient information.
See template
See template
VISION CLAIM FORM
PDF template
A standard form for submitting vision insurance claims with patient and insurance details.
See template
See template
Guarantee Trust Life Insurance Company Accident Insurance Enrollment
PDF template
Insurance enrollment form for accident coverage for special events, offering standard and deluxe policy options with varied rates and benefits.
See template
See template
Special Event Permit Insurance Requirements
PDF template
Guidelines for insurance documentation required for special event permits in Palm Beach County, detailing insurance certificate requirements and compliance standards.
See template
See template
Specialty Referral Form
PDF template
A medical referral form for patients being referred to a specialist within the Holston Medical Group network.
See template
See template
Retiree Special EnrollmentWaiver Form
PDF template
A special enrollment form for NYC retirees to modify health benefits, Medicare plan, or prescription drug coverage for September 1, 2023.
See template
See template
Special Wastewater Discharge Form Instruction Sheet
PDF template
Instructions for facilities seeking to discharge special wastewater not covered under a pretreatment permit within the Metropolitan Sewer District of Greater Cincinnati.
See template
See template
Exhibitor Appointed Contractor Form
PDF template
Form for exhibitors to designate a company other than the official contractor, requiring a certificate of insurance with specified coverage limits.
See template
See template
Spouse Disability Benefit Application Form
PDF template
Insurance claim form for spouse disability benefits, requiring comprehensive personal and medical information for claim assessment.
See template
See template
A Guide To Your Benefits From The Seafarers Pension Plan
PDF template
Comprehensive guide detailing pension benefits, eligibility, calculation, and application process for Seafarers Pension Plan participants.
See template
See template
Georgia Structural Pest Control Insurance Certification Form
PDF template
Guidance and form for structural pest control companies in Georgia to submit their insurance certification and liability coverage details.
See template
See template
Swampscott Public Schools EmergencyMedical Form
PDF template
A comprehensive form collecting student medical, contact, and emergency information for the school year 2018/2019.
See template
See template
Arkansas Motor Vehicle Accident Report (SR 1)
PDF template
Official form for reporting motor vehicle accidents involving property damage over $1,000 or bodily injury/death.
See template
See template
SSC 001C SUPP STATEMENT OF CLAIM FORM
PDF template
A comprehensive form for filing a group disability insurance claim, to be completed by the employee, employer, and healthcare provider.
See template
See template
List Of Additional Student Participants Form
PDF template
A form for documenting student participants, their details, and emergency contact information for university-sponsored travel activities.
See template
See template
Staff Expense Reimbursement Request Form
PDF template
A form for staff members to request reimbursement for work-related expenses with specific guidelines and certification requirements.
See template
See template
STAFF VEHICLE REGISTRATION FORM
PDF template
A form for staff to register their personal vehicles with an employer's security office, capturing vehicle and insurance details.
See template
See template
Carrier Freight Claim Form
PDF template
A standardized form for filing claims against a carrier for shipment damage, loss, or related shipping issues.
See template
See template
Dental EnrollmentChangeWaiver Group Insurance Form
PDF template
A form for employees to enroll, change, or waive dental group insurance coverage with details about employee and dependent information.
See template
See template
Standard Notice And Consent Documents Under The No Surprises Act
PDF template
Official documents for providing notice and consent requirements for nonparticipating healthcare providers and facilities under the No Surprises Act.
See template
See template
Texas Standard Prior Authorization Request Form For Health Care Services
PDF template
Standard form for requesting healthcare service authorization in Texas, used by various healthcare plans and issuers.
See template
See template
Arizona Prior Authorization Form
PDF template
A comprehensive form for requesting healthcare service authorization from an insurance provider in Arizona.
See template
See template
STANDARD WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims for tire defects or issues to Tireco.
See template
See template
Statement Of Rights Disability Benefits Law
PDF template
Official document outlining employee rights for non-occupational disability benefits in New York State.
See template
See template
Procedure And Filing Guidance For Approval Of Variable Text
PDF template
Guidelines for insurers on filing policy forms with variable material for approval by the Montana Department of Insurance.
See template
See template
STD 101C GROUP SHORT TERM DISABILITY (STD) CLAIM FORM
PDF template
A comprehensive form for employees to file a short-term disability claim, requiring detailed information about their medical condition and work status.
See template
See template
Short Term Disability Claim Form Report Of Continued Disability
PDF template
A form for participants to report ongoing short-term disability and provide medical update information for continued claim processing.
See template
See template
Disability Claims Accident Sickness (AS)Short Term Disability (STD)Salary Continuance
PDF template
A comprehensive form for filing disability claims, including sections for employer, employee, and physician/provider information.
See template
See template
Guardian Life Short Term Disability (STD) Claim Form
PDF template
A comprehensive form for employees to file a short-term disability insurance claim with detailed personal and medical information.
See template
See template
Your Disability Benefit Claim
PDF template
Comprehensive guide and forms for applying for disability insurance benefits through Standard Insurance Company.
See template
See template
Short Term Disability Claim Form Statement Of Employee
PDF template
A comprehensive form for employees to file a short-term disability claim, providing personal, employment, and medical information.
See template
See template
Granite School District Short Term Disability Claim Form
PDF template
A form for employees of Granite School District to file a claim for short-term disability benefits, detailing the nature of disability and employment information.
See template
See template
STANDARD WARRANTY CLAIM FORM
PDF template
A form for submitting warranty claims and product returns for tire defects or issues.
See template
See template
Disability Claim For Accident SicknessShort Term DisabilitySalary Continuance
PDF template
An employer-completed form for filing a disability insurance claim covering accident, sickness, and short-term disability benefits.
See template
See template
Short Term Disability Claim Form Statement Of Employer
PDF template
A form for employers to submit details about an employee's short-term disability claim, including employment information and income details.
See template
See template
Short Term Disability Claim Form Physician Statement
PDF template
A medical form for physicians to document a patient's disability claim details for Anthem Life Insurance Company.
See template
See template
Short Term Disability Claim Process
PDF template
Comprehensive guide for filing a short-term disability claim with USAble Life, detailing submission steps, claim phases, and contact information.
See template
See template
Shaftec Warranty Form
PDF template
A comprehensive warranty claim form for automotive parts and components, detailing product return and warranty claim process for Shaftec parts.
See template
See template
Camp Liability And Medical Release Form
PDF template
A comprehensive liability and medical release form for camp participants, covering medical treatment, property damage, and media usage consent.
See template
See template
PATIENT INFORMATION AND MEDICAL RELEASE FORM (FORM I)
PDF template
A comprehensive form for collecting patient insurance details, medical authorization, and payment responsibility for Bioness Inc.
See template
See template
St. Jude Affiliate Clinic Referral Form
PDF template
A referral form for patients seeking medical consultation at St. Jude Affiliate Clinic at Huntsville Hospital for Women and Children
See template
See template
Stryker Benefits Summary
PDF template
Comprehensive benefits summary for Stryker employees, including location-specific healthcare provisions and insurance options.
See template
See template
DAMAGE REPORT FORM
PDF template
A form used to document and assess property damage, including structural and utility damage details.
See template
See template
STUDENT ACCIDENT REPORT FORM
PDF template
A comprehensive form documenting details of a student accident, including location, injury specifics, and immediate actions taken.
