Insurance forms

Below are forms you may need:

Mac users: Please ensure to fill out the form using Adobe reader.

• Application for Insurance form (AMA disability, life, critical illness, professional overhead expense)
• Application for Accidental Death and Dismemberment Insurance form
• Beneficiary Designation forms:
  • Life Insurance (AMA policy #4328)
  • Accidental Death & Dismemberment (AMA policy # 50092201)
• Guaranteed Insurability Benefit(GIB) Rider forms (forms for physicians who have added the GIB rider):
  • GIB application form (for Disability Insurance)