Get the free CLHIA STD Form. 874289 Interactive PDF

CLEAR FORMIMPORTANT NOTICE: REPLACEMENT OF LIFE INSURANCE OR ANNUITIES This document must be signed by the applicant and a copy of the Notice must be provided to them. You are contemplating the purchase

How to fill out clhia std form 874289

How to fill out clhia std form 874289

1. To fill out CLHIA STD Form 874289, follow these steps:
2. Start by entering the policyholder's name and contact information in the appropriate fields.
3. Provide details about the insured person, including their name, date of birth, and occupation.
4. Indicate the type of claim being made by selecting the relevant option from the provided choices.
5. Specify the date when the disability began and provide a detailed description of the disability or medical condition.
6. Include any relevant medical information, such as diagnoses, treatments, and medications being taken.
7. Provide details about the treating physician or specialist, including their name, contact information, and any other relevant information.
8. If applicable, provide details about the employer, their name, and contact information.
9. Sign and date the form to certify the accuracy of the information provided.
10. Submit the completed form to the appropriate party or insurance provider for processing.

Who needs clhia std form 874289?

1. CLHIA STD Form 874289 is needed by individuals who are making a disability claim. It is typically used by policyholders who have a disability insurance policy through an insurance provider that follows the Canadian Life and Health Insurance Association (CLHIA) standards. This form is used to provide detailed information about the disability and initiate the claims process.

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What is clhia std form 874289?

Clhia std form 874289 is a standardized reporting form used by the Canadian Life and Health Insurance Association (CLHIA) for collecting specific data.

Who is required to file clhia std form 874289?

Insurance companies and other entities regulated by CLHIA are required to file clhia std form 874289.

How to fill out clhia std form 874289?

Clhia std form 874289 can be filled out electronically or manually following the instructions provided by CLHIA.

What is the purpose of clhia std form 874289?

The purpose of clhia std form 874289 is to gather consistent and accurate information for regulatory and statistical purposes.

What information must be reported on clhia std form 874289?

Information such as financial data, policyholder information, and claims data must be reported on clhia std form 874289.