See template
See template
Student Activity Liability Waiver Form
PDF template
A legal document that releases Whitworth University from liability for student activities, projects, and travel, requiring voluntary participant acknowledgment of risks.
See template
See template
Student Field Trip Insurance
PDF template
Insurance coverage form for students participating in university-sponsored field trips with details about insurance benefits and trip information.
See template
See template
Marymount University Student Medical Form
PDF template
Comprehensive medical form outlining immunization requirements and health insurance mandates for Marymount University students
See template
See template
StudentS Medical History
PDF template
A comprehensive medical history form required for new students at the University of Montevallo, collecting personal and health information.
See template
See template
STUDENT TRANSPORTATION FORM
PDF template
A form authorizing and documenting driver eligibility and vehicle details for student transportation by employees, parents, or volunteers.
See template
See template
Student Group Travel Insurance Form
PDF template
Form for documenting and calculating insurance charges for student group travel at the University of Arkansas.
See template
See template
Manufactured Housing Warranty Claim Form
PDF template
A warranty claim form for manufactured housing repair services with detailed service and part information requirements.
See template
See template
CITY OF LOS ANGELES INSTRUCTIONS AND INFORMATION ON COMPLYING WITH CITY INSURANCE REQUIREMENTS
PDF template
Instructions for contractors on submitting insurance documentation to the City of Los Angeles and meeting insurance requirements for city contracts.
See template
See template
Suburban Municipal Joint Insurance Fund Policies Procedures Manual
PDF template
Comprehensive policy manual for a municipal joint insurance fund detailing operational guidelines and regulatory compliance in New Jersey.
See template
See template
Subscriber Claim Form
PDF template
Insurance claim form for submitting medical service bills to Blue Cross Blue Shield of Massachusetts for reimbursement.
See template
See template
Subscriber Claim Form
PDF template
A comprehensive form for submitting medical insurance claims to Blue Cross Blue Shield of Massachusetts for reimbursement of healthcare services.
See template
See template
Summary Of Benefits And Coverage
PDF template
A comprehensive healthcare plan offering flexible enrollment and holistic health coverage options with traditional and alternative treatment approaches.
See template
See template
Patient Information And Insurance Form
PDF template
A comprehensive form for collecting patient personal information, contact preferences, and insurance details for the Advancing Access program.
See template
See template
Sun Life Financial Underwriting Evidence Guide
PDF template
A comprehensive reference for field underwriting and case submission for insurance producers, providing guidelines for submitting insurance cases to Sun Life Financial.
See template
See template
PROVIDER NOMINATION FORM
PDF template
Form for recommending healthcare providers to be considered for the Superior Vision Plan Preferred Provider Panel.
See template
See template
Warranty Claims Form
PDF template
A form for submitting warranty claims for equipment manufactured by Superior Grain Equipment, detailing product failure and claim requirements.
See template
See template
ILWU PMA Welfare Plan Supplemental CSDI Disability Claim Form
PDF template
A comprehensive disability claim form for ILWU-PMA Welfare Plan members to report disability details and seek benefits.
See template
See template
Lexmark End User Warranty Claim Form
PDF template
A form for end users to submit warranty claims for Lexmark products, detailing product issues and purchase information.
See template
See template
Dependent Care Reimbursements
PDF template
A guide explaining IRS requirements and reimbursement methods for dependent care expenses through Surency Flex.
See template
See template
Member Reimbursement Claim Form
PDF template
A form for submitting claims for vision services from out-of-network providers or in-store promotions through Superior Vision.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form used to document and submit warranty claims for Swaploader equipment and parts.
See template
See template
Proof Of Payment Affidavit Form
PDF template
A form for documenting and verifying payments related to underground storage tank cleanup claims.
See template
See template
Universal Referral Form
PDF template
A comprehensive medical referral form for specialty pharmacy services, collecting patient, insurance, and medical criteria information.
See template
See template
Texas AM University System Risk Management And Insurance Matrix
PDF template
A comprehensive tool for identifying, assessing, and managing potential risks associated with university activities and events.
See template
See template
Texas AM University System Risk Management And Insurance Matrix
PDF template
A comprehensive matrix for identifying, evaluating, and managing potential risks associated with university activities and events.
See template
See template
Team America Insurance Form
PDF template
Insurance coverage form for Team America rocket team participants to provide evidence of insurance for launch site owners and sponsors.
See template
See template
United States Fire Insurance Company Notice
PDF template
Insurance claim form for reporting accidents or injuries involving sports officials, with fraud warning and reporting requirements.
See template
See template
Tuberculosis Control Program Health Facility Discharge Planning Guidelines
PDF template
Guidelines for discharging patients with confirmed or suspected tuberculosis, outlining procedures for notification and approval from the California Department of Public Health.
See template
See template
Hospital Discharge Approval Request Form
PDF template
A medical form used by the New York City Department of Health and Mental Hygiene to process and approve hospital discharges for tuberculosis patients.
See template
See template
Current Report TRANSILVANIA BROKER DE ASIGURARE S.A.
PDF template
Official report documenting an Extraordinary General Meeting of Shareholders for TRANSILVANIA BROKER DE ASIGURARE S.A. on October 23, 2024.
See template
See template
TCEQ Exit Interview Form Potential Violations AndOr Records Request
PDF template
Texas Commission on Environmental Quality (TCEQ) exit interview form documenting potential violations at Bayou Vista Subdivision water facility
See template
See template
Accident Report Form
PDF template
Comprehensive form for documenting details of a vehicle accident, including driver, vehicle, and incident information.
See template
See template
Form TDI 22
PDF template
Instructions for filing annual reports for temporary disability insurance plans in Hawaii, detailing reporting responsibilities for different types of employers and insurance carriers.
See template
See template
Registration Form
PDF template
Comprehensive form for collecting patient and guardian information, emergency contacts, and insurance details for pediatric patients
See template
See template
Short Term Temporary Disability Benefits
PDF template
Policy describing temporary disability benefits for non-union employees of the Diocese of Camden, outlining eligibility requirements and benefit calculations.
See template
See template
Inbuilt Temporary Incapacity Benefits For Defined Benefit Division Members
PDF template
Detailed guide explaining temporary incapacity benefits for Defined Benefit Division members, including eligibility requirements and claim process.
See template
See template
Temporary Permanent Disability Claim Form
PDF template
A comprehensive insurance claim form for temporary and permanent disability claims, to be completed by the policyholder and employer.
See template
See template
Tenant Welcome Package
PDF template
A comprehensive welcome document for new tenants with contact information, emergency instructions, and insurance requirements.
See template
See template
TENANT WELCOME PACKAGE
PDF template
Comprehensive guide for new tenants with property management contact information, emergency procedures, and insurance requirements.
See template
See template
Term Owner And Policy Change Form
PDF template
A form used to change policy ownership, address, or legal name for insurance policies issued by Fidelity Investments Life Insurance Company.
See template
See template
Sample Discharge Form
PDF template
A comprehensive form for tracking a shelter guest's health status, medical needs, and transportation requirements during evacuation or return.
See template
See template
DentalOptical Benefit Application Form
PDF template
Application form for claiming dental and optical benefits through the Transport Friendly Society, requiring detailed expense and payment information.
See template
See template
Osteopathic Benefit Application Form
PDF template
Application form for claiming osteopathic treatment benefits, specifically for members of the Transport Friendly Society who joined prior to 1996.
