Electronic signature forms

Interested in the convenience of electronic form submission? Give it a try here.

Voluntary benefits forms

Bank Draft Authorization | Form SD-1149
Provide Unum with your bank account information and authorize us to transfer funds on your behalf. To expedite the process, have a check on hand.

Third Party Authorization | Form CS-1178
Authorize Unum to provide details about your policy to individuals or organizations you designate.

Removal of Dependent Child | Form CS-1182
Remove dependent children from your policy or policies.

Policy Cancellation | Form L-52490
Complete this form to request cancellation of your policy or policies.

Beneficiary Change | Form L-52490
Update your primary and/or contingent beneficiaries on your policy or policies.

Name Change | Form L-52490
Request a name change on your policy or policies by completing this form. Legal documentation is required unless due to marriage or divorce.

Request Additional Change | Form L-52490
Use this form to request changes to your policy or policies, such as a decrease in benefit amounts, request for conversion of rider to a stand-alone policy, or other changes.

Care Verification Form | Form CL-1254
Please have the caregiver complete the following form each week regarding the assistance being provided with Activities of Daily Living (ADLs) and daily functioning. Please have the caregiver sign and date the attached form.

Do you have questions about these forms?

Please call Unum at 800-635-5597. Representatives are available from 8 a.m. to 8 p.m. ET
Monday through Friday.