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Minnesota Life Insurance Company Evidence of Insurability Instructions 1. This Evidence of insurability (EOI) form should already have your Employer's Name and the Group Number(s) preprinted on it.

The form should be signed and dated. If your insurance policy or policy card was not obtained at our office, the form may be faxed to or written for that purpose. 3. An “SFR” form must be signed by the individual (and/or his or her authorized representative) and sent to Mercer Administration along with all applicable required documents. 4. An insurance companies representative will then review each signature on the “SFR” form and any other required documents to arrive at the final decision of approval or denial. 5. Within 5-7 days of receiving an “SFR” form, Mercer Administration will contact the policyholder to advise the policyholder of the decision regarding the amount and type of coverage requested (both Life and Disability coverage). Should an insurance company representative make changes to your plan after your filing, the policy will be canceled without notice if your coverage is denied. If your coverage is approved, the policy may not be transferred until the policyholder receives notice from Mercer Administration. 6. The policy will be issued within 30 days of approval or a copy of the policy will be sent to the policyholder within 10 days of approval. If you are currently covered under another policy before approval of the coverage requested, your previous coverage will be allowed to remain. An insurance representative or Mercer Administration representative will inform you of your coverage with the new policy once it has been accepted. 7. Policies of other companies will normally be approved or denied within 45 or 120 days after your application; therefore, the date of approval or denial is generally indicated. This period may vary depending on your insurance company's requirements and the status of your policy. 8. Policies of other companies will generally be rejected. 8B: Statement of Financial Responsibility (SFR) — Form 1412-2. This form must be completed by the individual with respect to the life insurance policy and should be completed and signed by the individual at the time of service. The form should be signed and dated. If your insurance policy was not obtained at our office, the form may be faxed to Mercer Administration or written for that purpose. 9. An “SFR” form must be signed by the individual for which financial responsibility is being requested and sent to Mercer Administration along with all applicable required documents.

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