See template
See template
ENROLLMENT FORM
PDF template
Comprehensive enrollment form for employees to select insurance and benefits options through The Hartford.
See template
See template
The Role Of A Surety In The Context Of A Construction Project
PDF template
A webinar discussing surety bonds, their role in construction projects, and differences from traditional insurance.
See template
See template
Pre Authorization Form For Bundled ART Services For Thiqa
PDF template
Insurance pre-authorization form for assisted reproductive technology (ART) services for Thiqa members.
See template
See template
Public Plans Provider Manual Claim Requirements, Coordination Of Benefits And Dispute Guidelines
PDF template
Comprehensive manual detailing claim submission methods, coordination of benefits, and dispute resolution processes for healthcare providers.
See template
See template
Senior Products Provider Manual
PDF template
A manual detailing claim submission guidelines, processing procedures, and coordination of benefits for healthcare providers working with Tufts Health Plan Senior Products.
See template
See template
Insurance Form Thrive
PDF template
Form authorizing Personal Touch Medical Claims to submit medical insurance claims on behalf of a patient and outlining payment terms for claim processing.
See template
See template
MRS Title 24 A, Chapter 27. THE INSURANCE CONTRACT
PDF template
Legal document defining scope, policies, premiums, and insurable interest in insurance contracts.
See template
See template
Order Request Form
PDF template
A comprehensive form for requesting title services and property-related documentation for real estate transactions.
See template
See template
Trail Life USA ADULT Weekend Health And Medical Record
PDF template
Comprehensive medical and health information form for adult participants in Trail Life USA weekend activities
See template
See template
WARRANTY CLAIM FORM
PDF template
A comprehensive form for submitting warranty claims for wheels and tires, including detailed vehicle and contact information.
See template
See template
Transcranial Magnetic Stimulation (TMS) Pre Authorization Form
PDF template
Medical pre-authorization form for requesting Transcranial Magnetic Stimulation (TMS) treatment, requiring patient and medical coding details.
See template
See template
Customer Service Representative Awards Competition Entry Form
PDF template
A nomination form for customer service representatives in the insurance industry to compete for state and national awards by submitting an essay and professional references.
See template
See template
Facility Rental Agreement Form
PDF template
A rental agreement form for using the Asphodel-Norwood Town Hall facility, detailing rental terms, conditions, and insurance requirements.
See template
See template
Annual Report Third Party Administrators
PDF template
Mandatory annual reporting form for third-party administrators operating in Nevada, requiring financial statements and contract details.
See template
See template
Third Party Administrator Annual Report Filing Information
PDF template
Instructions for Nevada third-party administrators to submit annual reports to the Division of Insurance within 90 days of fiscal year end.
See template
See template
Contributory Group Life Insurance TPAF
PDF template
Detailed explanation of contributory group life insurance coverage for TPAF members, including premium rates, benefits, and enrollment process.
See template
See template
Third Party Administrators Licensing, Renewal And Annual Report Instructions
PDF template
Comprehensive instructions for obtaining and renewing third party administrator licenses in Kansas for non-resident administrators.
See template
See template
TRINITY PROFESSIONAL GROUP REGISTRATIONCONSENT TO TREAT FORM AND HIPAA
PDF template
A comprehensive medical registration form for patient intake, consent to treatment, and insurance information collection.
See template
See template
Declaration Of Tobacco Use Or Non Tobacco Use Form
PDF template
A form for University of Texas System medical plan members to declare their tobacco use status and understand potential premium surcharges.
See template
See template
Declaration Of Tobacco Use Or Non Tobacco Use Form
PDF template
Form documenting tobacco use status for University of Texas System medical plan members with potential premium surcharges based on tobacco usage.
See template
See template
Trade And Food Vender Booking Form
PDF template
Application form for trade and food vendors to participate in the Wentworth Show, including booking requirements and regulations.
See template
See template
TRAFFIC ACCIDENT REPORT FORM
PDF template
A comprehensive form for documenting details of a traffic accident for insurance and police purposes.
See template
See template
Louisiana Office Of Risk Management Client Instructions For The Transportation Unit
PDF template
Detailed instructions for third-party administrators handling transportation-related claims for the Louisiana Office of Risk Management.
See template
See template
What To Do After An Accident
PDF template
A comprehensive guide outlining nine critical steps to take immediately following a car or bus accident, focusing on safety, documentation, and legal protection.
See template
See template
Travel Authorization Reimbursement
PDF template
Comprehensive guide for SUU employees and students on travel authorization, reimbursement procedures, and best practices for travel documentation.
See template
See template
Travel Claim Form Tips And Tricks
PDF template
Instructions for completing and electronically signing a travel claim form using Adobe PDF software.
See template
See template
School District Of Escambia County Travel Claim Procedures
PDF template
Comprehensive guidelines for travel arrangements, reimbursement, and claim procedures for the School District of Escambia County.
See template
See template
TRAVEL EXPENSE CLAIM
PDF template
A detailed form for claiming and documenting travel expenses related to university business, including transportation, accommodation, and meal costs.
See template
See template
Travel Medical History Questionnaire
PDF template
Comprehensive questionnaire for documenting medical and travel details for international travelers from Saint Xavier University Health Center.
See template
See template
UAF Vehicle Accident Reporting Procedure
PDF template
Comprehensive guidelines for reporting and handling vehicle accidents involving University of Alaska Fairbanks (UAF) vehicles and personnel.
See template
See template
Beckman Laser Travel Pre Authorization Form
PDF template
A form for documenting and pre-authorizing travel details for reimbursement purposes, including traveler information and trip specifics.
See template
See template
Travel Risk Assessment Form
PDF template
Comprehensive form for collecting traveler medical history and trip details prior to travel
See template
See template
Travel Risk Assessment Form
PDF template
A comprehensive form for evaluating health risks and medical history for travelers before an international trip.
See template
See template
Certificate Of Cancellation And Application For Withdrawal Trust Funded Prepaid Funeral Contract
PDF template
A document allowing the cancellation and withdrawal of funds from a prepaid funeral contract with specific refund terms and conditions.
See template
See template
Short Term Disability Claim Form
PDF template
Insurance claim form for documenting a short-term disability, including personal information, medical details, and potential compensation sources.
See template
See template
Trip Transit Insurance Form (Sponsored Owned)
PDF template
Insurance form for covering shipments of sponsored-owned property during commercial transit by Georgia Tech.
See template
See template
Trip Transit Insurance Form
PDF template
A form for documenting and insuring property shipments by Georgia Institute of Technology via commercial carriers.
See template
See template
University Of Arkansas Athletic Tryout Medical Documentation
PDF template
Required medical documentation for students attempting to join University of Arkansas intercollegiate athletic teams.
See template
See template
Warranty Claim Form
PDF template
A form for customers to submit warranty claims for Z Shade gazebo products with required documentation and details.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for Tube-Line equipment and products with required details about the product and failure.
See template
See template
Accident Information Form
PDF template
A comprehensive form for documenting details of a vehicle accident, including member, vehicle, and incident information.
See template
See template
Request To Cancel Workers Compensation Coverage
PDF template
Official form for requesting cancellation of workers' compensation insurance policy in Ohio.
