Electronic signature forms

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

Voluntary benefits forms

Bank Draft Authorization | Form L-5562
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.

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.