Download Insurance Forms

Here is a list of insurance applications and rate charts available for you to download. Click on the link and you can view or download the form.

Before completing an application be sure to review the plan information for eligibility, options, and a complete description of the coverage.

10_Year_Level_Premium_Rates
10_Year_Term_Life_Supplemental_Application
Business_Office_Package_Application
Change_of_Coverage_Form
Dental_Application
Dental_Plan_Rates-High_Option
Dental_Plan_Rates-Low_Option
Enrollment_Form_for_Real_Estate_Appraisers_Group_Insurance_Trust
Group_Health-California_Residents_Only-Quarterly_Premium_Rates[2000_Ind-4000_Family]
Group_Health-California_Residents_Only-Quarterly_Premium_Rates[3000_Ind-6000_Family]
Group_Health-California_Residents_Only-Quarterly_Premium_Rates[5000_Ind-10000_Family]
Group_Health_HSA_Rates
Long_and_Short_Term_Disability_Quarterly_Rates
Professional_Overhead_Expense_Plan_Quarterly_Premiums
 
 
To view the form(s) above, you will need Adobe® Acrobat® Reader. Adobe® Acrobat® Reader is free, and freely distributable software that lets you view and print Portable Document Format (PDF) files. Click on the icon below to download a copy.
 

© 2006 Affinity Insurance Services, Inc.