See template
See template
UB 04 Claim Form Instructions
PDF template
Comprehensive instructions for completing the UB-04 healthcare claim form with detailed guidance on form locator entries and billing specifications.
See template
See template
UB 04 CMS 1450
PDF template
Official standardized form used by healthcare facilities for medical billing and insurance claims processing.
See template
See template
UB92 Claim Form
PDF template
A standardized medical billing form used by healthcare facilities to submit patient treatment and billing information.
See template
See template
UC Medicare PPOHigh Option Supplement Enrollment Form
PDF template
Enrollment form for UC retirees and family members to assign and coordinate Medicare prescription drug plan coverage.
See template
See template
Vehicle Accident Report
PDF template
Document used to record details of a vehicle accident involving a University of California vehicle and personnel.
See template
See template
Change Of Address Form
PDF template
A form for UFCW members to update their contact information with the National Health and Welfare Fund.
See template
See template
MAE International Travel Checklist Form
PDF template
A checklist and registration form for University of Florida employees traveling internationally for business purposes.
See template
See template
Volunteer Agreement Insuring Volunteers At UGA
PDF template
Comprehensive guidelines for volunteer participation and liability coverage at the University of Georgia, detailing insurance provisions and volunteer program requirements.
See template
See template
PrescriPtion Reimbursement Request Form
PDF template
Form for requesting reimbursement for covered medications purchased at retail cost by insurance members.
See template
See template
UnitedHealthcare Medical Claim Form
PDF template
A form used to request payment for eligible healthcare services that have already been received from an out-of-network provider.
See template
See template
Employee Enrollment Form
PDF template
A comprehensive enrollment form for employees to sign up for medical, dental, and related insurance benefits.
See template
See template
Medical Claim Form
PDF template
A form for submitting medical expense claims to UnitedHealthcare for reimbursement of eligible healthcare services.
See template
See template
Waiver Of Premium
PDF template
Instructions for employers and employees on how to process a Waiver of Premium for life insurance during total disability.
See template
See template
Medical Claim Form
PDF template
A form for submitting out-of-network medical claims and requesting payment for eligible healthcare services
See template
See template
Pharmacy Student Enrollment Form
PDF template
Enrollment form for first-time pharmacy customers at University Health Services for students and their families.
See template
See template
Yandisa Benefit Application Form
PDF template
Application form for patients seeking medical benefits through Umvuzo Health Medical Scheme's Yandisa program, requiring comprehensive personal and medical information.
See template
See template
Member Medical Claim Submission Form
PDF template
A form for submitting medical insurance claims for reimbursement of eligible medical expenses when providers do not file claims directly.
See template
See template
Groundwater Discharge Permit
PDF template
Permit authorizing the University of Michigan to discharge portable power wash water into Michigan groundwater with specific limitations and conditions.
See template
See template
UMKC Safety Prescription Eyewear Order Form
PDF template
A form for UMKC employees to order prescription safety eyewear with various lens and frame options.
See template
See template
Medical Claim Form
PDF template
A form for submitting medical reimbursement requests for services from non-network providers under Uniform Medical Plans.
See template
See template
Uniform Medical Plan Prescription Drug Claim Form
PDF template
A form for requesting reimbursement of covered prescription drugs, vaccines, COVID-19 test kits, and compounded prescription medications from the Uniform Medical Plan.
See template
See template
Member Claim Submission Form
PDF template
A form for submitting medical and vision-related insurance claims for reimbursement with required patient and service details.
See template
See template
Member Claim Submission Form
PDF template
A form for submitting medical and vision service claims to UMR for reimbursement by members.
See template
See template
Designation Of Beneficiary For Life Insurance Kansas Board Of Regents Members
PDF template
A form for Kansas Board of Regents members to designate primary and contingent beneficiaries for life insurance benefits.
See template
See template
UNIVERSITY OF THE INCARNATE WORD FINANCIAL ASSISTANCE CHECKLIST
PDF template
A comprehensive checklist for students outlining financial assistance requirements and steps for the academic term prior to Fall 2020.
See template
See template
Certificate Of Liability Insurance (COI) Instructions
PDF template
Guidelines for vendors providing insurance documentation when working with public school facilities projects in New Mexico.
See template
See template
Undiscovered Frontiers Booking Form
PDF template
Comprehensive travel registration form for collecting traveler details, emergency contacts, and trip preferences for adventure travel.
See template
See template
Record Of Employment
PDF template
A form for documenting employment status for unemployment insurance claims in New York State.
See template
See template
Initial Unemployment Insurance Benefits Claim
PDF template
Comprehensive guide for filing an initial unemployment insurance claim in New Jersey, detailing required documentation and application process.
See template
See template
Maryland Uniform Consultation Referral Form
PDF template
A standardized form for healthcare providers to request medical consultations, referrals, and services between healthcare providers and facilities.
See template
See template
Uniform Consultation Referral Form
PDF template
A standardized form for healthcare providers to submit patient referrals and consultation requests through CareFirst insurance plans.
See template
See template
Unique Services Reimbursement Program Claim Form
PDF template
A claim form for submitting reimbursement requests for unique healthcare services through Presbyterian Health Plan for the City of Albuquerque.
See template
See template
DENTAL ENROLLMENT FORM
PDF template
Form for enrolling in dental insurance coverage, collecting employee and dependent information for group dental insurance.
See template
See template
Claim Information Form UnitedHealthcare StudentResources
PDF template
Insurance claim form for students to submit medical claims and accident information to UnitedHealthcare StudentResources
See template
See template
Universal Enrollment Form
PDF template
Comprehensive enrollment form for medical, dental, and vision insurance covering active employees, retirees, COBRA, and surviving spouse participants.
See template
See template
University Of Oregon Camps Accident Insurance Program
PDF template
Insurance policy providing primary accident medical benefits for University of Oregon camp participants with up to $25,000 coverage per injury.
See template
See template
DEA Biennial Controlled Substance Inventory Form
PDF template
Official form for documenting and tracking controlled substances used in research settings, including detailed inventory information.
See template
See template
Unum Disability Claim Form
PDF template
A comprehensive claim form for submitting disability insurance claims with Unum Group subsidiaries, covering multiple types of disability benefits.
See template
See template
Life Insurance Form
PDF template
A form for employees to designate life insurance beneficiaries and select coverage options for basic and supplemental life insurance.
See template
See template
How To File A Voluntary Benefits Claim
PDF template
A comprehensive guide for employees on how to file claims for voluntary benefits, including wellness and health screening benefits.
See template
See template
Life Insurance Form
PDF template
A comprehensive form for employees to enroll in life insurance coverage and designate beneficiaries with multiple coverage options.
See template
See template
Flu Shot Reimbursement Form
PDF template
Form for members to request reimbursement for out-of-pocket flu shot expenses through UPMC Health Plan.
See template
See template
UAB Urology New Patient Referral Form
PDF template
Medical referral form for new patients seeking urology services at UAB Department of Urology in Birmingham, Alabama.
See template
See template
CASE REPORT AND ACCIDENT INSURANCE CLAIM FORM
PDF template
A form for submitting accident insurance claims and reporting case details for medical expenses.
See template
See template
IZERVAY My WaySM Enrollment Form
PDF template
Comprehensive enrollment form for patient support services related to IZERVAY medication, including insurance and financial assistance screening.
