Agent Needed Documents
Statz and Associates Forms:
Individual Applications and Forms:
Individual Quote Request Fill-In Form
Individual Quote Request Paper Form
Group Forms:
Agent Change of Record Form Please have client fill in carrier, policy number, effective date, and have group controller or president sign the letter on Company Letterhead
Terminate Employee from Group Form
Terminate Dependent from Employee Policy Form
Terminate Group Policy
Terminate Individual Coverage Form
Small Group Quoting Checklist
Health Questionnaire for 2- 50 Lives
Small Group Submission Checklist
Large Group Quoting Checklist
Large Group Health Questionnaire
Employer Risk Assesment
Shock Claim Form
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