To simplify the way you do business with us, Protective Life has updated the following life insurance forms:

  • Drug and Alcohol Questionnaire: This new, standalone questionnaire combines and replaces the Alcohol Use Questionnaire and the Drug Use Questionnaire. It includes a broader spectrum of the types of drugs used presently or in the past.
  • Confidential Financial Statement: This form now reflects current requirements for use (for example, the face amount of $5,000,001 or greater age 0-79 and $3,000,001 or greater for age 71 and older). Additionally, specific business financial questions were added.
  • Rider Worksheet: This form now accommodates our additional benefits currently offered, along with instructions on how to complete rider supplemental forms if required.

Transition rules

  • For paper applications, old form versions will be accepted through August 27, 2021. After this date, the new versions will be required.
  • For ticket applications, we will honor the forms included with the application sent out for signatures following the TeleLife interview.

Please note that the Confidential Financial Statement and the Rider Worksheet are included in the PL-400 application packet and are also available as standalone forms. Find all three updated forms on third-party websites and on under Marketing Resources & Tools > Forms & Applications.

If you have additional questions, contact your Protective Life representative.

Let’s deliver on our promises. Together.

For Financial Professional Use Only. Not for Use With Consumers.

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