See template
See template
IZERVAY My WaySM Enrollment Form
PDF template
Enrollment form for patient support services related to IZERVAY medication, including insurance and financial assistance screening.
See template
See template
YOUTH JUNIOR VOLLEYBALL PLAYER MEDICAL RELEASE FORM
PDF template
A comprehensive medical release and consent form for youth and junior volleyball players to capture health information, emergency contacts, and participation permissions.
See template
See template
USA Warranty Labor Claim
PDF template
Instructions and guidelines for submitting warranty labor claims for equipment repairs with True Manufacturing Company.
See template
See template
Isaacs V. Metropolitan Life Insurance Company Court Opinion
PDF template
Judicial opinion regarding a long-term disability benefits claim against Metropolitan Life Insurance Company under ERISA regulations.
See template
See template
Order Granting In Part And Denying In Part Motion For Summary Judgment
PDF template
Judicial order addressing a dispute over insurance contract coverage related to contaminated feed causing cattle mortality
See template
See template
Order Granting DefendantS Motion To Compel Arbitration
PDF template
Court order addressing Aetna Life Insurance Company's motion to compel arbitration in a case filed by Lori Stover-Davis.
See template
See template
Order And Reasons Case No. 05 6849
PDF template
Court document addressing a motion for reconsideration in a life insurance policy beneficiary dispute involving First Colony Life Insurance Company and multiple parties.
See template
See template
ExecutionGarnishmentSequestration Application And Order
PDF template
Legal document detailing a garnishment proceeding against State Farm to satisfy a judgment debt from Eugene Roedder to Greg and E'Wana Monroe.
See template
See template
Monarch Life Ins. Co. V. Estate Of Robert Tarone, III
PDF template
Judicial memorandum resolving a dispute over annuity beneficiary rights between an estate and a sister following a settlement from a 1980 motorcycle accident
See template
See template
Memorandum Opinion And Order
PDF template
Legal document addressing an insurance coverage dispute involving policy stacking and liability allocation in a wrongful death lawsuit settlement.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form for customers to document and submit warranty claims for product defects or failures.
See template
See template
Emergency Medical Release Form
PDF template
A medical release form for riders to provide emergency contact and medical information for horse trials events.
See template
See template
USERRA Life Insurance Form
PDF template
Form for military service members to continue life insurance coverage during active duty service under USERRA protections.
See template
See template
Life Insurance Claim Form
PDF template
A comprehensive form for filing a life insurance claim with authorization and personal information sections
See template
See template
COB Prescription Co Pay Reimbursement Form
PDF template
A form for members to request reimbursement for prescription co-pay expenses through US Family Health Plan.
See template
See template
Outpatient Referral Form
PDF template
A referral form for patients seeking specialist medical care within the USFHP network, requiring physician completion and details about the referral.
See template
See template
Notification Of Injury
PDF template
Form for submitting medical accident claims to United States Fire Insurance Company with detailed instructions for claim submission.
See template
See template
PARENTGUARDIAN CONSENT AND PLAYER MEDICAL RELEASE FORM
PDF template
Medical release and consent form for youth soccer players, providing emergency contact and health information.
See template
See template
Sports Camp Application For UT Owned Operated Camps
PDF template
Insurance application form for University of Texas sports camps covering accident and liability risks for campers and staff.
See template
See template
Initial Controlled Substance Inventory Form
PDF template
A mandatory form for documenting initial inventory of controlled substances at a registered location, required by DEA regulations.
See template
See template
University Of Washington Claim Form
PDF template
Official form for filing claims with the University of Washington's Claim Services department, used to document potential damages or incidents.
See template
See template
Volunteer Agreement Form
PDF template
A document outlining the terms and conditions for volunteers at the University of West Georgia, including liability coverage and volunteer responsibilities.
See template
See template
ADA Dental Claim Form Completion Instructions
PDF template
Comprehensive instructions for completing the American Dental Association's dental claim form, detailing recent version changes and field completion guidelines.
See template
See template
Group Short Term Disability Claim Form
PDF template
A comprehensive form for employees to file a short-term disability insurance claim with medical and employment details.
See template
See template
Vacation Rental Agreement
PDF template
A rental agreement for vacation property rental with details about payment, insurance, and booking terms.
See template
See template
Variform Claim Packet Homeowner Warranty Claim Form
PDF template
A detailed form for homeowners to file a warranty claim for Variform vinyl siding, documenting product details and installation information.
See template
See template
Vision Reimbursement Claim Form
PDF template
A form for employees to claim reimbursement for vision-related medical expenses under an employer's vision benefit plan.
See template
See template
Vehicle Accident Reporting Quick Guide
PDF template
Comprehensive guide for reporting vehicle accidents while driving on official state business for Louisiana State University Health Sciences Center.
See template
See template
Prescription Reimbursement Claim Form
PDF template
A form for submitting prescription medication reimbursement claims, detailing patient, pharmacy, and insurance information.
See template
See template
Request For Reimbursement
PDF template
A form for submitting out-of-network vision care reimbursement claims with detailed processing instructions.
See template
See template
HILL GROUP DRIVERS AUTO ACCIDENT REPORT FORM
PDF template
A comprehensive form for documenting details of a vehicle accident involving company vehicles and drivers.
See template
See template
Hill Group DriverS Auto Accident Report Form
PDF template
Comprehensive form for documenting details of a vehicle accident involving company vehicles and drivers.
See template
See template
Vehicle Accident Report
PDF template
Official government document for recording details of a vehicle accident involving county-owned or insured vehicles.
See template
See template
Fleet Unit Accident Incident Reporting Procedure
PDF template
Detailed procedure for reporting and handling vehicle accidents involving city fleet units, including required steps and documentation.
See template
See template
Vehicle Accident Reporting Procedure
PDF template
Comprehensive instructions for employees on how to handle and report vehicle accidents involving fleet or rental vehicles.
See template
See template
Vehicle AccidentIncident Procedures
PDF template
Guidelines for employees involved in motor vehicle accidents while conducting official state business, detailing step-by-step responsibilities at the accident scene.
See template
See template
Stetson Vehicle Accident Report
PDF template
Comprehensive form for documenting details of a vehicle accident involving Stetson employees or vehicles.
See template
See template
SCSU Vehicle Accident Report Form
PDF template
A comprehensive form for documenting details of a vehicle accident involving an SCSU Sport Club driver.
See template
See template
Vehicle Accident Report
PDF template
Comprehensive form for reporting vehicular accidents involving district staff or district vehicles with damage to property or persons.
See template
See template
Vehicle Accident Reporting Form (STD 270)
PDF template
Instructions for reporting vehicle accidents involving state-owned or rental vehicles, including form completion and distribution requirements.
See template
See template
Accident Report Kit
PDF template
A comprehensive guide and form for reporting various types of accidents, including vehicle incidents, property damage, and personal injuries.
See template
See template
Vehicle Accident Report
PDF template
Comprehensive guide for reporting vehicle accidents involving Iowa state university vehicles and personnel, including step-by-step procedures for handling accidents.
See template
See template
Vehicle Accident Report Form
PDF template
A comprehensive form for collecting details and information following a vehicle accident, designed to assist in insurance claims and documentation.
See template
See template
Vehicle Accident Reporting Procedures
PDF template
Policy outlining procedures for reporting and managing vehicle accidents involving university-owned or personal vehicles used for university business.
