Life Insurance Application Form - California
Life Insurance Application and Forms Package
IDENTITY VERIFICATION:
To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial
institutions to obtain, verify, and record information that identifies each person who applies for life insurance.
WHAT THIS MEANS FOR YOU:
When you apply for a policy, we will ask for your name, address, date of birth, and other information that will allow us to
identify you. We may also ask to see your driver's license or other identifying documents.
What Customers Should Know
Table of Contents and Instructions
APP-PACK-IDG-CA (08/08)
PEANUTS © United Feature Syndicate, Inc.
eF
Form Name Form Number Instructions/Notes
Application for Life Insurance
ENB-7-07-CA Application for Individual Life Insurance for all MetLife
affiliated companies.
Signatures Required
Authorization EAUTH-07 Proposed Insured’s authorization for release of
information to comply with the requirements of the
Health Insurance Portability and Accountability Act
(HIPAA).
Signatures Required
Notice and Consent for HIV-Related Testing EHIV-04 Notice and Consent Authorization form for HIV related
testing. Note: Use the applicable form for each
Proposed Insured's state of residence.
Signatures Required
Producer Identification & Certification
EPID-54-07 This is to be completed by the Producer attesting to
completion of the application and certification of
Owner identity.
Signatures Required - Producer and
Agency Management
Personal Financial Information
EFIN-05 To be completed when the amount of coverage is
$1,000,000 or over. Used to obtain information about
income and assets/liabilities of the Proposed Insured(s).
Medical Supplement EMED-48-07-CA This form is to be completed by the Proposed Insured
regarding his/her health for underwriting purposes.
Note: Completion is optional if a full Paramedical/
Medical Exam is required. Best practice is to answer all
medical questions to enable the underwriter to
promptly begin the underwriting process.
For use in the State of:
California
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