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Value | |
---|---|
Cash & Savings | |
Non-Retirement Securities/Stocks | |
Retirement Accounts (401k. IRA, Pension, etc) | |
Life Insurance Cash Value | |
Non-Qualified Annuities | |
Real Estate (Residence) | |
Real Estate (Investment) | |
Business Interests | |
Other |
Value | |
---|---|
Cash & Savings | |
Non-Retirement Securities/Stocks | |
Retirement Accounts (401k. IRA, Pension, etc) | |
Life Insurance Cash Value | |
Non-Qualified Annuities | |
Real Estate (Residence) | |
Real Estate (Investment) | |
Business Interests | |
Other |
Full Name | Date of Birth | SSN | Relationship to Insured | % | Phone Number | ||
---|---|---|---|---|---|---|---|
1 | fsg | dfg | fdsg | dfg | |||
2 | |||||||
3 | |||||||
4 | |||||||
5 | |||||||
6 |
Doctor | Specialty | Phone Number | Date of Last Visit | Reason for Visit | |
---|---|---|---|---|---|
Primary | |||||
Specialist 1 | |||||
Specialist 2 | |||||
Specialist 3 | |||||
Specialist 4 |
IMPORTANT: By signing below I acknowledge that providing my banking details above does not represent nor constitute a premium payment for any for of insurance to any agent, agency, entity, or insurance company; Accordingly, I understand that completing this form does not provide, promise, suggest, allude to, nor bind any insurance coverage whatsoever, temporary or otherwise. The information provided above is for reference only for the prepartation of an electronic application (eApp).
As Policy Owner/Applicant signing below:
I understand that this electronic form is not an application for any type of insurance. I further acknowledge that my completion and submission of this form does not represent or constitute a premium payment for life insurance to any agent, agency, entity, or insurance company; Accordingly, I understand that completing this form does not provide, promise, suggest, allude to, nor bind any coverage whatsoever, temporary or otherwise.
I understand that this form is being used for collecting the details necessary for populating an electronic application (eApp) which will be sent to me as a separate correspondence via email link. I understand that I am responsible for reviewing, confirming accuracy of the aforementioned eApp by applying my electronic signature, and submitting the eApp electronically.
I understand that completing the eApp is one of several underwriting requirements to obtain coverage. The most common requirements include, but are not limited to: Telephone Interview, Completing a Medical Exam, Providing Fluid/Specimen Sample, Review of Medical Records, details of Personal, or Financial History. Occasionally, other details relevant to assessing risk may be required. These requirement vary based on many factors and will be determined upon initial review of your application once a Telephone Interview has been completed.
I agree to complete, and/or provided details for the above referenced requirements requested as part of the underwriting process in a timely fashion.
I certify that the information provided on this form for all associated parties is accurate and complete to the best of my knowledge.
Submission Details
A pay stub is used by employers to notify an employee of their pay amount and provide documentation for it. With Jotform’s free Pay Stub Template, you can automatically generate PDF pay stubs for your employees. Simply customize the attached form to match your business needs, input each employees’ weekly or monthly wages, and watch as the form converts your submissions in PDF pay stubs — easy to download or print for your accounting records, or to instantly share with employees using an email autoresponder.Customize this Pay Stub Template to match your business with our drag-and-drop PDF Editor. Upload your company logo, add more form fields, or change fonts and colors to personalize the design. If you’d like to store pay stubs in other accounts you already rely on, such as Google Drive, Dropbox, or Box, sync PDFs to them automatically with our 100+ free form integrations. With an online Pay Stub Template generating PDF pay stubs for you, you can save time that can be better spent on growing your business.
An employee equipment agreement is a contract that outlines the terms and conditions for employee use of company-provided equipment. The agreement establishes the responsibilities, liabilities, and use restrictions of both parties to ensure that equipment is secure and accounted for.Stay on top of company equipment loans with this free Employee Equipment Agreement template from Jotform Sign. Our ready-made template allows you to quickly gather information such as employee name, position, division and/or department — as well as the borrowed equipment identifying information. Share your form via email and get notified as soon as it’s been filled out and signed.Customizing this Employee Equipment Agreement template couldn’t be easier. Using Jotform’s intuitive builder, simply drag and drop to add or change text boxes, upload your company’s branding, change fonts and colors, add additional signature fields, include images of the loaned equipment, and much more. Once both parties have signed and completed the form, you’ll receive a finalized PDF document ready to download, share, or print for your records. Never lose track of company equipment again with this customizable Employee Equipment Agreement. If you want to take your signing process online, create an e-sign document with Jotform Sign.
A Vaccination Record Card is a document that servers as proof that an individual already received a vaccine from a health facility. Due to the COVID-19 pandemic, the government is requiring the citizens to receive vaccines as soon as they can be based on the provided schedule. If the citizen received a vaccine, there's a chance that it will minimize the spread of the virus or it will prevent the individual to be hospitalized due to bad conditions.This Vaccination Record Card PD template shows the name of the individual, age, date of birth, gender, batch number, patient number, vaccination record table, reminders, return date and time, and other important information. This PDF template is using the A5 paper size and the landscape layout so that it is more presentable and easy to read. This PDF template is using the Input Table tool in order to display the vaccination date, dosage, lot number, manufacturer, and the location where the patient received the vaccine. Customize freely this PDF template via the PDF Editor which is very easy to use.
Need a quick and easy way to generate customizable employment contracts for your business? With Jotform Sign’s free Employment Contract Template, you can fill out this form with your new employee’s position, work hours, general conditions of service, and monthly salary. Once the new employee fills out and signs this contract, you’ll automatically receive a finalized PDF to share or keep for your records.Need to make changes to this Employment Contract Template? No problem! Just use Jotform Sign’s intuitive online builder to add or edit form fields, include additional signature fields, update terms and conditions, upload your company’s logo, change fonts and colors, and more. You can also set up an automated signature order to make sure you receive signatures in a timely manner. Streamline your hiring process with a customizable Employment Contract from Jotform Sign.
Here is a well-designed employee information PDF template that is suitable for all businesses. If you are running a business or working in an HR department that needs to collect and manage information of the employees, this PDF template will highly ease your process, as you will be able to view each employee's information in one interface.This template which has made by using Jotform's new PDF Editor divides the information of the employee in three sections in order to keep the information more manageable. These three sections are; personal information, job information and emergency contact information. Personal information section has the basic personal information of the employee along with their contact information. Job information section includes employee's salary, department, start date with their employee ID. Lastly, emergency contact information section has the basic contact information of the employee's chosen emergency contact.
Doctor’s notes, also known as doctor’s excuses, are documents that medical professionals give to their patients who are unable to attend work or school because of an illness. With Jotform Sign, you can create your own Doctor’s Excuse for Work seamlessly. Include details like illness that patient has, date of diagnosis, patient name, and doctor signature. Design your Doctor’s Excuse for Work to align with your clinic or hospital’s needs. Use our drag-and-drop online form builder to upload logos or branding, create an automated signing order, pick fonts and colors, and more. Once you’re done designing, send directly to your patients to print or store for their records.
These templates are suggested forms only. If you're using a form as a contract, or to gather personal (or personal health) info, or for some other purpose with legal implications, we recommend that you do your homework to ensure you are complying with applicable laws and that you consult an attorney before relying on any particular form.