See template
See template
Physician Referral Fax Form
PDF template
A comprehensive medical referral form for patient information, insurance details, and physician contact for vascular specialist consultation.
See template
See template
Program Enrollment Form
PDF template
A comprehensive form for patient enrollment in a Pfizer healthcare program, collecting personal, insurance, and healthcare professional information.
See template
See template
IRIS Vendor Claim Form
PDF template
Form for providers to submit non-HIPAA claims for IRIS-funded healthcare services.
See template
See template
Vendor Information June 2025
PDF template
Application guidelines and requirements for non-food vendors participating in the Friday the 13th event in Port Dover, Ontario.
See template
See template
Prescription Prior Authorization Request Form
PDF template
A medical form used to request prior authorization for prescription medications from an insurance provider or healthcare plan.
See template
See template
Veteran Income Tax Exemption Submission Form
PDF template
Form for veterans to claim income tax exemption in New Jersey by submitting discharge documentation.
See template
See template
My Benefit Plan Booklet
PDF template
Comprehensive benefit plan booklet for post-doctoral fellows at the University of Toronto, detailing group benefits through Green Shield Canada.
See template
See template
Out Of Network Reimbursement Instructions
PDF template
Detailed instructions for submitting out-of-network healthcare reimbursement claims to VBA, including required documentation and submission methods.
See template
See template
Member Reimbursement Claim Form
PDF template
Form for members to request reimbursement for vision services from out-of-network providers or in-store promotions.
See template
See template
Out Of Network Vision Services Claim Form
PDF template
A claim form for submitting out-of-network vision care service expenses for reimbursement by EyeMed Vision Care through First American Administrators.
See template
See template
Delta Dental Of Wisconsin EnrollmentChangeWaiver Form DeltaVision
PDF template
Insurance enrollment form for Delta Dental of Wisconsin's vision benefits, allowing employees to accept, change, or waive coverage.
See template
See template
Enrollment Change Waiver Group Insurance Form
PDF template
Insurance enrollment form for eye care coverage, allowing employees to add or modify group insurance benefits and dependent coverage.
See template
See template
Vision Enrollment
PDF template
Form for ACERA retirees to enroll in or modify vision insurance coverage options.
See template
See template
Supplemental Vision Active Employee Enrollment Form
PDF template
Employee enrollment form for supplemental vision insurance coverage through Delta Dental of Wisconsin.
See template
See template
University Health Center Vision Insurance Form
PDF template
A form for students to submit vision insurance information for processing at the University Health Center
See template
See template
Vision Plan Out Of Network Claim Form
PDF template
Form for employees to submit out-of-network vision care expenses for reimbursement through their employer's vision plan.
See template
See template
Vision Claim Form
PDF template
A form for submitting vision care expenses for reimbursement through a health benefits plan.
See template
See template
VitalityLife Discretionary Trust
PDF template
A legal document outlining the terms of a discretionary trust related to life insurance benefits, allowing flexibility in benefit allocation and ownership.
See template
See template
VNSNY Physician Referral Form
PDF template
Comprehensive medical referral form for home care services, collecting patient information, insurance details, and physician certification.
See template
See template
City Of Springfield STD Cancellation Form
PDF template
Insurance form for cancelling short-term disability coverage through Hartford Life and Accident Insurance Company
See template
See template
Voluntary Audit Form
PDF template
An insurance document requesting payroll records and documentation to finalize workers' compensation insurance premium calculations.
See template
See template
Voluntary Waiver Form
PDF template
Legal document for participants to acknowledge risks and waive liability when engaging in activities at Providence College
See template
See template
Providence College Voluntary Waiver Form
PDF template
A legal document for participants or parents/guardians to acknowledge risks and provide consent for activities at Providence College
See template
See template
Volunteer Activity Waiver Form
PDF template
A comprehensive waiver form for volunteers to authorize participation and medical treatment in case of emergencies.
See template
See template
Volunteer Activity Waiver Form
PDF template
A comprehensive waiver form for volunteers to release liability and provide emergency contact information for parish or school activities.
See template
See template
GIT Structured Volunteer Form (012021)
PDF template
A document outlining insurance coverage and guidelines for volunteers at Georgia Institute of Technology
See template
See template
GIT Structured Volunteer Form
PDF template
A document outlining insurance and claims management for volunteers at Georgia Institute of Technology, specifying coverage limitations and volunteer program guidelines.
See template
See template
Volunteer Driver Application Form
PDF template
A comprehensive form for screening and qualifying volunteer drivers for child and family services transportation.
See template
See template
BOA Volunteer Firefighter Disability Claim Form
PDF template
Official claim form for Alabama volunteer firefighters seeking disability benefits due to service-related injury.
See template
See template
Agreement For Non Reimbursed Volunteer Services
PDF template
A legal document outlining volunteer service terms and conditions for University of Montana Western volunteers.
See template
See template
Volunteer Workers Compensation Form Instructions
PDF template
Guidelines for obtaining workers compensation insurance for volunteers at the University of North Dakota based on task risk and frequency.
See template
See template
Oberlin College Volunteer Form And Release
PDF template
A comprehensive volunteer agreement outlining responsibilities, risks, and liability waivers for volunteers at Oberlin College.
See template
See template
Volunteer Release And Waiver Of Liability Form
PDF template
Legal document releasing United Food Bank from liability for volunteer activities and potential injuries during service.
See template
See template
Travel Reimbursement Form
PDF template
Official form for submitting travel expenses and per diem reimbursement for county employees or volunteers
See template
See template
Volunteer Workers Limited Medical Cost Reimbursement Policy
PDF template
Policy outlining medical cost reimbursement for volunteer workers not covered by workers' compensation, with a maximum reimbursement of $5,000 for work-related injuries.
See template
See template
ANPACANG Homeowners And Rental Owners Change Form Revision
PDF template
Official communication detailing revisions to the Homeowners/Rental Owners Policy Change Form for ANPAC agency personnel.
See template
See template
Request For Reimbursement
PDF template
A form for submitting out-of-network vision care reimbursement claims to Vision Service Plan (VSP)
See template
See template
VSP Member Reimbursement Form
PDF template
A form for VSP vision care members to request reimbursement for vision-related services and expenses.
See template
See template
Enrollment Form With Dependent Data
PDF template
A form for employees to enroll in health insurance coverage and provide dependent information.
See template
See template
VSP Member Reimbursement Form
PDF template
A form for VSP vision care members to request reimbursement for vision-related services and expenses.
See template
See template
WAIVER FORM
PDF template
A form to decline participation in the VSP (Vision Service Plan) vision program offered by an employer.
See template
See template
Humana Inc. Life Insurance EnrollmentUnderwriting Form
PDF template
Form for employees to enroll in voluntary term life insurance coverage through Humana Inc., including coverage for associates, spouses, and dependent children.
See template
See template
Waiver Form And Acknowledgement Of Receipt Of Policies
PDF template
Patient form acknowledging financial responsibility for medical services not covered by insurance and agreeing to office policies.
See template
See template
Waiver And Rental Agreement Form
PDF template
A comprehensive waiver and rental agreement for clients renting Daybreak Point Bible Camp's island facility, outlining liability, risks, and client responsibilities.
