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PROTECTIVE LIFE INSURANCE COMPANY P.O. Box 830619 Birmingham, AL 352830619 State of Domicile: Tennessee SUPPLEMENTAL APPLICATION CHILD RIDER NONMEDICAL DECLARATIONS (a) Child # 1 (Print name) Date
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How to Fill out State of Domicile Tennessee:

01
Obtain the necessary forms: Start by visiting the official website of the Tennessee Secretary of State or the local County Clerk's office to download the appropriate form for declaring your state of domicile. Alternatively, you can also visit their office in person to obtain the physical form.
02
Provide personal information: Begin by filling in your full name, current residential address, phone number, and email address in the designated fields. Make sure to use accurate and up-to-date information.
03
Declare your intention: Indicate that your intention is to establish Tennessee as your state of domicile. Include a brief statement explaining why you have chosen Tennessee as your primary residence.
04
Provide supporting documentation: Attach any necessary documentation to support your claim of domicile in Tennessee. This may include copies of your lease or purchase agreement for a Tennessee property, utility bills, bank statements, or proof of employment or enrollment in a Tennessee educational institution. Check the specific requirements outlined in the form instructions.
05
Sign and date the form: After completing the form and attaching supporting documents, sign and date it in the designated areas. Ensure that your signature matches the one on your identification documents.
06
Submit the form: Once you have filled out the form completely, submit it to the appropriate office. This may involve mailing it, submitting it in person, or using an online submission system if available. Remember to keep a copy of the form for your records.

Who needs state of domicile Tennessee?

01
Individuals relocating to Tennessee: If you are planning to move to Tennessee and establish it as your primary residence, you will need to establish your state of domicile by completing the necessary paperwork.
02
Students studying in Tennessee: Non-resident students attending educational institutions in Tennessee may be required to establish Tennessee as their state of domicile for tuition and fee purposes.
03
Individuals seeking eligibility for Tennessee-specific benefits: Some state-specific benefits or programs in Tennessee may require individuals to declare Tennessee as their state of domicile in order to qualify.
04
Those registering to vote in Tennessee: As part of the voter registration process in Tennessee, you may need to declare Tennessee as your state of domicile.
05
Individuals applying for certain licenses or permits: Some professional licenses or permits in Tennessee may require proof of state of domicile as part of the application process.
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State of domicile Tennessee refers to the state where an individual declares their permanent residence.
Individuals who consider Tennessee as their permanent residence are required to file state of domicile Tennessee.
To fill out state of domicile Tennessee, individuals need to provide personal information such as name, address, and declaration of Tennessee as their permanent residence.
The purpose of state of domicile Tennessee is to establish an individual's permanent residence in the state for tax and legal purposes.
Information such as name, address, and declaration of Tennessee as permanent residence must be reported on state of domicile Tennessee.
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