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Directory Results for ELECTION TO CONTINUE YOUR LONG TERM CARE INSURANCE COVERAGE Mail to: Unum Life Insurance Company of America LTC Customer Services 2211 Congress Street Portland, Maine 04122 Policy Number: TO BE COMPLETED BY THE EMPLOYER Company Name Plan - to Election to Contribute Additional Contributions - Tier 1 and Tier 2

ELECTION TO CONTINUE YOUR LONG TERM CARE INSURANCE COVERAGE Mail to: Unum Life Insurance Company of America LTC Customer Services 2211 Congress Street Portland, Maine 04122 Policy Number: TO BE COMPLETED BY THE EMPLOYER Company Name Plan -
Election to Contribute Additional Contributions - Tier 1 and Tier 2