See template
See template
Waiver Of Health, Dental AndOr Vision Coverage
PDF template
A form allowing employees to decline health, dental, and vision insurance coverage offered by their employer.
See template
See template
Research And Academic Areas Use Assumption Of Risk And Release Of Liability For Volunteers And Visit
PDF template
A legal document for non-student and non-employee volunteers to assume risks and release the University of Michigan from liability when using university facilities.
See template
See template
Waiver Of Medical Coverage Form
PDF template
Form for employees to waive State Employee Group Insurance Program (SEGIP) medical coverage when having alternative coverage.
See template
See template
Waiver Of Pre Tax Insurance Form
PDF template
A form allowing employees to opt out of pre-tax deductions for employer-sponsored insurance premiums at UND.
See template
See template
Securing Waivers Of Liability From Volunteers Of Nonprofit Organizations
PDF template
A comprehensive guide for nonprofit organizations on obtaining and implementing volunteer liability waivers to protect the organization from potential legal claims.
See template
See template
Warfarin Care Hospital Discharge Form
PDF template
A specialized hospital discharge form for patients in the Warfarin Care program, tracking medication and health status upon patient release.
See template
See template
Warranty Claim Form
PDF template
A form used to submit warranty claims for product failures and replacements.
See template
See template
Warranty Claim Form 1
PDF template
A form for customers to submit warranty claims for office products with specific instructions and conditions.
See template
See template
Warranty Claim Form 1
PDF template
A form for submitting warranty claims for office products with specific instructions and limitations.
See template
See template
WARRANTY CLAIM FORM
PDF template
A comprehensive form for submitting property damage warranty claims, requiring detailed property and damage information.
See template
See template
Warranty Claim
PDF template
A form for submitting warranty claims for defective parts or equipment within 15 days of repair.
See template
See template
Warranty Claim Form
PDF template
A detailed form for submitting warranty claims for mattresses and box springs to manufacturers, requiring specific documentation and photographs.
See template
See template
Warranty Claim Form 2
PDF template
A form used to submit warranty claims for office and manufacturing products like staplers, hole punches, and sharpeners.
See template
See template
Damage, Missing Part, Warranty Claim Form 2021
PDF template
A form for submitting warranty claims, damage reports, or parts requests for window and door products within specified timeframes.
See template
See template
Warranty Claim Form
PDF template
Form for submitting warranty claims for cabinet products with instructions for documenting and reporting damage.
See template
See template
Warranty Claim FORM
PDF template
A form for consumers to claim warranty coverage for Tenneco products with detailed vehicle and product information.
See template
See template
Damage, Missing Part, Warranty Claim Form 2021
PDF template
A form for submitting warranty claims, missing parts, or damage reports for window and door products within 30 days of delivery.
See template
See template
CEC INC. WARRANTY CLAIM FORM
PDF template
A warranty claim form for Carlson fiberglass tanks, outlining the process for submitting warranty claims and conditions of coverage.
See template
See template
Warranty Claim Form
PDF template
Form for submitting warranty claims for home repairs and construction issues through the Build it Back program.
See template
See template
Warranty Claim Form
PDF template
A detailed form for submitting warranty claims for equipment, requiring comprehensive information about the failed unit and repair details.
See template
See template
WARRANTY CLAIM REQUEST FORM
PDF template
A form for customers to submit warranty claims for inverter products, requiring detailed product and installation information.
See template
See template
Frontier Power Warranty Claim Form
PDF template
Detailed instructions for submitting warranty claims for Frontier Power Products, including required documentation and claim processing guidelines.
See template
See template
Warranty Claim Form
PDF template
A form for dealers to submit warranty claims for product repairs or replacements.
See template
See template
WARRANTY CLAIM FORM
PDF template
A form used by dealers to submit warranty claims for product parts and labor
See template
See template
QF83.1 002 Warranty Claim Form
PDF template
A form for submitting warranty claims for Spheros North America product defects, including details about the product, customer, and defect.
See template
See template
Consumer Warranty Claim
PDF template
A form for customers to submit warranty claims for ACCO UK products, requiring product details and proof of purchase.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for products from Portaco, Inc., a Goldschmidt Company.
See template
See template
Warranty Claim Form
PDF template
A form for submitting warranty claims for La Marzocco equipment, detailing product failures and warranty terms.
See template
See template
Damage, Missing Part, Warranty Claim Form 2021
PDF template
Form for submitting warranty claims, damage reports, or missing parts for window and door products from Interstate Window & Door Company.
See template
See template
WARRANTY CLAIM FORM CRESTCHIC LOADBANKS
PDF template
A document used to submit warranty claims for Crestchic loadbank equipment, detailing the specific issue and customer declaration.
See template
See template
Mattress Warranty Claim Form
PDF template
A form for customers to submit warranty claims for mattress purchases, requiring detailed product and purchase information.
See template
See template
Warranty Claim Form
PDF template
Detailed guide for completing a warranty claim form, including requirements for information entry and special instructions for various scenarios.
See template
See template
Warranty Claim Form
PDF template
A comprehensive form for submitting warranty claims for automotive parts purchased from Dayco Australia Pty Ltd.
See template
See template
Waste Hauler Discharge Form
PDF template
Official form for documenting waste hauler discharge details, customer information, and permit compliance.
See template
See template
Water Permit Applications
PDF template
Guide to various water permit application forms for different types of wastewater discharge and treatment scenarios for stationary sources.
See template
See template
Behavioral Health Inpatient Discharge Form
PDF template
A form for documenting patient discharge details, medications, and care coordination for behavioral health inpatient services.
See template
See template
Claim Payment Appeal Submission Form
PDF template
A form for healthcare providers to submit appeals regarding claim payment decisions made by Amerigroup Washington, Inc.
See template
See template
Substance Use Disorders Inpatient Discharge Form
PDF template
A comprehensive medical form for documenting patient discharge details, medications, and care coordination for substance use disorder inpatient treatment.
See template
See template
WASHINGTON YOUTH SOCCER PARENTGUARDIAN CONSENT AND PLAYER MEDICAL RELEASE FORM
PDF template
Medical release and consent form for youth soccer players, including emergency contact and medical history information.
See template
See template
Notice Of Designation As Independent Contractor
PDF template
A form for workers to declare their status as an independent contractor and verify their insurance and business details for workers' compensation purposes
See template
See template
WCC10 Alabama Assessment Form
PDF template
Annual reporting form for documenting workers' compensation claim expenses and settlements in Alabama.
See template
See template
Limited Power Of Attorney For Purpose Of Regulatory Filings
PDF template
A legal document authorizing Minnesota Workers' Compensation Insurers Association to file rating plans with the Department of Commerce on behalf of multiple insurers.
See template
See template
WorkerS Compensation Witness Report Form
PDF template
Form for documenting witness details and observations of a workplace incident for workers compensation purposes.
See template
See template
Prepare Our Island Week 4 Important Documents
PDF template
A comprehensive guide for organizing critical personal documents in preparation for potential disasters like earthquakes.
See template
See template
Weekly Disability Benefit Claim Form
PDF template
A form for filing a weekly disability benefit claim for Teamsters Health and Welfare Fund members seeking disability benefits.
See template
See template
Weekly Disability Benefit
PDF template
A disability insurance program offering partial wage replacement for non-work related injuries or illnesses for eligible employees.
