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INSTRUCTIONS AND INFORMATION FOR COMPLETING THE EVIDENCE OF INSURABILITY FORM Unum Life Insurance Company of America Unum is a registered trademark and marketing brand of Unum Group and its insuring
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Document Date: 2013-10-30 15:05:35

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File Size: 265,29 KB

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City

Portland / /

Company

Colonial Life & Accident / Accident Insurance Company / The Paul Revere Life Insurance Company / Casualty Insurance Company / The Paul Revere Variable Annuity Insurance Company / Immune Deficiency / Employer’s Name Employer / Unum Life Insurance Company of America / First Unum Life Insurance Company / Unum Life Insurance Company / Provident Life / Unum Group / Immune Deficiency Syndrome / /

Currency

USD / /

IndustryTerm

non-financial products / financial products / treatment for diabetes / insurance application containing / mailing services / state law / insurance / treatment for epilepsy / insurance benefits / treatment for stroke / insurance support organizations / insurance support / insurance products / organizations performing services / insurance support organization / insurance service providers / insurance product / /

MedicalCondition

muscular dystrophy / HIV / chest pain / Fibromyalgia / internal cancer / Hodgkin’s disease / neurological disorders / alcohol abuse / ALS / cirrhosis / chronic renal disease / No cystic fibrosis / transient ischemic attack / melanoma / injury / mental illness / No Syndrome / endocrine disease / angina / hepatitis / liver disease / respiratory disorder / asthma / leukemia / paralysis / cerebral palsy / congestive heart failure / circulatory disorder / squamous cell carcinoma / paraplegia / hypertension / cancer / heart disorder / emphysema / Chronic Fatigue Syndrome / stroke / diabetes / mental disorder / systemic lupus / chronic lung disease / heart attack / epilepsy / joint disorder / high blood pressure / connective tissue disease / Acquired Immune Deficiency / /

MedicalTreatment

counseling / heart surgery / /

Position

driver / plan administrator / physician / authorized representative / Privacy Officer / /

ProvinceOrState

Maine / /

URL

www.coloniallife.com / www.Unum.com/privacy / /

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