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RETURN COMPLETED FORM TO: UNM Life Insurance Company of America Attn: Group Life Benefits 2211 Congress Street, C232 Portland, ME 04122 FAX: 2075757407 Policyholder/EmployerASSIGNMENT OF LIFE INSURANCE For

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Cs-1179 is needed by individuals who are seeking medical treatment or benefits through a government agency, such as the Department of Veterans Affairs (VA) or a related program. This form is typically required to gather personal and medical information necessary for the evaluation of an individual's eligibility or treatment plan. It may be required for various purposes, such as disability claims, healthcare enrollment, or accessing specific medical services.

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