See template
See template
Weekly Disability Claim Form
PDF template
A comprehensive form for reporting employee disability claims, including sections for employee, employer, and physician statements.
See template
See template
Certificate Of Liability Insurance Request Form
PDF template
A form for requesting liability insurance coverage for Synodical Women's Organization events under ELCA's insurance policy.
See template
See template
Certificate Of Liability Insurance Request Form
PDF template
Form for requesting liability insurance coverage for Synodical Women's Organization events under ELCA's insurance policy.
See template
See template
Joint Welfare Fund LU 164 HRA Reimbursement Form
PDF template
Health Reimbursement Account (HRA) claim form for submitting medical expense reimbursement requests for members and dependents.
See template
See template
Accident Procedures Form
PDF template
Comprehensive guide for handling vehicle accidents, including reporting procedures and documentation requirements.
See template
See template
Student Insurance Claim Form
PDF template
A comprehensive insurance claim form for students to report medical examinations, illnesses, injuries, and insurance coverage details.
See template
See template
WELLNESS BENEFIT CLAIM FORM (Accident Insurance)
PDF template
A form for submitting wellness exam and preventive health screening claims under an accident insurance policy.
See template
See template
Wellness Benefit Claim Form
PDF template
A claim form for submitting wellness-related medical tests and screenings for potential insurance benefits.
See template
See template
DISINTERESTED THIRD PARTY CONTINUING EDUCATION AFFIDAVIT
PDF template
Instructions for obtaining continuing education credits for insurance agents in West Virginia through proctored examinations.
See template
See template
Claim Form
PDF template
A form for seeking reimbursement of eligible out-of-pocket healthcare and dependent care expenses from a flexible spending account or health reimbursement arrangement.
See template
See template
Claim Form
PDF template
A form used to request reimbursement for eligible out-of-pocket healthcare and dependent care expenses through a flexible spending account.
See template
See template
Application For Life AndOr Critical Illness Insurance
PDF template
Notice of changes to Equitable Life's insurance application process and form requirements with new version and submission guidelines.
See template
See template
Westlake High School 2020 2021 Application For Student Parking Permit
PDF template
A form for high school students to apply for a parking permit to drive and park at Westlake High School during the academic year.
See template
See template
Hirer Collision Or Damage Report Form
PDF template
A comprehensive form for documenting details of a vehicle rental accident, including driver, witness, vehicle, and incident information.
See template
See template
Medical Form
PDF template
Comprehensive medical history form for participants in outdoor adventure activities, including health conditions, emergency contacts, and liability acknowledgment.
See template
See template
Inmate Admissions, Transfers And Discharges
PDF template
Administrative directive outlining policies for inmate admissions, transfers, and discharges with guidelines for immigration detainers and correctional resources.
See template
See template
Pre Filed Witness Statement Of Michael A. Pedraja
PDF template
A detailed document presenting Allstate Insurance Company's proposed restructuring plan submitted to the Illinois Director of Insurance.
See template
See template
Acord 35 Cancellation Request
PDF template
A document discussing ACORD insurance policy cancellation procedures and related certificate changes.
See template
See template
Consent To Treat Form
PDF template
A form allowing University of Kentucky Medical Center to provide medical treatment and file insurance claims with patient consent.
See template
See template
WMCMetLife Employee Benefit Plan Contact Information
PDF template
Comprehensive contact information for WMC and MetLife employee benefit plan administrators, claims processing, and customer service.
See template
See template
CP 4866 01 01 WOODCOAL BURNING STOVE SUPPLEMENTAL INSPECTION FORM
PDF template
A detailed inspection form for assessing the safety and installation of wood or coal burning stoves.
See template
See template
Warranty Claim Form
PDF template
A form used to submit warranty claims for various bath and plumbing brands and products.
See template
See template
Workers Compensation Claim Forms Alphabetical Index
PDF template
Comprehensive reference guide for workers' compensation claim forms, covering various documents used in the claims process.
See template
See template
Workers Compensation Online Interview Form
PDF template
A detailed form for documenting workplace injury, medical treatment, and compensation claims for employees.
See template
See template
WORKERS COMPENSATION PATIENT INTAKE FORM
PDF template
A form for documenting patient information and details related to a work-related injury for insurance and medical processing purposes.
See template
See template
Working Spouse Premium Waiver Form
PDF template
Form for Purdue employees to certify spouse's medical insurance eligibility and waive working spouse premium
See template
See template
Tax Sharing In Insurance Markets A Useful Parameterization
PDF template
An academic research paper examining the economic impacts of taxation on insurance payments and moral hazard using a principal-agent framework.
See template
See template
My Benefit Plan Booklet
PDF template
Group benefits booklet for professional firefighters in the City of Windsor, provided through Green Shield Canada.
See template
See template
MY BENEFIT PL AN BOOKLET
PDF template
A benefit plan booklet for retired firefighters and their surviving spouses from the City of Windsor, providing group benefits through Green Shield Canada.
See template
See template
WUL Wrap Up Liability Insurance Form
PDF template
A certificate of insurance documenting wrap-up liability coverage for a project involving multiple parties and participants.
See template
See template
Mountaineer Flexible Benefits Enrollment Form
PDF template
A comprehensive form for employees to enroll, modify, or cancel flexible benefits during open enrollment period.
See template
See template
PATIENT AUTHORIZATION FOR XTANDI SUPPORT SOLUTIONS
PDF template
Comprehensive patient information and authorization form for Xtandi patient assistance program and support services.
See template
See template
Yale Health Prescription Drug Claim Form
PDF template
Form for submitting prescription drug reimbursement claims through Yale Health and Prime Therapeutics.
See template
See template
Year 12 Work Experience Insurance Form
PDF template
A mandatory form for employers to provide insurance and health & safety details for student work experience placements.
See template
See template
Your Home Inventory
PDF template
A comprehensive guide for creating and maintaining a detailed inventory of personal property for insurance, tax, and estate planning purposes.
See template
See template
Liability Release Form
PDF template
A comprehensive legal document releasing the church from liability and granting medical treatment authorization for participants in church activities or trips.
See template
See template
Zenith Power Products LLC Warranty Claim Request
PDF template
Dealer form for submitting warranty repair claims for Zenith Power Products equipment and engines.
See template
See template
Employee Flexible Spending Account (FSA) Enrollment Form
PDF template
A comprehensive form for employees to enroll in and select flexible spending account options for healthcare and dependent care expenses.
See template
See template
Group Personal Accident Certificate
PDF template
Insurance certificate providing accident coverage for eligible persons under a group policy issued to the State of Wisconsin Group Insurance Board.
See template
See template
Utah State University Voluntary Accidental Death Dismemberment Insurance
PDF template
Insurance policy providing accidental death and dismemberment coverage for Utah State University employees and their dependents.
See template
See template
Start filling Death Claim Discharge Form for free
Why product teams love Anvil
Vouch logo
Travis Hedge
Co-Founder
Anvil plays a really important role for us in being able to translate the unique risks and needs of our client base into the models of how traditional insurance companies operate.
See the full case study
Easy to implement
Pre-built components, clear
documentation
, and AI tools make Anvil a time-saver.
Launch in days
Don't reinvent the wheel building software in-house.
Make it fully yours
Style
components to be on brand, then embed them into your application.