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BOSTON MUTUAL LIFE INSURANCE COMPANY 120 Royal Street Canton, MA 0202118006692668 Ext. 473STATEMENT OF INSURABILITY FORM FOR GROUP INSURANCE To be completed for all proposed insureds who are applying
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01
To fill out a statement of insurability form, follow these steps:
02
Begin by providing your personal information such as your full name, date of birth, gender, and contact details.
03
Provide details about your current health condition. This may include information about any pre-existing medical conditions, medications you are currently taking, and recent medical treatments or surgeries.
04
Answer questions about your lifestyle and habits. This may include questions about your smoking or drinking habits, participation in extreme sports or risky activities, and any dangerous hobbies you may have.
05
Provide information about your family medical history. This may include details about any hereditary conditions or diseases that run in your family.
06
Fill out the form completely and truthfully. It is important to provide accurate information as any false or misleading information may affect your eligibility for insurance coverage.
07
Review the form before submitting it to ensure all information is correctly filled out and signed.
08
Submit the completed form to your insurance provider either online or by mail as per their instructions.
09
Keep a copy of the filled-out form for your records.

Who needs statement of insurability form?

01
A statement of insurability form is typically required by individuals who are applying for life insurance or certain types of health insurance policies.
02
Employers may also request their employees to fill out a statement of insurability form if they offer group insurance plans.
03
Additionally, individuals who want to increase their coverage or add additional riders to their existing insurance policy may be required to fill out this form.
04
It is best to consult with your insurance provider or employer to determine if you need to fill out a statement of insurability form.
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The statement of insurability form is a document that provides information about an individual's health and other relevant factors to determine the insurability of the individual for insurance coverage.
Individuals who are applying for insurance coverage are typically required to file a statement of insurability form.
The form can be filled out by providing accurate and detailed information about your health history, lifestyle factors, and other relevant details that may impact your insurability.
The purpose of the form is to assess the risk associated with providing insurance coverage to an individual based on their health and other relevant factors.
Information about an individual's health history, lifestyle, medical conditions, and other relevant factors must be reported on the statement of insurability form.
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