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Forms and Tools to Manage Your Account

Welcome to the downloadable forms resource page. Below you will find all of the necessary forms and applications you need to process a claim or apply for additional coverages.

Downloads

Welcome to the downloadable forms resource page. Files are available in PDF format to be downloaded, printed and mailed accordingly. Acrobat Reader is a free application that can be downloaded at adobe.com/reader/.

Mail all claim forms to the following address:
AGIA Affiliate Services
Claims Department
P.O. Box 9060
Phoenix, AZ 85068

Form Product Form Type Download
Accidental Death & Dismemberment Enrollment Form Accidental Death and Dismemberment Enrollment Application Download
ADD Downloadable Enrollment Form Accidental Death and Dismemberment Enrollment Application Download
Beneficiary Information Form - New York Residents Group Term Life Insurance General Insurance Form Download
Group Term Life Insurance - California Residents Group Term Life Insurance Enrollment Application Download
Group Term Life Insurance - New York Residents Group Term Life Insurance Enrollment Application Download
Group Term Life Insurance Application Group Term Life Insurance Enrollment Application Download
Hospital Income Insurance Plan Enrollment Form Hospital Income Plan Enrollment Application Download
Important Replacement Notice - NY Group Term Life Insurance Insurance Notice Download
Long Term Disability Insurance Application Group Term Life Insurance Insurance Notice Download
Long Term Disability Insurance Application - California Residents Group Term Life Insurance Insurance Notice Download
Long Term Disability Insurance Application - New York Residents Group Term Life Insurance Insurance Notice Download
Medicare Replacement Notice Long Term Disability Insurance Notice Download
Notice of Insurance Practice Long Term Disability Insurance Notice Download
Senior Term Life Enrollment Senior Term Life Insurance Enrollment Application Download